EXERCISE, EXERCISE TESTING and EXERCISE TRAINING
SEE ALSO – Pulmonary rehabilitation


GUIDELINE on EXERCISE TESTING:
ATS/ACCP Statement on cardiopulmonary exercise testing (2003). Am J Respir Crit Care Med, 167, 211–277.
ajrccm.atsjournals.org/cgi/reprint/167/2/211


Aboussouan LS (2009) Mechanisms of exercise limitation and pulmonary rehabilitation for patients with neuromuscular disease. Chr Respir Dis, 6, 4, 231-49
crd.sagepub.com/cgi/content/abstract/6/4/231
• benefits of carefully-managed exercise training for neurological patients, including support from noninvasive ventilation, neuromuscular electrical stimulation, or diaphragm pacing

Andrade FMD (2016) The role of physical exercise in obstructive sleep apnea. Brazilian J Pulmol; 42(6):1806-3756
• exercise can reduce severity of obstructive sleep apnoea, daytime sleepiness and cardiovascular risk

Andrianopoulos V, Celli BR, Franssen FM et al (2016) Determinants of exercise-induced oxygen desaturation including pulmonary emphysema in COPD: Results from the ECLIPSE study. Respir Med; 119:87-95. doi: 10.1016/j.rmed.2016.08.023

Araneda OF, Carbonell T, Tuesta M (2016) Update on the mechanisms of pulmonary inflammation and oxidative imbalance induced by exercise. Oxidative Med Cellular Longevity; 4868536. doi:10.1155/2016/4868536.
www.ncbi.nlm.nih.gov/pmc/articles/PMC4736402/

Barberan-Garcia A, Arbillaga-Etxarri A, Gimeno-Santos E et al (2015) Nordic walking enhances oxygen uptake without increasing the rate of perceived exertion in patients with chronic obstructive pulmonary disease. Respiration; 89(3):221-5. doi: 10.1159/000371356

Bardin MG, Dourado VZ (2016) Association between the occurrence of falls and the performance on the incremental shuttle walk test in elderly women. Rev Bras Fisioter, 16(4):275-280. dx.doi.org/10.1590/S1413-35552012005000033
www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-35552012000400004&lng=en&nrm=iso&tlng=en
• the ISWT is a valid measure to assess the risk of falls and balance and therefore may be useful for the simultaneous assessment of cardiorespiratory fitness and balance in older women.

Boone J, Barstow TJ, Celie B et al (2016) The interrelationship between muscle oxygenation, muscle activation, and pulmonary oxygen uptake to incremental ramp exercise: influence of aerobic fitness. Appl Physiol Nutr Metab; 41(1):55-62. doi: 10.1139/apnm-2015-0261

Budde H, Schwarz R, Velasques B et al (2016) The need for differentiating between exercise, physical activity, and training. Autoimmun Rev; 15(1):110-1. doi: 10.1016/j.autrev.2015.09.004

Cao G, González J, Müller A et al (2016) Beneficial effect of moderate exercise in kidney of rat after chronic consumption of cola drinks. PLoS One; 11(3):e0152461. doi: 10.1371/journal.pone.0152461
www.ncbi.nlm.nih.gov/pmc/articles/PMC4816544/

Carrieri-Kohlman V et al (2001) Dyspnea and the affective response during exercise training in obstructive pulmonary disease. Nurs Res, 50, 136
• exercise reduces anxiety related to breathlessness

Casanova C et al (2011) The 6-min walk distance in healthy subjects: reference standards from seven countries. Eur Respir J; 37(1):150-6. doi: 10.1183/09031936.00194909
• average 6-minute distance is 571 ± 90 m

Cejudo P (2013) Randomized controlled trial of exercise training in chronic respiratory failure due to kyphoscoliosis. Respir Care; 59(3):375-382. doi:10.4187/respcare.02484

Chaddha A, Jackson EA, Richardson CR et al (2017) Technology to help promote physical activity. Am J Cardiol; 119(1):149–152

Charkoudian N, Halliwill JR, Morgan BJ et al (2016) Influences of hydration on post-exercise cardiovascular control in humans. J Physiol; 552(Pt 2):635-44
www.ncbi.nlm.nih.gov/pmc/articles/PMC2343381/
• dehydration increases heart rate and orthostatic intolerance after exercise

