Resistance (or strength) training is an exercise modality in which local muscle groups are trained by repetitive lifting of relatively heavy loads (116–118). Resistance training is considered important for adults to promote healthy aging (119) and also appears to be indicated in individuals with chronic respiratory disease (21, 120), such as those with COPD, who have reduced muscle mass and strength of their peripheral muscles, relative to healthy control subjects (65, 121). These systemic manifestations of COPD are related to survival, health care use, and exercise capacity (61, 122–125). Further, as falling appears to be common among people with COPD (126, 127), and muscle weakness is an important risk factor for falls in the older population (128), optimizing muscle strength is likely to be an important goal of rehabilitation in this population. In addition to the expected effects on muscle strength, it is possible that resistance training may also assist with maintaining or improving bone mineral density (129), which has been shown to be abnormal low (e.g., osteoporosis or osteopenia) in about 50% of individuals with COPD (130, 131).
阻力（或力量）訓練是一種通過重複克服相對較重的負荷來訓練局部肌肉群的運動方式。阻力訓練被認為對成年人促進健康老齡化很重要，而且在慢性呼吸系統疾病患者中也有體現，例如與健康對照組相比，慢性阻塞性肺病患者的外周肌肉質量和力量都有所降低。慢性阻塞性肺病的這些系統性表現與生存率、醫療服務的使用和運動能力有關。此外，由於跌倒在慢性阻塞性肺病患者中很常見，而且肌無力是老年人跌倒的一個重要風險因素，因此優化肌肉力量可能是該人群康復的一個重要目標。除了對肌肉力量的預期效果外，阻力訓練也有可能有助於維持或改善骨密度，在約50%的慢性阻塞性肺病患者中，骨密度異常低（例如骨質疏鬆症或骨質疏鬆症）。
Of note, endurance training, which is the mainstay of exercise training in pulmonary rehabilitation programs, confers suboptimal increases in muscle mass or strength compared with programs that include specific resistance exercise (15, 132, 133). Resistance training has greater potential to improve muscle mass and strength than endurance training (21, 120, 132, 134–136), two aspects of muscle function that are only modestly improved by endurance exercises (23). Moreover, strength training results in less dyspnea during the exercise period, thereby making this strategy easier to tolerate than endurance constant-load training (101).
值得注意的是，耐力訓練是肺康復項目中運動訓練的主要部分，與包括特定阻力訓練的項目相比，耐力訓練使肌肉質量或力量的增加不太理想。與耐力訓練相比，阻力訓練在提高肌肉質量和力量方面具有更大的潛力，通過耐力訓練這兩個方面的肌肉功能只能得到適度改善。此外，力量訓練在運動期間可減少呼吸困難程度，因此患者相對於耐力恆負荷訓練來說更容易接受這種方式。
The optimal resistance training prescription for patients with chronic respiratory disease is not determined, as evidenced by the wide variation in its application among clinical trials (117). The American College of Sports Medicine recommends that, to enhance muscle strength in adults, 1 to 3 sets of 8 to 12 repetitions should be undertaken on 2 to 3 days each week (116). Initial loads equivalent to either 60 to 70% of the one repetition maximum (i.e., the maximal load that can be moved only once over the full range of motion without compensatory movements [137]) or one that evokes fatigue after 8 to 12 repetitions are appropriate. The exercise dosage must increase over time (the so-called overload) to facilitate improvements in muscular strength and endurance. This increase occurs when an individual can perform the current workload for 1 or 2 repetitions over the desired number of 6 to 12, on 2 consecutive training sessions (116). Overload can be achieved by modulating several prescriptive variables: increasing the resistance or weight, increasing the repetitions per set, increasing the number of sets per exercise, and/or decreasing the rest period between sets or exercises (116, 118). Because the optimal resistance training approach for patients with chronic respiratory disease is not known, clinicians often follow these recommendations. Alternative models for progression in training intensity, such as daily undulating periodized resistance training (e.g., making alterations in training volume and intensity on a daily basis [138]) may be advantageous (139), but data are lacking.
