Effectiveness of Non-Presential Individualized Exercise Training PrOgram (NIETO) in Lower Limb Physical Performance in Advanced COPD

Muscle training, a component of pulmonary rehabilitation (PR), improves the physical performance of patients with chronic obstructive pulmonary disease (COPD). Despite the existing evidence, the traditional center-based PR model is applied to a small percentage of patients and presents numerous problems of accessibility, adherence, and costs. This study presents a home model of simple muscle training, non-presential, monitored by telephone and individualized, according to the severity of the COPD. In addition, to evaluate the results, simple tests associated with the physical performance of the lower limbs, previously validated in COPD, have been used, such as the four-meter walk, speed test (4MGS) and the five-repetition test sitting and standing (5STS). The objective was to evaluate whether the Individualized Non-Presential Exercise Training PrOgram (NIETO) induces improvements in the 4MGS, 5STS and quadriceps muscle strength (QMS) tests in outpatients with advanced COPD (FEV1 ≤ 50%). After one year, the QMS was significantly higher in the intervention group (IG) than in the control group (CG) (2.44 ± 4.07 vs. 0.05 ± 4.26 kg; p = 0.009). The 4MGS and 5STS tests were significantly shorter in IG than in CG (−0.39 ± 0.86 vs. 0.37 ± 0.96 s; p = 0.001) and (−1.55 ± 2.83 vs. 0.60 ± 2.06 s; p = 0.001), respectively. A home model of simple muscle training monitored by telephone such as NIETO, can improve 4MGS, 5STS, and quadriceps strength tests in outpatients with advanced COPD.


Grupo 1
Sitting on the floor, stretch legs and straight back, set a roller(rolled towel) under your knees and keep ankle at 90º. Pressing towel.
Lying down with one stretched leg and the other one flexed. First lifting one leg full stretched 30 cm. from the ground, in this position draw little circles as we were drawing with the ankle. Repeat with both legs.
Upright, legs lightly separated from the hip. Breathe and take a step keeping straight trunk. Forwarded leg must flex till thigh, set as much parallel to ground as posible. Rear leg stays fixed by foot to the ground but it must lift down to foot till knee. Exhaling back to initial position.
Leaning back and buttocks on the wall, parallel and separated feet, go slowly down flexing legs and keeping the back on the wall till possible. Then go up to initial position without leaning on.
Sitting down on a chair, feet on the ground. Inhale while arms up to maximum, ahead of eyes. Exhale slowly, lips frowning, arms down to initial position. Standing up is optional.
Inhale while opening arms to máximum and exhale slowly wiht tight lips, hugging oneself. Sitting down is optional.

Physical Exercise: Legs
From sitting position, feet on the ground, inhale and stand up, no leaning on. Full breathing and back to initial position.
From sitting position, feet on the ground, leaning hands at the edge of the chair. Lift bottom up as one wanted to stand up, but did not. Make effort with arms but specially with buttocks and legs.

Grup 2
Number of repetitions Lying down with one stretched leg and the other one flexed. First lifting one leg full stretched 30 cm from the ground, in this position draw little circles as we were drawing with the ankle. Repeat with both legs.

Number of repetitions
Upright, legs lightly separated from the hip. Breathe and take a step keeping straight trunk. Forwarded leg must flex till thigh, set as much parallel to ground as posible. Rear leg stays fixed by foot to the ground but it must lift down to foot till knee. Exhaling back to initial position.

Ejercicios: brazos
*Start doing the exercises as explained above and we are adding weight little by little and according to our tolerance Grup 2

Physical Exercise: Arms
Sitting down on a chair, feet on the ground. Inhale while arms up to maximum, ahead of eyes. Exhale slowly, lips frowning, arms down to initial position. Standing up is optional.

Number of repetitions
Inhale while opening arms to máximum and exhale slowly wiht tight lips, hugging oneself. Sitting down is optional.

Grup 3
Sitting on the floor, stretch legs and straight back, set a roller(rolled towel) under your knees and keep ankle at 90º. Pressing towel.
Lying down with one stretched leg and the other one flexed. First lifting one leg full stretched 30 cm. from the ground, in this position draw little circles as we were drawing with the ankle. Repeat with both legs.
Upright, legs lightly separated from the hip. Breathe and take a step keeping straight trunk. Forwarded leg must flex till thigh, set as much parallel to ground as posible. Rear leg stays fixed by foot to the ground but it must lift down to foot till knee. Exhaling back to initial position.
Leaning back and buttocks on the wall, parallel and separated feet, go slowly down flexing legs and keeping the back on the wall till possible. Then go up to initial position without leaning on.
Standing, support your arms on a fixed chair. Bend one knee (about 90 0 degrees), then extend it and bring it back about 30 0 degrees, without touching the ground. It is important to keep the body straight during exercise.

Grup 3
Number of repetitions

Grup 3
Sit in a chair with feet flat on the floor Take in air as we raise our arms to the maximum, in front of our eyes, breathe out slowly with tight lips, slowly lower our arms to the starting position. This exercise can be done standing Take in air while we open our arms to the maximum and breathe out slowly with tight lips, hugging ourselves. This exercise can be done sitting down.
It can be done with half a kilo of weight in each hand, and progressively increase according to tolerance. run or walk quickly slowly, on flat terrain and without forcing, increasing according to difficulty breathing, at the pace you tolerate, when you feel fatigue, stop, recover and continue slower If it is an exercise bike, increase the resistance little by little according to the respiratory difficulty, do not forcé.
Avoid the warmest and the coolest moments of the day minuts