Fidelity and tolerability of two high-intensity interval training protocols in patients with COPD: a randomised cross-over pilot study

Stine Buus Nymand, Jacob Hartmann, Iben Elmerdahl Rasmussen, Ulrik Winning Iepsen, Mathias Ried-Larsen, Regitse Højgaard Christensen, Ronan Martin Griffin Berg*

*Corresponding author for this work

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Objectives High-intensity interval training (HIIT) during pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD) may alleviate the symptom burden, but the fidelity and tolerability of HIIT using long or short intervals in patients with COPD are unknown. Methods Twelve patients with moderate-to-severe COPD were included in a randomised cross-over pilot study. They completed two supervised HIIT protocols (4×4 and 10×1). To compare the two HIIT protocols, completed training amount, exercise intensity and perceived tolerability (assessed by a 10-point Likert scale) were integrated in a red-amber-green rating system. If a training session received a red ranking, it was considered unacceptable, if it received an amber ranking it was applicable with precautions, and if it received a green ranking it was considered feasible. Results All patients completed the total training amount in both protocols. The 4×4 protocol resulted in three amber training sessions due to low perceived tolerability. The 10×1 protocol resulted in two red training sessions due to intensity reductions, and two amber training sessions because of low perceived tolerability. There was no statistical difference in perceived tolerability or time spent with an HR ≥85% of HR max. Conclusions HIIT using longer intervals (4×4) at a relatively lower intensity resulted in higher fidelity expressed by fewer adjustments to the protocol, whereas there was no difference between protocols in perceived tolerance. The 4×4 protocol seems to have a higher fidelity compared with the 10×1 protocol in patients with moderate-to-severe COPD. Trial registration number NCT05273684.

Original languageEnglish
Article numbere001486
JournalBMJ Open Sport & Exercise Medicine
Issue number1
Number of pages9
Publication statusPublished - 8. Mar 2023

Bibliographical note

Funding Information:
This work was supported by a grant from the Svend Andersen Foundation. The Centre for Physical Activity Research (CFAS) is supported by TrygFonden (grants ID 101390 and ID 20045).


  • Exercise rehabilitation
  • Lungs
  • Training


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