慢性呼吸系統疾病患者的最優抗阻訓練處方尚未確定，臨床試驗中應用的廣泛差異證明了這一點。美國運動醫學院建議，為了增強成年人的肌力，每周2-3天進行1-3組8-12次的重複運動。初始荷載相當於一次重複最大值的60%至70%（即，在沒有輔助運動的情況下，僅能在整個運動範圍內移動一次的最大荷載），或在8至12次重複後引起疲勞的荷載。運動劑量必須隨著時間的推移而增加（所謂的超負荷）即在2個連續的運動訓練中，一個人完成當前期望的次數6到12次後的1~2次運動量，以促進肌肉力量和耐力的提高。超負荷可以通過調節幾個規定的變量來實現:增加阻力或重量，增加每組的重複次數，由於慢性呼吸系統疾病患者的最佳阻力訓練方法尚不清楚，臨床醫生通常遵循這些建議。對於訓練強度的進展的有多種模型，例如每天波動周期性的阻力訓練（例如，每天改變訓練量和強度）可能是有利的，但缺乏數據。
Clinical trials in COPD have compared resistance training with no training and with endurance training. Lower limb resistance training consistently confers gains in muscle force and mass compared with no exercise training (136, 140–143). The effects on other outcomes are less consistent. It appears that the capacity for increased lower limb muscle force to translate into increased maximal or submaximal exercise capacity is dependent, at least in part, on the magnitude of the training load. Studies that have used loads equal to or exceeding 80% of one repetition maximum throughout the training program have reported improvements in submaximal exercise capacity (21, 120) and peak power measured via cycle ergometry (142) as well as peak walk speed measured over a 30-m track (140). Similar findings have been reported in individuals with chronic heart failure (144). In some (120, 136), but not all studies (141), training loads between 50 and 80% of one repetition maximum were sufficient to improve endurance exercise capacity. Training programs that appear to have used more modest loads are ineffective at conferring gains in exercise capacity (143).
COPD的臨床試驗比較了阻力訓練與無訓練和耐力訓練。與無運動訓練相比，下肢阻力訓練持續增加肌肉力量和質量。對其他結果的影響就不那麼一致了。這樣看來下肢肌力增加轉化為極限或亞極限運動能力至少有部分是取決於訓練負荷的大小。在整個訓練計劃中使用的負荷不小於單次最大重複次數，80%的研究報告了亞極限運動能力和通過循環測功法測得的峰值功率的改善，以及在30米跑道上測得的峰值步行速度。在慢性心力衰竭患者中也有類似的發現。在部分的研究中，訓練負荷在50%到80%的一個重複的最大值是足夠提高耐力運動能力。似乎使用了更適度負荷的訓練計劃在提高運動能力方面是無效的。
When added to a program of endurance constant-load exercise, resistance training confers additional benefits in muscle force, but not in overall exercise capacity or health status (15, 117, 132, 133). However, gains in quadriceps muscle strength may optimize performance of tasks that specifically load these muscles, such as stair-climbing and sit-to-stand (145). Resistance training for the muscles of the upper limbs has been demonstrated to increase the strength of the upper limb muscles and translate this into improvements in related tasks, such as the 6-minute peg board and ring test (146, 147).
當加入耐力恆負荷運動計劃時，阻力訓練在肌肉力量上有額外的好處，但對整體運動能力或健康狀況沒有好處。然而，股四頭肌肌力的增加可以優化這些肌肉的做功的表現，例如爬樓梯和從坐到站。上肢肌肉的阻力訓練已經被證明可以增加上肢肌肉的力量，並將其轉化為相關任務的改進，例如6分鐘平板試驗和旋轉測試。
Resistance exercise elicits a reduced cardiorespiratory response compared with endurance exercise (101). That is, resistance exercise demands a lower level of oxygen consumption and minute ventilation, and evokes less dyspnea (101). In the clinical setting, this makes resistance exercise an attractive and feasible option for individuals with advanced lung disease or comorbidities who may be unable to complete high-intensity endurance or interval training because of intolerable dyspnea (60, 101). It may also be an option for training during disease exacerbations (148).
與耐力運動相比，阻力運動誘發的心肺反應降低。也就是說，阻力運動需要較低的氧耗量和更少的通氣，並且引起較輕症狀的呼吸困難。在臨床環境中，對於晚期肺部疾病或共病患者來說阻力運動是一個有吸引力和可行的選擇，這些患者可能因為難以忍受的呼吸困難而無法完成高強度耐力或間歇訓練。它也可能是疾病加重期間訓練的一種選擇。
In summary, the combination of constant-load/interval and strength training improves outcome (i.e., exercise capacity and muscle strength [15]) to a greater degree than either strategy alone in individuals with chronic respiratory disease, without unduly increasing training time (132).
總而言之，持續負荷/間歇訓練和力量訓練的結合提高了結果(例如。在慢性呼吸系統疾病患者中，在同樣的運動時間內，持續負荷/間隔和力量訓練的結合比單獨使用任何一種方案都能更大程度地改善結果（即運動能力和肌肉力量）。