Cockburn E, Robson-Ansley P, Hayes P et al (2012) Effect of volume of milk consumed on the attenuation of exercise-induced muscle damage. Eur J Appl Physiol, 112, 9, 3187-3194

Daniels SR (2015) Physical activity, inflammation, and intima-media thickness. J Pediatrics; 166(4):783–787. doi:10.1016/j.jpeds.2015.02.025
• exercise improves vascular health in children

Dolmage TE, Janaudis-Ferreira T, Hill K et al (2013) Arm elevation and coordinated breathing strategies in patients with COPD. Chest; 144(1):128-35. doi: 10.1378/chest.12-2467.
• exhalation should be co-ordinated with arm elevation

Dyer F, Marriner P, Cheema K et al (2011) Is a practice incremental shuttle walk test really necessary? Chr Respir Dis, 8, 3, 201-5
• yes

Dziubek W, Kowalska J, Kusztal M et al (2016) The level of anxiety and depression in dialysis patients undertaking regular physical exercise training - a preliminary study. Kidney Blood Press Res; 41(1):86-98. doi: 10.1159/000368548

Eberhardt RT (2002) Exercise for intermittent claudication. J Cardiopulm Rehabi, 22, 199-200
• long-term exercise may reduce ischaemic-related cardiovascular complications

Edvardsen E, Skjønsberg OH, Holme I et al (2015) High-intensity training following lung cancer surgery: a randomised controlled trial. Thorax;70:244-250. doi:10.1136/thoraxjnl-2014-205944
• high-intensity endurance and strength training post-op is well tolerated and improves fitness and quality of life

Evans RA, Dolmage TE, Robles PG et al (2016) The effects of exercise modality and intensity on energy expenditure and cardiorespiratory response in adults with obesity and treated obstructive sleep apnoea. Chr Respir Dis; doi: 10.1177/1479972316643699

Fukusaki C, Masani K, Miyasaka M et al (2016) Acute positive effects of exercise on center-of-pressure fluctuations during quiet standing in middle-aged and elderly women. J Strength Cond Res; 30(1):208-16. doi: 10.1519/JSC.0000000000001062

Hamasaki H (2016) Daily physical activity and type 2 diabetes: a review. World J Diabetes; 7(12):243-51. doi: 10.4239/wjd.v7.i12.243
• regular exercise improves glycaemic control and reduces the risk of cardiovascular disease and mortality

Handa S, Masuki S, Ohshio T et al (2016) Target intensity and interval walking training in water to enhance physical fitness in middle-aged and older women: a randomised controlled study. Eur J Appl Physiol; 116(1):203-15. doi: 10.1007/s00421-015-3267-9
• walking in water for middle-aged and older women resulted in greater gains in physical fitness

Hareendran A, Leidy NK, Monz BU et al (2012) Proposing a standardized method for evaluating patient report of the intensity of dyspnea during exercise testing in COPD. Int J Chron Obstruct Pulmon Dis, 7, 345–355
www.ncbi.nlm.nih.gov/pmc/articles/PMC3379870/?tool=pmcentrez

Hay-Smith EJC, McClurg D, Frawley H et al (2016) Exercise adherence: integrating theory, evidence and behaviour change techniques. Physiotherapy; 102(1): 7–9. doi: dx.doi.org/10.1016/j.physio.2015.08.006

Hedermann G, Vissing CR, Heje K et al (2016) Aerobic training in patients with congenital myopathy. PLoS One; 11(1):e0146036. doi: 10.1371/journal.pone.0146036
journals.plos.org/plosone/article?id=10.1371/journal.pone.0146036
• endurance training is safe and improves fitness in patients with congenital myopathies.
• training did not cause sarcomeric injury, even though sarcomeric function is affected by the genetic abnormalities in most patients
• severe fatigue is a limiting factor for initiating training but tends to improve

Hellsten Y, Nyberg M (2015) Cardiovascular adaptations to exercise training. Compr Physiol; 6(1):1-32. doi: 10.1002/cphy.c140080

