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A Systematic Review of Resistance Training Versus Endurance Training in COPD

Iepsen, Ulrik Winning MD; Jørgensen, Karsten Juhl MD, DMSc; Ringbaek, Thomas MD, DMSc; Hansen, Henrik MSc; Skrubbeltrang, Conni MLISc; Lange, Peter MD, DMSc

Journal of Cardiopulmonary Rehabilitation and Prevention: May/June 2015 - Volume 35 - Issue 3 - p 163–172
doi: 10.1097/HCR.0000000000000105
Scientific Review

PURPOSE: Endurance training (ET) as part of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD) has been shown to improve exercise capacity and health-related quality of life, but dyspnea limits the exercise intensity. Therefore, resistance training (RT), which may cause less dyspnea, could be an alternative. The purpose of this review was to formulate evidence-based recommendations on the use of RT in pulmonary rehabilitation of patients with COPD. Our primary outcomes were health-related quality of life, activities of daily living, dyspnea, possible harm, and total mortality. Our secondary outcomes were walking distance, lean body mass, muscle strength, and exercise capacity.

METHODS: We identified randomized controlled trials through a systematic multidatabase search. One author checked titles and abstracts for relevance using broad inclusion criteria, whereas 2 authors independently checked the full-text articles for eligibility. Two authors independently extracted data and assessed the risk of bias and quality of evidence. Meta-analyses were performed when deemed feasible based on the quality and amount of data.

RESULTS: We included 8 randomized controlled trials (328 participants). On the basis of moderate- to very low-quality evidence, we found no clinically important difference between RT and ET. We did not find sufficient data for a meta-analysis of total mortality, adverse events, dyspnea, or lean body mass.

CONCLUSIONS: We found that in patients with COPD, RT seems to induce the same beneficial effects as ET. Therefore, we recommend that RT should be considered according to patient preferences when designing a pulmonary rehabilitation program for patients with COPD.

In this review, we found that in patients with COPD, resistance training seems to induce the same beneficial effects as endurance training. This indicates that patients who are unable or unwilling to participate in endurance training may achieve similar improvements in physical function and quality of life from resistance training.

The Centre of Inflammation and Metabolism and The Centre for Physical Activity Research, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (Drs Iepsen and Lange); The Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark (Dr Jørgensen); Department of Respiratory Medicine, University Hospital Hvidovre, Copenhagen, Denmark (Drs Ringbaek and Lange); Municipality of Copenhagen, Copenhagen, Denmark (Mr Hansen); Medical Library, Aalborg University Hospital, Aalborg, (Ms Skrubbeltrang); and Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark (Dr Lange).

Correspondence: Ulrik Winning Iepsen, MD, The Centre of Inflammation and Metabolism and The Centre for Physical Activity Research, University of Copenhagen, Rigshospitalet 7641, Blegdamsvej 9, 2100 Copenhagen, Denmark (

The authors declare no conflicts of interest.

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