Advertisement

Effects of Intermittent Hypoxic Training on Exercise Tolerance in Patients with Chronic Obstructive Pulmonary Disease

  • Martin BurtscherEmail author
Chapter

Abstract

Intermittent hypoxic training (IHT) has been suggested to increase exercise tolerance in patients with cardiovascular disease by enhancing stress resistance and/or improving oxygen delivery. This is also assumed to be true for patients with chronic obstructive pulmonary disease (COPD). This chapter discusses findings, derived from randomized controlled studies, on the effects of IHT on exercise tolerance in patients suffering from mild COPD. Three weeks of IHT increased total haemoglobin mass (+4% vs. 0%, P < 0.05), total exercise time (+9.7% vs. 0%, P < 0.05) and the exercise time to the anaerobic threshold (+13% vs. −7.8%, P < 0.05) compared to controls. Changes in the total exercise time were positively related to the changes in total haemoglobin mass (r = 0.59, P < 0.05), and changes in the time to the anaerobic threshold were positively related to the changes in the lung diffusion capacity for carbon monoxide (DLCO) (r = 0.48, P < 0.05). Increases in vagal activity after IHT were related to the reduced values of heart rate and blood lactate concentration observed during submaximal exercise (6-min walk test), and changes in respiratory pattern after IHT were related to the lower ventilatory equivalents for oxygen and carbon dioxide (V E/VO2 and V E/VCO2) at the anaerobic threshold determined by incremental cycle ergometry. In conclusion, IHT can improve exercise tolerance in patients with mild COPD. IHT is considered as repeated stress training and subsequent adaptations resulting in corrections of impaired DLCO, improved ventilatory efficiency, enhancement of total haemoglobin mass and changes of the autonomic balance to higher vagal and lower sympathetic activity. Thus, IHT may be a valuable tool to complement the known beneficial effects of exercise training in patients with COPD.

Keywords

Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease Patient Exercise Tolerance Obstructive Sleep Apnoea Anaerobic Threshold 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

