High-intensity interval training helps patients with COPD

André Nyberg is Associate Professor and Senior Lecturer at the Department of Community Medicine and Rehabilitation, Section of Physiotherapy at Umeå University. After a few years of studying sports pedagogy and medicine, he turned to physiotherapy. After completing his studies André got the opportunity to become a doctoral student in a project involving people with chronic obstructive pulmonary disease, COPD.

"It was, as often, a coincidence. I wasn't focused on that group or even starting research, but I was encouraged by a supervisor. Then, when working with Karin Wadell, who researched the importance of exercise for people with COPD, I became interested in the group and in what way physical exercise can be used as a treatment".

there are great opportunities to help them to a better life with physical training

"I'm happy about that. It's a fantastic group of people to work with, and there are great opportunities to help them to a better life with physical training".

Good results from highly competitive strength training

André has always been interested in exercise, body fuctions and how exercise training can be used in rehabilitation. In his dissertation from 2014, he studied how highly competitive strength training is optimized for people with COPD by reducing the load on the lungs.

"By training smaller muscle groups, such as one leg at a time, we could see that people with COPD also got good results from highly competitive strength training, including improved muscle function and a better functional ability," André says.

After a postdoctoral stint in Canadian Quebec – also there for studies on physical exercise and COPD – he is now back in Sweden and Umeå. Last Fall, he was awarded a three-year research grant of SEK 6 million from the Swedish Heart and Lung Foundation, to study how treatment with high-intensity and short-term interval training, HIT, eventually can effect on muscles, cardiovascular and brain function among people with COPD.

"We know that HIT affects healthy people. Now we want to see if an adapted HIT variant  affcts persons with COPD," says André Nyberg.

Short but high-intensity training

Since the beginning of 2022, they are now trying to find the correct levels of training intensity, length of intervals and scope.

"It is widespread for people with COPD to be limited by their shortness of breath in connection with physical exercise, especially if it is prolonged or high intensity. This is problematic because high intensity is needed for the exercise to have an effect".

The starting point of the project is a concept of short duration high-intensity interval training developed by my colleagues within the project "Umeå-HIT", and which consists of a setup with very short but high-intensity training intervals – ten times six seconds of intervals with one minute of rest between. Then the training intensity can be kept at a higher level than, for example, in tests of maximum oxygen uptake, so-called work tests. Work has now begun on adapting the modality to people with COPD.

And André Nyberg already can see good results.

"Definitely. We can be at 3-4 times higher intensity than conventional continuous exercise, without the patient being limited by shortness of breath or increasing the load on the lungs".

Extended to a larger, three-year project

The purpose of the study, which in 2022 will be extended to the larger, three-year project, is thus to see if the high-intensity exercise model leads to positive health effects for people with COPD.

André Nyberg is convinced of the connection.

"COPD is an incurable lung disease that limits patients a lot, but also a systemic disease where impaired function in the heart, muscles and brain affects negatively. Unfortunately, we can't do anything about the lung disease itself. Still, we believe we can improve muscle, cardiovascular and brain function with the proper high-intensity interval training. If the study shows that the hypothesis is correct, the treatment of people with COPD may change", André Nyberg believes.

"Absolutely. And it can impact on both the quality of life and the prognosis of the individual with COPD".

In 2022, André Nyberg received the prestigious Starting Grant of EUR 1.5 million (approximately SEK 16 million) over five years from the European Research Council, within which supramaximal HIT at COPD will continue to be studied. Supramaximal HIT and its impact on COPD is the starting point also in the ERC project, but research objectives have been added. A combination of clinical in vivo and experimental in vitro studies and methods will be used to answer the project's research objectives and collaborations with researchers at several of the faculty's departments and internationally make the project possible.

“A key to the implementation of the project is the infrastructure that exists at Umeå University and the involvement of researchers within the faculty and internationally. Through this collaboration, we get an opportunity to dig deeper than previously done regarding explanatory mechanisms of training performed at different intensities and it provides a unique opportunity to investigate more closely to what extent the disease affects treatment effects over time and specifically the role of inflammation. Among other things, we will follow people with COPD during a two-year period where the role of physical exercise, the importance of exercise intensity and inflammation will be studied regarding neurodegenerative changes over time, something that has not previously been studied within the COPD population," says André Nyberg.