Response to one-legged cycling in patients with COPD

Background: In patients with COPD, exercise intensity is often limited by the ventilatory system. We hypothesized that by exercising with a smaller muscle mass, ventilatory-limited patients would perform more high-intensity, muscle-specific work. The study objectives were as follows: (1) to determine the limitations of exercising with a smaller muscle mass, compared with conventional two-legged exercise; and (2) to determine the endurance time, using the same muscle-specific intensity, during one-legged vs two-legged exercise. Methods: Nine patients (mean +/- SD FEV1, 36 +/- 13% of predicted) completed incremental exercise, and nine other patients (mean FEV1, 42 +/- 16% of predicted) completed constant-power exercise. Nine healthy subjects (FEV1, 104 +/- 14% of predicted) completed both tests. All subjects completed tests using two-legged and one-legged pedaling. Results: Peak oxygen uptake (VO(2)peak) was similar during one-legged and two-legged incremental exercise among patients (difference, 0.03 L/min; 95% confidence interval [CI], - 0.10 to 0.16 L/min; p = 0.60), as were ventilation and dyspnea scores. Vo(2)peak was lower during one-legged vs two-legged exercise (- 0.57 mL/min; 95% CI, - 0.81 to - 0.32 mL/min; p < 0.001) among healthy subjects with substantial ventilatory and heart rate reserve. Patients endured one-legged pedaling at a constant power longer than two-legged pedaling (16.97 min; 95% CI, 9.98 to 23.96 min; p < 0.001), resulting in greater work (12.48 kilojoules [kJ]; 95% CI, 2.58 to 22.39 kJ; p = 0.02). Healthy subjects completed similar work (- 4.02 kJ; 95% CI, - 18.59 to 10.55 kJ; p = 0.54) with one-legged vs two-legged pedaling. Conclusion: These observations demonstrate the effectiveness of using one-legged exercise at the same muscle-specific intensity in extending the duration of exercise among patients with COPD. This has important implications for training approaches designed to enhance exercise function among ventilatory-limited patients.