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Interval hypoxic training improves autonomic cardiovascular and respiratory control in patients with mild chronic obstructive pulmonary disease

Haider, Thomasa; Casucci, Gaiab; Linser, Tobiasa; Faulhaber, Martina; Gatterer, Hannesa; Ott, Guenterc; Linser, Armind; Ehrenbourg, Igore; Tkatchouk, Elenae; Burtscher, Martina; Bernardi, Lucianof

doi: 10.1097/HJH.0b013e32832c0018
Original papers: Autonomic control

Objectives Chronic obstructive pulmonary disease (COPD) is associated with cardiac autonomic nervous system dysregulation. This study evaluates the effects of interval hypoxic training on cardiovascular and respiratory control in patients with mild COPD.

Methods In 18 eucapnic normoxic mild COPD patients (age 51.7 ± 2.4 years, mean ± SEM), randomly assigned to either training or placebo group, and 14 age-matched healthy controls (47.7 ± 2.8 years), we monitored end-tidal carbon dioxide, airway flow, arterial oxygen saturation, electrocardiogram, and continuous noninvasive blood pressure at rest, during progressive hypercapnic hyperoxia and isocapnic hypoxia to compare baroreflex sensitivity to hypoxia and hypercapnia before and after 3 weeks of hypoxic training. In double-blind fashion, both groups received 15 sessions of passive intermittent hypoxia (training group) or normoxia (placebo group). For the hypoxia group, each session consisted of three to five hypoxic (15–12% oxygen) periods (3–5 min) with 3-min normoxic intervals. The placebo group inhaled normoxic air.

Results Before training, COPD patients showed depressed baroreflex sensitivity, as compared with healthy individuals, without evident chemoreflex abnormalities. After training, in contrast to placebo group, the training group showed increased (P < 0.05) baroreflex sensitivity up to normal levels and selectively increased hypercapnic ventilatory response (P < 0.05), without changes in hypoxic ventilatory response.

Conclusion Eucapnic normoxic mild COPD patients already showed signs of cardiovascular autonomic abnormalities at baseline, which normalized with hypoxic training. If confirmed in more severe patients, interval hypoxic training may be a therapeutic strategy to rebalance early autonomic dysfunction in COPD patients.

aDepartment of Sport Science, Medical Section, University of Innsbruck, Innsbruck, Austria

bDepartment of Internal Medicine, University of Pavia and IRCCS Ospedale S.Matteo, Pavia, Italy

cPulmonologist Office, Innsbruck, Austria

dPrimary Care Physician Office, Innsbruck, Austria

eHypoxia Medical Academy, Moscow, Russia

fInstitute of Motor Sciences, University of Pavia and IRCCS Sopedale S.Matteo, Pavia, Italy

Received 17 April, 2008

Revised 30 January, 2009

Accepted 20 March, 2009

Correspondence to Luciano Bernardi, MD, Clinica Medica 2, Universita' di Pavia and IRCCS Ospedale S. Matteo, 27100 Pavia, Italy Tel: +39 0382 502979; fax: +39 0382 526259; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.