Henriques I, Lopes-Pacheco M, Padilha GA et al (2016) Moderate aerobic training improves cardiorespiratory parameters in elastase-induced emphysema. Front Physiol; 7:329. doi:10.3389/fphys.2016.00329
www.ncbi.nlm.nih.gov/pmc/articles/PMC4971418/
• exercise can reduce lung inflammation, remodeling and pulmonary arterial hypertension in emphysema

Holland AE, Hill CJ, Rasekaba T (2010) Updating the minimal important difference for six-minute walk distance in patients with chronic obstructive pulmonary disease. Arch Phys Med Rehab, 91, 1, 221-25
• a clinically-significantly change in 6MD is 25 meters

Iepsen UW, Jørgensen KJ, Ringbaek T et al (2015) A systematic review of resistance training versus endurance training in COPD. J Cardiopulm Rehabil Prev; 35(3):163-72. doi: 10.1097/HCR.0000000000000105
• strength training brings similar benefits to endurance training

Inder JD, Carlson DJ, Dieberg G et al (2016) Isometric exercise training for blood pressure management: a systematic review and meta-analysis to optimize benefit. Hypertens Res; 39(2):88-94. doi: 10.1038/hr.2015.111

Inoue S, Shibata Y, Kishi H (2017) Decreased left ventricular stroke volume is associated with low-grade exercise tolerance in patients with chronic obstructive pulmonary disease. BMJ Open Respir Res; 4(1):e000158
bmjopenrespres.bmj.com/content/4/1/e000158

Janaudis-Ferreira T (2009) Differences in training effects following training with and without supplemental oxygen in patients with COPD. Adv Physiother, 11 (4): 186-92

Johansen KL, Painter P (2012) Exercise in individuals with CKD. Am J Kidney Dis, 59, 1, 126–134. doi: 10.1053/j.ajkd.2011.10.008
www.ncbi.nlm.nih.gov/pmc/articles/PMC3242908/

Karimov HN, Hosseini M, Nemati M et al (2012) Lifelong physical activity affects mini mental state exam scores in individuals over 55 years of age. J Bodywork Movement Ther, 16, 1, 230-235

Kartolo A, Cheng S, Petrella T (2016) Motivation and preferences of exercise programmes in patients with inoperable metastatic lung cancer: a need assessment. Support Care Cancer; 24(1):129-37. doi: 10.1007/s00520-015-2767-9

Kazuya S, Masashi K, Hideaki S et al (2015) Distractive auditory stimuli alleviate the perception of dyspnea induced by low-intensity exercise in elderly subjects with COPD. Respir Care; 60(5):689-694

Kennis E, Verschueren SM, Bogaerts A et al (2013) Long-term impact of strength training on muscle strength characteristics in older adults. Arch Phys Med Rehabil, 94(11):2054-2060

Keteyian SJ, Piña IL, Hibner BA (2010) Clinical role of exercise training in the management of patients with chronic heart failure. J Cardiopulm Rehab Prev, 30, 2, 67-76

Keyser RE, Woolstenhulme JG, Chin LMK et al 2016 Cardiorespiratory function before and after aerobic exercise training in patients with interstitial lung disease. J Cardiopul Rehabil Prevention; 35(1):47-55. doi: 10.1097/HCR.0000000000000083.
www.ncbi.nlm.nih.gov/pmc/articles/PMC4276491/

Kilpatrick MW, Greeley SJ, Ferron JM (2016) A comparison of the impacts of continuous and interval cycle exercise on perceived exertion. Eur J Sport Sci; 16(2):221-8. doi: 10.1080/17461391.2015.1017538
• interval exercise can be performed with lower perceived work, which may encourage increased participation.

