Supplemental Oxygen during Exercise Training in Chronic Obstructive Pulmonary Disease.

Introduction: chronic obstructive pulmonary disease is a leading cause of mortality worldwide and a debilitating condition that leads to years of poor quality of life. Physical exercise training is an evidence-based treatment well documented to improve these outcomes as well as morbidity, dyspnoea and functional capacity. Moreover, scientific evidence from pooled analyses currently provides equivocal evidence for oxygen supplementation to overcome ventilatory limitations during exercise training, with several studies reporting no additional benefits when compared with training in room air. However, when individually analyzing the underlying studies from an exercise physiology perspective, some critical aspects arise.

Purpose: this review aims to systematically investigate and highlight the impact of patients' characteristics, exercise induced desaturation, oxygen delivery, influence of breathing conditions during exercise testing and prescription, outcome-training specificity, exercise intensity and modality, as well as progressive work rate adjustments over the course of the training intervention.

Methods: the research methodology is based on a literature search of the available evidence starting from the published systematic reviews and meta-analyses, and integrating available original articles from the respective reference lists.

Results: although evidence is still limited, supplemental oxygen might be specifically useful for certain responding patients and in specific clinical conditions, when high-intensity training is performed, thereby increasing exercise tolerance in order to improve training adaptations and thus peak exercise capacity/endurance.

Conclusions: future well-designed clinical trials may better implement these methodological training principles in their study design and investigate if advantages from normoxic and hyperoxic exercise training can be weighed, showing how, when and in which patients supplemental oxygen could be best used in order to reach predefined training goals in pulmonary rehabilitation.