High Intensity Interval Training and Technologies in COPD

April 10, 2024 updated by: Hull University Teaching Hospitals NHS Trust

Promoting Activity in Chronic Obstructive Pulmonary Disease (COPD): Optimising High Intensity Interval Training and Technologies, a Pilot Study

Trials in COPD have shown that HIIT leads to the same positive outcomes as constant load training but causes less breathlessness and leg discomfort during training. However, HIIT protocols in existing trials have all been different and use relatively long interval durations (30 s) and short rests. This is sub-optimal because long interval durations lead to greater breathlessness and patients may fear that they will not fully recover during short rests, potentially decreasing adherence. A novel HIIT protocol involving very brief intervals (e.g. 10 s) with longer rests may provide the same benefits with less distress due to breathlessness.

Study Overview

Status

Terminated

Conditions

Intervention / Treatment

Detailed Description

Chronic Obstructive Pulmonary Disease (COPD) is a common and disabling smoking-related lung disease that is predicted to become the 3rd leading cause of death world-wide by 2030 (WHO, 2017). The economic burden of COPD in the United Kingdom is estimated by the British Lung Foundation (BLF) to be around £48.5 billion per year - higher than all other respiratory diseases, including lung cancer. Although widespread, Hull is a COPD 'hot spot' (BLF), with prevalence and mortality rates 36% and 75% higher than the national average, respectively. COPD is characterised by symptoms of breathlessness and cough that typically progress over time.

As a consequence of these symptoms, physical activity (PA) is reduced in COPD patients, with lower levels associated with higher symptom burden, hospital admissions and mortality. Breathlessness is the most commonly reported barrier to PA in COPD, resulting in a cycle of deconditioning that ultimately leads to greater breathlessness and disability.

Pulmonary rehabilitation (PR) improves symptoms and increases exercise capacity in COPD but uptake and adherence are poor. Patients with greater breathlessness are less likely to complete PR programmes which is unsurprising given that exercise-induced breathlessness can be distressing in COPD.

One potential solution is high-intensity interval training (HIIT). HIIT involves short bursts of high-intensity exercise interspersed with periods of rest. The short duration of high-intensity exercise can reduce distressing breathlessness during exercise in COPD, mitigating the most common barrier to exercise.

As mentioned above, PR participants benefit from increased exercise capacity. However, what patients can do (exercise capacity) does not always translate into what patients do (PA) and the effect of PR on PA has been disappointing.

Interventions that aim to improve PA in COPD patients have been trialed, but the quality of evidence is low and results inconsistent. Physical inactivity is the strongest predictor of mortality in COPD patients and therefore, effective interventions that increase PA are desperately needed.

Study Type

Interventional

Enrollment (Actual)

18

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United Kingdom
    • East Yorkshire
      • Cottingham, East Yorkshire, United Kingdom, HU16 5JQ
        • Castle Hill Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

30 years to 90 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Mild, Moderate and severe* COPD forced expired volume (FEV-1) ≥30 with an FEV-1/ forced vital capacity (FVC) ratio <70%) confirmed on spirometry within 6 months of recruitment.

    • Chronic breathlessness that limits exercise capacity (mMRC ≥2).
    • Using inhaled therapy for COPD including a long-acting bronchodilator agonist (LABA and/or long acting muscarinic agonist (LAMA) with or without inhaled corticosteroids (ICS).
    • Oxygen saturations ≥90% breathing room air.
    • Willing and able to undertake study procedures.
    • Has provided informed consent. * Mild and Moderate COPD patients will be recruited from the start of the study. A review of exercise session completion rates and adverse events will be performed after 10 patients have been recruited to assess the tolerability and acceptability of the different HIIT protocols prior to beginning recruitment of people with severe COPD

Exclusion Criteria:

  • Significant physical or psychological comorbidity considered by the investigator likely to affect study outcomes.

    • Active cardiovascular disease or recent significant cardiovascular event (myocardial infarction within 6 months, cardiac arrhythmias including atrial fibrillation/flutter within 6 months, unstable angina within 6 months, stable angina with current symptoms).
    • Moderate or severe COPD exacerbation within 4 weeks of screening (an exacerbation requiring treatment with steroids and/or antibiotics or leading to hospitalisation).
    • Unable or unwilling to undertake exercise as set out in the study protocol

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: Randomized
  • Interventional Model: Crossover Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: HIIT protocol ABC

HIIT protocol A, then HIIT protocol B, then HiIT protocol C. Patients first received HIIT A -High-intensity duration and intensity: 5 seconds, Rest duration: 40 seconds, Number of Repetitions: 54, Total duration of HIIT protocol: 2,430 seconds (40 minutes, 30 seconds).