Kim H, Suzuki T, Saito K et al (2013a) Effects of exercise and tea catechins on muscle mass, strength and walking ability in community-dwelling elderly Japanese sarcopenic women: A randomized controlled trial. Geriatr Gerontol Internat, 13, 2, 458–465. doi: 10.1111/j.1447-0594.2012.00923.x

Kovelis D, Zabatiero J, Furlanetto J (2012) Short-term effects of using pedometers to increase daily physical activity in smokers: a randomized trial. Respir Care, 57, 7, 1089-97

La Gerche A (2015) Let's keep running… exercise, basic science and the knowledge gaps. Heart; 101(10):742-744. doi:10.1136/heartjnl-2015-307557

Lanzi S, Codecasa F, Cornacchia M et al (2014) Acute post-exercise oxygen uptake, hormone and plasma metabolite response in obese men. Horm Metab Res; 46(7):521-7. doi: 10.1055/s-0034-1368712

Laughlin MH (2016) Physical activity-induced remodeling of vasculature in skeletal muscle: role in treatment of type 2 diabetes. J Appl Phys; 120(1):1-16. doi: 10.1152/japplphysiol.00789.2015
jap.physiology.org/content/120/1/1

Leung RW, McKeough ZJ, Alison JA (2013) Tai Chi as a form of exercise training in people with chronic obstructive pulmonary disease. Expert Rev Respir Med; 7(6):587-92. doi: 10.1586/17476348.2013.839244

Liao W-h, Chen J-w; Chen X et al (2015) Impact of resistance training in subjects with COPD: a systematic review and meta-analysis. Respir Care; 60(8):1130-1145

Loughney L, West MA, Kemp GJ et al (2016) Exercise intervention in people with cancer undergoing neoadjuvant cancer treatment and surgery: A systematic review. Eur J Surg Oncol; 42(1):28-38. doi: 10.1016/j.ejso.2015.09.027
• exercise training is safe and feasible for this group of patients

Louvaris Z et al (2013) Intensity of daily physical activity is associated with central hemodynamic and leg muscle oxygen availability in COPD. J Appl Phys; 115(6):794-802. doi:10.1152/japplphysiol.00379.2013

Maddocks M (2013) Immunological and hormonal effects of exercise: implications for cancer cachexia. Curr Opin Support Palliat Care; 7(4):376-82

Maharaj SS, Nuhu JM (2016) Rebound exercise: A beneficial adjuvant for sedentary non-insulin-dependent type 2 diabetic individuals in a rural environment. Aust J Rural Health; 24(2):123-9. doi: 10.1111/ajr.12223

Malcolm, L., Mein, G., Jones, J., et al. 2017. Strength in numbers: patient experiences of group exercise within hospice palliative care. BMC Palliative Care. 15:97

Metcalfe R, Babraj J, Fawkner S et al (2012) Towards the minimal amount of exercise for improving metabolic health: beneficial effects of reduced-exertion high-intensity interval training. Eur J Appl Physiol, 112, 7, 2767 - 2775

Munch GDW, Svendsen JH, Damsgaard R et al (2014) Maximal heart rate does not limit cardiovascular capacity in healthy humans: insight from right atrial pacing during maximal exercise. J Physiol; 592(2):377-390. doi: 10.1113/jphysiol.2013.262246

Meriem M, Cherif J, Toujani S et al (2015) Sit-to-stand test and 6-min walking test correlation in patients with chronic obstructive pulmonary disease. Annals Thorac Med; 10(4):269-273. doi: 10.4103/1817-1737.165289.

O'Brien KK, Tynan AM, Nixon SA et al (2016) Effectiveness of aerobic exercise for adults living with HIV: systematic review and meta-analysis using the Cochrane Collaboration protocol. BMC Infect Dis; 16(1):182. doi: 10.1186/s12879-016-1478-2
www.ncbi.nlm.nih.gov/pmc/articles/PMC4845358/
• constant or interval exercise can improve pain, fatigue and depression

Osadnik CR, Borges RC, McDonald CF et al (2016) Two 6-minute Walk Tests are required during hospitalisation for acute exacerbation of COPD. COPD; 13(3): 288-292. doi: 10.3109/15412555.2015.1082541

Palange P, Ward SA, Casaburi R et al (2007) Recommendations on the use of exercise testing in clinical practice Eur Respir J, 29, 185-209
erj.ersjournals.com/content/29/1/185.full?sid=047de61c-c67b-4aae-8e2d-ab6bb602c26d

Parto P, O’Keefe JH, Lavie CJ (2016) The exercise rehabilitation paradox: less may be more? The Ochsner J; 16(3):297-303.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5024813/

