An unappropriated exercise training program

Exercise training is a key component of pulmonary rehabilitation and should be prescribed by an exercise specialist competent in respiratory disease. We report a case of a 72 years COPD male (mild obstruction) with cardiovascular morbidity (myocardial infarction in 2004) referred to our outpatient clinic for excessive exertion dyspnea during exercise in the gym. In 2013, the patient performed a moderate-walking training program for 8 weeks, 2 one-hour sessions a week. At the end of the program, a home-based training was prescribed (speed 4.5 km/h, 30 min, 3/week). Later, he decided to attend the gym, following a non-supervised cardio-fitness program. He was in beta-blocker but the speed was adjusted by the trainer according to the heart rate (HR). Currently, he is training at 6 km/h, slope of 6%, complaining a worsening dyspnoea. At the moment of the visit, spirometry and EKG were unchanged. A cardio-pulmonary exercise test (CPET) was made, mimicking the training session at the gym. Protocol started at 3 km/h progressively increased until 4.4 km/h at a slope of 0%. After 8 minutes the test was stopped for oxygen desaturation (SpO2 89%). At that point, HR was 82 bpm (55% of HRmax); the anaerobic threshold was reached; CO2 equivalent: 40; ventilatory reserve: 17 L; inspiratory capacity reduced from 2.58 L at rest to 1.55 L. The results of CPET can explain the causes of dyspnoea. Conclusion: An expert staff should supervise patients during the training session at the gym. In fact, this case emphasizes the inadequacy of monitoring only the heart rate during exercise in chronic patients and the importance of evaluating other data (i.e. SpO2 and previous maximal exercise test) to plan and follow an exercise training program.