Abstract
Introduction: Training-induced adaptations of the oxidative capacity have been shown to be blunted in alpha-1 antitrypsin deficiency (AATD)-related chronic obstructive pulmonary disease (COPD). To improve training outcomes in AATD, this study was aimed to compare the effects of two exercise training programmes with different training intensities. Methods: Thirty patients with AATD (genotype PiZZ) and COPD III-IV were randomly assigned to either high-intensity (HIT) or moderate-intensity training (MIT), each consisting of endurance, strength, and squat training for a duration of 3 weeks. 6-Min walk distance (6MWD) was used as the primary outcome. Results: Twenty-five subjects augmented with alpha-1 antitrypsin (HIT: n = 12, FEV1 41.3 ± 17.4%pred., MIT: n = 13, FEV1 45.9 ± 15.5%pred.) completed the study. In HIT and MIT, 6MWD (+37 ± 43 m vs. +32 ± 28 m, p = 0.741), 1-min sit-to-stand test (5.6 ± 4.9 repetitions vs. 5.6 ± 4.5 repetitions, p = 0.766), exercise-induced BORG dyspnoea (−1.4 ± 1.7 pts vs. −1.5 ± 2.4 pts, p = 0.952), and all CRQ domains have improved after training without between-group differences. When considering only subgroups of (probably) anxious or depressive patients (Hospital Anxiety and Depression Scale [HADS] ≥8 pts), only HIT induced a significant reduction of anxiety (−4.8 pts, 95% CI [2.1–7.5]) or depression symptoms (−5.0 pts, 95% CI [2.8–7.3]). Conclusion: Although HIT and MIT were equally effective by improving exercise capacity, quality of life, and dyspnoea in homozygous AATD, HIT may show advantages over MIT, if anxiety or depression symptoms were present. The goal should be personalized training based on the patient’s personal preference in order to achieve long-term adherence.
Plain Language Summary
A high-intensity versus moderate-intensity exercise training programme in alpha-1 antitrypsin deficiency-related COPD (IMAC): a randomized, controlled trial. Exercise training is one of the most important non-pharmacological interventions in COPD and has a significant impact on patients’ daily life and quality of life. In the past, differences in adaptation to exercise have been found between COPD patients with and without alpha-1 antitrypsin deficiency (AATD), including less improvement in exercise endurance. The aim of this study was to optimize exercise training in patients with AATD and to compare the efficacy of two exercise programmes with different exercise intensities. Thirty homozygous AATD patients with COPD were enrolled and randomized to perform a 3-week exercise training programme with either high-intensity (interval ergometer cycling, intense strength training, and squat training on a whole-body vibration platform [HIT]) or moderate-intensity components (continuous ergometer cycling, moderate strength training, and squat training on the floor [MIT]). The main results showed that both training modalities were equally effective in improving exercise capacity, health-related quality of life, and exercise-induced dyspnoea. Although no significant between-group differences were found, HIT showed some advantages over MIT, especially in the area of psychological comorbidities. In particular, patients with significant symptoms of anxiety and/or depression may improve in the respective symptom only after HIT. As anxiety and depression symptoms are common in AATD (we found 56% and 32%, respectively, in this cohort), this finding may help to optimize the effectiveness of training in this subgroup. In addition, training recommendations should always be individualized and take into account patient preferences to ensure long-term adherence to the programme.