Pedersen BK, Saltin B (2015) Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports; 25 Suppl 3:1-72. doi: 10.1111/sms.12581

Pepera G, McAllister J, Sandercock G (2010) Long-term reliability of the incremental shuttle walking test in clinically stable cardiovascular disease patients. Physiotherapy, 96, 3, 222-7
• practice test not required

Petrovic M, Deschamps K, Verschueren SM et al (2016) Is the metabolic cost of walking higher in people with diabetes? J Appl Physiol; 120(1):55-62. doi: 10.1152/japplphysiol.00413.2015
• yes

Platta ME, Ensari I, Motl RW et al (2016) Effect of exercise training on fitness in multiple sclerosis: a meta-analysisreview article. Arch Phys Med Rehabil; 97(9):1564-1572.
• exercise can improve fitness

Probst VS et al (2004) Mechanisms of improvement in exercise capacity using a rollator in patients with COPD. Chest, 126, 1102-7
www.chestjournal.org/cgi/content/full/126/4/1102?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=probst&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=126&firstpage=1102&resourcetype=HWCIT
• a rollator improves walking distance of patients with COPD through improved ventilatory capacity and/or walking efficiency

Puente-Maestu L, Palange P, Casaburi R et al 2016) Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement. Eur Respir J; 47(2):429-60. doi: 10.1183/13993003.00745-2015.

Puhan MA (2011) The minimal important difference of exercise tests in severe COPD. Eur Respir J, 37, 4, 784-90
erj.ersjournals.com/content/37/4/784.abstract?sid=87ccb19c-5e59-40f9-9fc9-03e5ef4d0138

Ramos EMC, Vanderlei LCM, Ito JT et al (2015) Acute mucociliary clearance response to aerobic exercise in smokers. Respir Care; 60(11):1575-1584

Rapin A (2013) Aerobic capacities and exercise tolerance in neuromuscular diseases. Ann Physical Rehab Med, 56(6):420–33

Ribeiro F, Thériault M-E, Debigaré R et al (2013) Should all patients with COPD be exercise trained?
J Appl Phys; 114(9):1300-1308. doi:10.1152/japplphysiol.01124.2012

Rodríguez DA, Arbillaga A, Barberan-Garcia A et al (2016) Effects of interval and continuous exercise training on autonomic cardiac function in COPD patients. Clin Respir J; 10(1):83-9. doi: 10.1111/crj.12189
• both interval and continuous exercise training results in an improvement of aerobic capacity and cardiac function in patients with COPD

Roman MA, Rossiter HB, Casaburi R (2016) Exercise, ageing and the lung. Eur Respir J; 48(5):1471-1486. doi: 10.1183/13993003.00347-2016

Ross RM, Murthy JN, Wollak ID (2010) The six minute walk test accurately estimates mean peak oxygen uptake. BMC Pulm Med, 10, 31. doi:10.1186/1471-2466-10-31
www.biomedcentral.com/1471-2466/10/31/abstract

Ross MD, Malone E, Florida-James G (2016) Vascular ageing and exercise: focus on cellular reparative processes. Oxid Med Cell Longev. 2016:3583956. doi: 10.1155/2016/3583956

Sallam N, Laher I (2016) Exercise modulates oxidative stress and inflammation in aging and cardiovascular diseases. Oxid Med Cell Longev; 7239639. doi: 10.1155/2016/7239639

Sandberg C, Pomeroy J, Thilén U et al (2016) Habitual physical activity in adults with congenital heart disease compared with age- and sex-matched controls. Can J Cardiol; 32(4):547-53. doi: 10.1016/j.cjca.2015.08.021

Shioya T (2016) Improvement of physical activity in patients with COPD. Nihon Rinsho; 74(5):843-9
• use of a pedometer

Sloan JA, Cheville AL, Liu H et al (2016) Impact of self-reported physical activity and health promotion behaviors on lung cancer survivorship. Health and Quality of Life Outcomes; 14:66. doi: 10.1186/s12955-016-0461-3.
www.ncbi.nlm.nih.gov/pmc/articles/PMC4850698/
• physically activity cancer survivors live on average 4 years longer than those who are not active