AT

Anaerobic threshold

CO2-et

End-tidal CO2

COPD

Chronic obstructive pulmonary disease

DLCO

Lung diffusion capacity for carbon monoxide

FEV1

Forced expiratory volume in 1 s

FEVC

Forced expiratory vital capacity

FiO2

Inspiratory fraction of oxygen

HCVR

Hypercapnic ventilatory response

HIF

Hypoxia-inducible factor

HR

Heart rate

HVR

Hypoxic ventilatory response

IH

Intermittent hypoxia

IHT

Intermittent hypoxic training

NO

Nitric oxide

OSA

Obstructive sleep apnoea

RPE

Ratings of perceived exertion

SaO2

Arterial oxygen saturation

SD

Standard deviation

VE

Minute ventilation

VO2

Oxygen uptake

VE/VO2

Ventilatory equivalent for oxygen

VE/VCO2

Ventilatory equivalent for carbon dioxide

References

  1. 1.
    Mannino DM, Braman S. The epidemiology and economics of chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2007;4:502–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Andreas S, Anker SD, Scanlon PD, et al. Neurohumoral activation as a link to systemic manifestations of chronic lung disease. Chest. 2005;128:3618–24.PubMedCrossRefGoogle Scholar
  3. 3.
    O’Donnell DE, Webb KA. The major limitation to exercise performance in COPD is dynamic hyperinflation. J Appl Physiol. 2008;105:753–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Belfer MH, Reardon JZ. Improving exercise tolerance and quality of life in patients with chronic obstructive pulmonary disease. J Am Osteopath Assoc. 2009;109:268–78.PubMedGoogle Scholar
  5. 5.
    Casaburi R. Limitation to exercise tolerance in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2003;168:409–10.PubMedCrossRefGoogle Scholar
  6. 6.
    Burtscher M, Haider T, Domej W, et al. Intermittent hypoxia increases exercise tolerance in patients at risk for or with mild COPD. Respir Physiol Neurobiol. 2009;165:97–103.PubMedCrossRefGoogle Scholar
  7. 7.
    Haider T, Casucci G, Linser T, et al. Interval hypoxic training improves autonomic cardiovascular and respiratory control in patients with mild chronic obstructive pulmonary disease. J Hypertens. 2009;27:1648–54.PubMedCrossRefGoogle Scholar
  8. 8.
    Neubauer JA. Physiological and pathophysiological responses to intermittent hypoxia. J Appl Physiol. 2001;90:1593–9.PubMedGoogle Scholar
  9. 9.
    Lavie L. Oxidative stress – a unifying paradigm in obstructive sleep apnea and comorbidities. Prog Cardiovasc Dis. 2009;51:303–12.PubMedCrossRefGoogle Scholar
  10. 10.
    O’Donnell CP. Metabolic consequences of intermittent hypoxia. Adv Exp Med Biol. 2007;618:41–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Meerson FZ, Ustinova EE, Orlova EH. Prevention and elimination of heart arrhythmias by adaptation to intermittent high altitude hypoxia. Clin Cardiol. 1987;10:783–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Tkatchouk EN, Gorbatchenkov AA, Kolchinskaya AZ, et al. Adaptation to interval hypoxia with the purpose of prophylaxis and treatment. Hypoxia Med J. 1994;11:308–28.Google Scholar
  13. 13.
    Meerson FZ, Malyshev YI, Zamotrinsky AV. Differences in adaptive stabilisation of structures in response to stress and hypoxia relate with the accumulation of hsp70 isoforms. Mol Cell Biochem. 1992;111:87–95.PubMedCrossRefGoogle Scholar
  14. 14.
    Berton DC, Barbosa PB, Takara LS, et al. Bronchodilators accelerate the dynamics of muscle O2 delivery and utilisation during exercise in COPD. Thorax. 2010;65:588–93.PubMedCrossRefGoogle Scholar
  15. 15.
    Sin DD, Man SF. Skeletal muscle weakness, reduced exercise tolerance, and COPD: is systemic inflammation the missing link? Thorax. 2006;61:1–3.PubMedCrossRefGoogle Scholar
  16. 16.
    Anthonisen NR, Connett JE, Enright PL, et al. Hospitalizations and mortality in the Lung Health Study. Am J Respir Crit Care Med. 2002;166:333–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Sin DD, Wu L, Anderson JA, et al. Inhaled corticosteroids and mortality in chronic obstructive pulmonary disease. Thorax. 2005;60:992–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Yende S, Waterer GW, Tolley EA, et al. Inflammatory markers are associated with ventilatory limitation and muscle dysfunction in obstructive lung disease in well functioning elderly subjects. Thorax. 2006;61:10–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Mador MJ, Bozkanat E. Skeletal muscle dysfunction in chronic obstructive pulmonary disease. Respir Res. 2001;2:216–24.PubMedCrossRefGoogle Scholar
  20. 20.
