COPD

‘Alarming’ study links high intensity exercise to mortality in COPD


A leading Melbourne researcher has urged caution over a new ‘alarming’ study that links increased mortality in COPD patients with high intensity exercise.

The small study conducted by researchers at the University of Copenhagen revealed one third of the 15 patients enrolled in the high-intensity exercise group died in the months after the eight-week program.

This compared to none in the 16 patient-group that participated in the regular intensity exercise program.

“Four of the five deaths were due to COPD exacerbations,” the researchers reported. The other patient died from an aortic aneurysm.

Their findings have been published in the International Journal of Chronic Obstructive Pulmonary Disease.

“These results are alarming and the first to indicate that even subtle increases in rehabilitation intensity are associated with unacceptable risks,” the authors wrote.

“It is possible that regular exercise intensity is challenging the participants to their maximum, and that even subtle increases in intensity may tip the load undesirably.

“It is surprising that a minor adjustment in a subset of the rehabilitation may lead to such dramatic adverse effects, and these results suggest that COPD rehabilitation programs should be designed and executed very carefully.”

However Dr Christian Osadnik, physiotherapist, senior lecturer at Monash University and recipient of the prestigious Lung Foundation Australia/Boehringer Ingelheim post-doctoral COPD research fellowship (2016-18), said the study findings should not be taken purely at face value.

“There is very real potential for people to jump on findings such as these and inadvertently cause more harm than good,” he said.

“The reality is we are talking about findings from a very small pilot investigation of a training modality that is not typical of mainstream pulmonary rehabilitation around the world.

“People should not expect that referral to conventional pulmonary rehabilitation will involve very high (95% of maximum) intensity walking training.”

He said there were many unanswered questions from the study, including more detailed information regarding patient’s baseline medical status, the extent to which they adhered to and performed during the training program and activities that occurred after the program finished, which is when most of the deaths occurred.

“I would stress there is no reason to suspect the study authors have been careless in their study design, but there is just simply a lot of detail missing that could help explain this unusual finding,” he told the limbic.

“I think it is best to view this as a cautionary tale. We know that all forms of therapy (including exercise training) have elements of inherent risk, and what this study really reinforces is the importance of comprehensive assessment and regular patient monitoring during rehabilitation by experienced physiotherapists.”

He said it was well accepted that, on average, pulmonary rehab had many positive effects including reductions in hospital readmissions.

“One of the biggest priorities in clinical COPD practice is the urgent need to increase patient access to pulmonary rehabilitation,” he said.

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