Stubbs B, Rosenbaum S, Vancampfort D et al (2016) Exercise improves cardiorespiratory fitness in people with depression: A meta-analysis of randomized control trials. J Affect Disord; 190:249-53. doi: 10.1016/j.jad.2015.10.010
• people with depression can achieve clinically relevant improvements in cardiorespiratory fitness

Sydó N, Sydó T, Merkely B et al (2016) Impaired heart rate response to exercise in diabetes and its long-term significance. Mayo Clin Proc; 91(2):157-65. doi: 10.1016/j.mayocp.2015.10.028

Tian Q, Studenski SA, Resnick SM et al (2016) Midlife and late-life cardiorespiratory fitness and brain volume changes in late adulthood: results from the Baltimore longitudinal study of aging. J Gerontol A Biol Sci Med Sci; 71(1):124-30. doi: 10.1093/gerona/glv041
• higher midlife cardiorespiratory fitness may play a role in slowing brain atrophy

Vainshelboim B, Fox BD, Oliveira J et al (2016) Exercise training in idiopathic pulmonary fibrosis. Expert Rev Respir Med; 10(1):69-77. doi: 10.1586/17476348.2016.1121104

van Vulpen JK, Peeters PH, Velthuis MJ et al (2016) Effects of physical exercise during adjuvant breast cancer treatment on physical and psychosocial dimensions of cancer-related fatigue: A meta-analysis. Maturitas; 85:104-11. doi: 10.1016/j.maturitas.2015.12.007

Vorrink SN, Kort HS, Troosters T et al (2016) A mobile phone app to stimulate daily physical activity in patients with chronic obstructive pulmonary disease: development, feasibility, and pilot studies. JMIR Mhealth Uhealth; 4(1):e11. doi: 10.2196/mhealth.4741

Watanabe FT, Koch VH, Juliani RC et al (2016) Six-minute walk test in children and adolescents with renal diseases: tolerance, reproducibility and comparison with healthy subjects. Clinics (Sao Paulo); 71(1):22-7. doi: 10.6061/clinics/2016(01)05
www.ncbi.nlm.nih.gov/pmc/articles/PMC4737086/

Williams CA (2016) Physical activity and health of adults with cystic fibrosis. Respirology; 21(3):404-5. doi: 10.1111/resp.12765

Wilson MG, Ellison GM, Cable NT (2016) Basic science behind the cardiovascular benefits of exercise. Br J Sports Med; 50(2):93-9. doi: 10.1136/bjsports-2014-306596rep

Witcher CSG, McGannon KR, Hernandez P et al (2015) A qualitative exploration of exercise among pulmonary rehabilitation participants: insight from multiple sources of social influence. Respir Care; 60(11):1624-1634

Xiang L et al (2013) Strenuous exercise alters gene expression of Th1/Th2 imbalance in human peripheral blood mononuclear cells of marathon participants. Brain Behavior Immunity:32:e4
• exhaustive training can impair immunity

Yu Y-B, Liao Y-W, Su K-H et al (2012) Prior exercise training alleviates the lung inflammation induced by subsequent exposure to environmental cigarette smoke. Acta Physiologica, 205, 4, 532–54

Zagol BW, Krasuski RA (2010) Effect of motorized scooters on quality of life and cardiovascular risk. Am J Cardiol, 105, 5, 672-676
www.sciencedirect.com/science?_ob=PublicationURL&_tockey=%23TOC%234876%232010%23998949994%231746096%23FLA%23&_cdi=4876&_pubType=J&_auth=y&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=804c5791ab0ec479ceb347a83d97f9a7
• interventions such as motorised scooters which reduce activity can increase cardiovascular risk, particularly insulin resistance.

Zainuldin R, Mackey MG, Alison JA (2016) Prescribing cycle exercise intensity using moderate symptom levels in chronic obstructive pulmonary disease. J Cardiopulm Rehabil Prev; 36(3):195-202. doi: 10.1097/HCR.0000000000000172


6MD = six-minute distance
ACCP = American College of Chest Physicians
ATS = American Thoracic Society
CF = cystic fibrosis
CHF = chronic heart failure
HR = heart rate
MRC = Medical Research Council
QoL = quality of life
SOB = shortness of breath
VO2max = maximum oxygen consumption