After a rest of at least 2 days they received HIIT B: High-intensity duration and intensity: 10 seconds, Rest duration: 80 seconds, Number of Repetitions: 27, Total duration of HIIT protocol: 2,430 seconds (40 minutes, 30 seconds).

After a further rest of at least 2 days they received HIIT C-High-intensity duration and intensity: 30 seconds, Rest duration: 240 seconds, Number of Repetitions: 9 Total duration of HIIT protocol: 2,430 seconds (40 minutes, 30 seconds).
Other: HIIT exercise program ABC
Delivery of 3 different exercise programs to patients with COPD to determine which program gives least breathlessness with the same exercise benefits
Experimental: HIIT protocol CAB

HIIT protocol C, then HIIT protocol A, and lastly HIIT protocol B. Patients first received HIIT C:-High-intensity duration and intensity: 10 seconds, Rest duration: 80 seconds, Number of Repetitions: 27, Total duration of HIIT protocol: 2,430 seconds (40 minutes, 30 seconds). After a rest of at least 2 days they received HIIT A:-High-intensity duration and intensity: 5 seconds, Rest duration: 40 seconds, Number of Repetitions: 54, Total duration of HIIT protocol: 2,430 seconds (40 minutes, 30 seconds).

After a further rest of at least 2 day they performed HIIT protocol B:-High-intensity duration and intensity: 10 seconds, Rest duration: 80 seconds, Number of Repetitions: 27 Total duration of HIIT protocol: 2,430 seconds (40 minutes, 30 seconds).
Other: HIIT exercise program CAB
Delivery of 3 different exercise programs to patients with COPD to determine which program gives least breathlessness with the same exercise benefits
Active Comparator: HIIT protocol BCA

HIIT protocol B, then HIIT protocol C, and lastly HIIT protocol A. Patients firstly received HIIT protocol B:-High-intensity duration and intensity: 10 seconds, Rest duration: 80 seconds, Number of Repetitions: 27, Total duration of HIIT protocol: 2,430 seconds (40 minutes, 30 seconds).

Following at least 2 days rest the patient will receive HIIT protocol C:-High-intensity duration and intensity: 10 seconds, Rest duration: 80 seconds, Number of Repetitions: 27, Total duration of HIIT protocol: 2,430 seconds (40 minutes, 30 seconds). After at least another 2 days rest they will lastly receive Protocol A:-High-intensity duration and intensity: 5 seconds, Rest duration: 40 seconds, Number of Repetitions: 54, Total duration of HIIT protocol: 2,430 seconds (40 minutes, 30 seconds).
Other: HIIT exercise program BCA
Delivery of 3 different exercise programs to patients with COPD to determine which program gives least breathlessness with the same exercise benefits

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Comparison of the Change from baseline in mean Borg Dyspnoea scale (the higher the score the worst the breathlessness) following HIIT protocols
Time Frame: Through study completion, on average 2 wks
The Dyspnoea Borg scale was assessed at rest and then at the beginning and end of each high intensity interval. during and following each of the HIIT protocols lasting 40 min. the scale ranges from 0-10 with 0 being no breathlessness and 10 being maximum breathlesness
Through study completion, on average 2 wks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Comparison of maximum Dyspnoea Borg score for each HIIT protocol (the higher the score the worse the breathlessness
Time Frame: through study completion, on average 2 wks
Assessed the maximum score for Dyspnoea during high intensity training for each of the HIIT protocols with 0 being no breathlessness and 10 the maximum breathlessness.
through study completion, on average 2 wks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Hull University Teaching Hospitals NHS Trust

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

May 8, 2019

Primary Completion (Actual)

November 25, 2022

Study Completion (Actual)

November 25, 2022

Study Registration Dates

First Submitted

November 23, 2021

First Submitted That Met QC Criteria

April 19, 2022

First Posted (Actual)

April 25, 2022

Study Record Updates

Last Update Posted (Actual)

April 11, 2024

Last Update Submitted That Met QC Criteria

April 10, 2024

Last Verified

October 1, 2023

More Information

Terms related to this study

Other Study ID Numbers

  • 01022019

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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