    Cooper CB. Airflow obstruction and exercise. Respir Med. 2009;103:325–34.PubMedCrossRefGoogle Scholar
  21. 21.
    Vogtel M, Michels A. Role of intermittent hypoxia in the treatment of bronchial asthma and chronic obstructive pulmonary disease. Curr Opin Allergy Clin Immunol. 2010;10:206–13.PubMedCrossRefGoogle Scholar
  22. 22.
    Borukaeva IK. Intermittent hypoxic training in the sanatorium and spa treatment for patients with chronic obstructive pulmonary disease. Vopr Kurortol Fizioter Lech Fiz Kult. 2007;5:21–4 [In Russian].PubMedGoogle Scholar
  23. 23.
    Alexandrov OV, Struchkov PV, Vinitskaya RS, et al. Responses of the cardiorespiratory system to a hypoxic exposure in the course of hypoxic therapy in patients with chronic obstructive lung diseases. Hypoxia Med J. 1997;1:18–22.Google Scholar
  24. 24.
    Ehrenbourg I, Kondrykinskaya I. The efficiency of interval hypoxic training in therapy of chronic obstructive pulmonary diseases. Hypoxia Med J. 1993;1:17–8.Google Scholar
  25. 25.
    Serebrovskaya TV. Intermittent hypoxia research in the former Soviet Union and the Commonwealth of Independent States: history and review of the concept and selected applications. High Alt Med Biol. 2002;3:205–21.PubMedCrossRefGoogle Scholar
  26. 26.
    Falch D, Stromme SB. Pulmonary blood volume and interventricular circulation time in physically trained and untrained subjects. Eur J Appl Physiol Occup Physiol. 1979;40:211–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Manukhina EB, Downey HF, Mallet R. Role of nitric oxide in cardiovascular adaptation to intermittent hypoxia. Exp Biol Med. 2006;231:343–65.Google Scholar
  28. 28.
    Clini E, Bianchi L, Vitacca M, et al. Exhaled nitric oxide and exercise in stable COPD patients. Chest. 2000;117:702–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Girgis RE, Champion HC, Diette GB, et al. Decreased exhaled nitric oxide in pulmonary arterial hypertension. Am J Respir Crit Care Med. 2005;172:352–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Crawford JH, Isbell TS, Huang Z, et al. Hypoxia, red blood cells, and nitrite regulate NO-dependent hypoxic vasodilation. Blood. 2006;107:566–74.PubMedCrossRefGoogle Scholar
  31. 31.
    Calbet JA, Lundby C, Koskolou M, et al. Importance of haemoglobin concentration to exercise: acute manipulations. Respir Physiol Neurobiol. 2006;151:132–40.PubMedCrossRefGoogle Scholar
  32. 32.
    Neya M, Enoki T, Kumai Y, et al. The effects of nightly normobaric hypoxia and high intensity training under intermittent normobaric hypoxia on running economy and hemoglobin mass. J Appl Physiol. 2007;103:828–34.PubMedCrossRefGoogle Scholar
  33. 33.
    Frede S, Berchner-Pfannschmidt U, Fandrey J. Regulation of hypoxia-inducible factors during inflammation. Methods Enzymol. 2007;435:405–19.PubMedGoogle Scholar
  34. 34.
    Zhuang J, Zhou Z. Protective effects of intermittent hypoxic adaptation on myocardium and its mechanisms. Biol Sig Recept. 1999;8:316–22.CrossRefGoogle Scholar
  35. 35.
    Böning D, Klarholz C, Himmelsbach B, et al. Extracellular bicarbonate and non-bicarbonate buffering against lactic acid during and after exercise. Eur J Appl Physiol. 2007;100:457–67.PubMedCrossRefGoogle Scholar
  36. 36.
    Bernardi L. Interval hypoxic training. Adv Exp Med Biol. 2001;502:377–99.PubMedGoogle Scholar
  37. 37.
    Bernardi L, Passino C, Serebrovskaya Z, et al. Respiratory and cardiovascular adaptations to progressive hypoxia; effect of interval hypoxic training. Eur Heart J. 2001;22:879–86.PubMedCrossRefGoogle Scholar
  38. 38.
    Burtscher M, Pachinger O, Ehrenbourg I, et al. Intermittent hypoxia increases exercise tolerance in elderly men with and without coronary artery disease. Int J Cardiol. 2004;96:247–54.PubMedCrossRefGoogle Scholar
  39. 39.
    Milic-Emili J. Expiratory flow limitation: Roger S. Mitchell lecture. Chest. 2000;117:219S–23.PubMedCrossRefGoogle Scholar
  40. 40.
    Kokkinos P, Myers J, Kokkinos JP, et al. Exercise capacity and mortality in black and white men. Circulation. 2008;117:614–22.PubMedCrossRefGoogle Scholar
  41. 41.
    Cote CG, Pinto-Plata V, Kasprzyk K, et al. The 6-min walk distance, peak oxygen uptake, and mortality in COPD. Chest. 2007;132:1778–85.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2012

Authors and Affiliations

  1. 1.Department of Sport Science, Medical SectionUniversity of InnsbruckInnsbruckAustria

Personalised recommendations