German Clinical Trials Register

Acronym/abbreviation of the study

ECC and COPD

URL of the study

No Entry

Brief summary in lay language

Chronic obstructive pulmonary disease (COPD) is a respiratory disease that is characterised by inflammation and remodelling of the respiratory airways producing a reduced blood oxygenation in the lungs and peripheral muscles, and a diminished expiratory force that maintain a hyperinflation of lungs. Over time, this disease debilitates patients, limiting their normal activities of daily living such as walking or climbing stairs in comparison to healthy individuals. These characteristics also have systemic consequences such as muscle wasting and weakness, and physical inactivity that concomitantly promote the development of comorbidities including type II diabetes and cardiovascular disease. Furthermore, an association between systemic inflammation and oxidative stress with muscle wasting has been proposed as an aggravating factor in COPD. These characteristics of the disease generate a vicious cycle that promotes muscle wasting, inactivity and reduced quality of life due to the low tolerance to exercise in these patients. This project aims to administrate exercise to improve this condition. We will investigate the effect of a particular mode of exercise called eccentric exercise, which is very low in the metabolic demand for patients. We will implement a training study of 16 weeks in order to observe the health benefits of this kind of exercise in comparison to the more convectional exercises that are included in respiratory rehabilitation in COPD patients.

Brief summary in scientific language

Chronic obstructive pulmonary disease (COPD) is a respiratory disease that is characterized by inflammation and remodeling of the respiratory airways producing a reduced blood oxygenation in the lungs and peripheral muscles, and a diminished expiratory force that maintain a hyperinflation of lungs. Over time, this disease debilitates patients, limiting their normal activities of daily living such as walking or climbing stairs in comparison to healthy individuals. These characteristics also have systemic consequences such as muscle wasting and weakness, and physical inactivity that concomitantly promote the development of comorbidities including type II diabetes and cardiovascular disease. Furthermore, an association between systemic inflammation and oxidative stress with muscle wasting has been proposed as an aggravating factor in COPD. These characteristics of the disease generate a vicious cycle that promotes muscle wasting, inactivity and reduced quality of life due to the low tolerance to exercise in these patients. However, pulmonary rehabilitation (i.e. exercise) has shown to improve mobility, functionality and quality of life of COPD patients in all stages of the disease. Typically, endurance exercises have been used to improve exercise tolerance and aerobic capacity. On the other hand, resistance training programs have shown improvements on functionality, mobility and quality of life. Interestingly, eccentric cycling is a more novel exercise modality that has the unique feature of requiring only 35-50% of the oxygen than a concentric cycling exercise (i.e. endurance) to perform the same workload. This characteristic makes of eccentric cycling an ideal exercise modality for patients with limited pulmonary capacity, thus patients can train at higher workloads at a very low cardiopulmonary stress. This allows greater increases in muscle strength and mass when eccentric cycling is performed chronically as training. Additionally, besides increasing muscle mass at low cardiopulmonary demand, eccentric exercise has been prove to be a powerful exercise modality to decrease lipid profiles, markers of systemic inflammation and insulin resistance. In fact, some studies have shown that eccentric exercise could be more beneficial than endurance or resistance training programs when used on elderly subjects, cardiac patients and patients with type II diabetes. However, there is a lack of research exploring the acute and chronic responses of eccentric cycling in COPD patients. Hence, to safely apply this novel modality of exercise in COPD patients, more research is warranted to assess and understand the long-term adaptations. Therefore, the proposed project aims to investigate the chronic effects of an eccentric cycling training program on metabolic disease biomarkers, muscle function, body composition, systemic inflammation and oxidative stress in patients with COPD in comparison to endurance and resistance exercise training programs. The proposed methodology to achieve these aims includes a controlled parallel trial to compare the effects of a 16-week eccentric training with two more conventional training programs (endurance and resistance) on metabolic disease biomarkers, muscle function, body composition, systemic inflammation and oxidative stress. We expect to demonstrate that COPD patients can tolerate eccentric cycling and more importantly we predict that eccentric cycling training is a more ideal training exercise for COPD patients than endurance and resistance exercises it involves less cardiopulmonary demand, but allowing patients to workout at greater intensities. This would maximize the gains in muscle mass and strength in concordance with improvements on the health related outcomes, such as systemic inflammation oxidative stress, body composition, dyslipidemia, and insulin resistance.