Advice on how to design a long-term training for COPD patients over several years is rarely found in literature. Concerning the occurring changes in the muscles during the progress of the disease it is only sensible to focus on a training program with light intensities already in the early stages of the disease.

Food for thought
A training program with light intensities enables the extensive use of metabolism with sufficient oxygen supply. Thus, this kind of energy production is trained and the used structures in the muscles are maintained. In other words, if the training is constantly too intense (or if high intensity strain occurs in everyday life due to reduced exercise capacity), only the energy production fuelled with insufficient oxygen supply is used and only this system is optimized and the muscle's structure (energy production and muscle fibre) changes.

This also applies when taking up a training program: first of all, there should always be a "settling-in period" for all active and passive structures. Only then, after triggering essential signs of adjustment, does a more intensive training program in order to achieve further improvements (e.g. maximum exercise capacity) make sense. No high performance athlete would exercise on high intensity levels without basic training. E.g. professional racing cyclists perform more than 50 % of their total training hours per year on a light intensity level. The following table demonstrates a simple, general training program (12 weeks, 3 phases of training, 3 weeks gradually increasing, followed by a one week break) for taking up systematic training (with respect to intensity data).

Different intensities ("How fast can I walk?", "How many watts can I pedal on the ergometer"?) need to be practiced using perceived exertion in order to perform them safely in the required time. Those areas need to be redefined and practiced after every single infection. Controlling the training by intensity (e.g. as Wmax) requires regular exercise stress tests in order to constantly keep up a work load of e.g. 70 % Wmax. This means: training increases exercise capacity and keeping the physical load (in watt or walking pace) at one level is not an appropriate training stimulus in the long run. In practice, training units are too often increased subliminally due to lacking exercise stress tests or each unit is basically increased by a few percentages. Quite often, the consequences are overstraining and insufficient results. If there are no exercise stress tests or if controlling the training by appropriate parameters is not possible, the Borg scale should be used. Generally, the intensity seems to be the crucial "set screw" for achieving ideal physiological changes while the duration of exertion primarily influences the cardiovascular risk factors.

In general, intensity levels of 60-80% of the maximum work rate in watts [Wmax] - determined by an individual exercise stress test - are considered a high-intensity training [HIT]. Areas between 50% and 60% Wmax are considered a low-intensity training. If higher intensities cannot be sustained over the period of time required for the phase of training, the interval method might be a good solution. This way, the required high-intensity levels can be performed with almost no symptoms (breathlessness and physical fatigue and little dynamic hyperinflation. The achieved effects can be compared in many ways to those of a (low-intensity) continuous method.

Depending on the degree of exercise capacity, there are different options of implementing an endurance training (see following chapter). At the end of a phase of training a new exercise stress test should be conducted (with the intention: determination of new intensities) and/or a change of training method should be considered.

Approach to endurance training: general training program (duration 4 weeks each)
Basically, one can choose the following approach: 1 day exercising + at least 1 day break.
Total time per training phase 4 weeks each: 3 weeks advancing training + 1 week regeneration
Settling-in phase:
getting started slowly, low intensities (Borg up to 4) in continuous or interval method, training duration 30-60 minutes, week 1 and 2: 1-2 units a week, 3 units a week after that.

No/mild fatigue: keep values of e.g. respiration and heart rate constant, choose pace at which the named values remain constant after increasing the physical exertion.
Basic phase:
exercising on 3 days a week, intensity: extensive (Borg 4-6) in continuous or interval method, training duration 30-60 minutes.
values of e.g. respiration and heart rate rise towards the end of the physical exertion. The required training duration should be performed without termination of exertion ("one still has reserves").
Start-up phase:
training on 3 days a week, intensity: increasing from extensive to intensive (Borg 6-7) in continuous or interval method, training duration 20-40 minutes.
Pronounced fatigue:
values for e.g. respiration and heart rate rise towards the end of the physical load. Termination of exertion (due to fatigue) should coincide with the end of the training.