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Are the Effects of High-Intensity Exercise Training Different in Patients with COPD Versus COPD+Asthma Overlap?



This study aimed to investigate whether patients with chronic obstructive pulmonary disease (COPD) presenting asthma overlap (ACO) benefit similarly in comparison to patients with only COPD after a 12-week high-intensity exercise training (ET) program.


Subjects with a diagnosis of COPD alone or ACO were evaluated and compared before and after a high-intensity ET program composed of walking and cycling plus strengthening exercises of the upper and lower limbs (3 days/week, 3 months, 36 sessions). Assessments included spirometry, bioelectrical impedance, 6-min walk test (6MWT), London Chest Activity of Daily Living Scale (LCADL), Hospital anxiety and depression Scale, modified Medical Research Council Scale (mMRC), Saint George Respiratory Questionnaire (SGRQ), and respiratory and peripheral muscle strength [manovacuometry and 1-repetition maximum test (quadriceps femoris, biceps and triceps brachialis), respectively]. ACO was defined according to Sin et al. (Eur Respir J 48(3):664-673, 2016).


The sample was composed of 74 subjects (57% male, age 67 ± 8 years, BMI 26 (21–32) kg/m2, FEV1 47 ± 17%predicted), and 12 (16%) of them were classified as presenting ACO. Both groups improved pulmonary function, 6MWT, peripheral and inspiratory muscle strength, LCADL, and SGRQ after ET (p < 0.005 for all). There were no significant interactions between ACO and COPD on ET effects (p > 0.05 for all). Likewise, there was no difference in the proportion of patients achieving the minimum clinical important difference for 6MWT and mMRC.


High-intensity exercise training generates similar benefits in patients with COPD regardless of whether presenting asthma overlap or not.

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Fig. 1
Fig. 2



One-repetition maximum test


6-Min walk test


Asthma-chronic obstructive pulmonary disease overlap


Bronchodilator response


Chronic obstructive pulmonary disease


Exercise training


Forced expiratory volume in the first second per forced vital capacity

FEV1 :

Forced expiratory volume in the first second


Forced vital capacity


Global Initiative for Asthma Management and Prevention


Global Initiative for Chronic Obstructive Pulmonary Disease


Hospital Anxiety and Depression Scale


25–75 Interquartile range




London Chest Activity of Daily Living Scale


Minimal clinical important difference


Maximum expiratory pressure


Maximum inspiratory pressure


Modified Medical Research Council Scale


Pulmonary rehabilitation


Standard deviation


St. George’s Respiratory Questionnaire


Londrina State University


University of Northern Parana


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Coordination for the Improvement of Higher Education Personnel (CAPES), Brazil. National Council of Technological and Scientific Development (CNPq), Brazil.


Antenor Rodrigues, Joice Mara de Oliveira, Felipe Vilaça Cavallari Machado, Letícia Fernandes Belo, Lorena Paltanin Schneider, Andrea Akemi Morita, Ana Carolina Andrelo, Jéssica Fonseca, Igor Lopes Brito, and Thaís Paes were supported by the Coordination for the improvement of Higher Education Personnel (CAPES), Brazil. Karina Couto Furlanetto is supported by Fundação Nacional do Desenvolvimento do Ensino Superior Particular (FUNADESP), Grant Number 5301164. Fabio Pitta is supported by the National Council of Technological and Scientific Development (CNPq), Brazil.

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Correspondence to Fabio Pitta.

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All authors declare that they have no conflict of interest in relation to this work.

Ethical Approval

This study was approved by the institutional ethics committee (Number: UEL n. 123/09 and UNOPAR n. 0377/10), and all subjects gave informed consent.

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Informed consent was obtained from all subjects included in the study.

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Rodrigues, A., de Oliveira, J.M., Furlanetto, K.C. et al. Are the Effects of High-Intensity Exercise Training Different in Patients with COPD Versus COPD+Asthma Overlap?. Lung 198, 135–141 (2020).

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  • Pulmonary disease
  • Chronic obstructive
  • Asthma
  • Pulmonary rehabilitation