{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T14:24:24Z","timestamp":1794493464814,"version":"4.9.1"},"reference-count":46,"publisher":"BMJ","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013363","name":"Lunge Z\u00fcrich","doi-asserted-by":"publisher","award":["2021-03"],"award-info":[{"award-number":["2021-03"]}],"id":[{"id":"10.13039\/501100013363","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008477","name":"Heubergstiftung","doi-asserted-by":"publisher","award":["09-2022"],"award-info":[{"award-number":["09-2022"]}],"id":[{"id":"10.13039\/501100008477","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Thorax"],"accepted":{"date-parts":[[2026,8,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Dyspnoea is a major barrier to effective pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD). Low-load blood flow restriction (LL-BFR) resistance exercise may reduce ventilatory demand and dyspnoea burden compared with traditional high-load resistance exercise (HL-TRA). However, its acute physiological and perceptual effects in COPD remain unclear. We compared the acute physiological and perceptual responses to LL-BFR and HL-TRA in patients with COPD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In a randomised crossover trial, 24 patients with moderate to severe COPD performed LL-BFR (30% of one-repetition maximum (1RM); four sets separated by three rest periods) and HL-TRA (70% of 1RM; three sets separated by two rest periods). Ventilation (V\u0307E), tidal volume (VT), oxygen uptake (V\u0307O\u2082), carbon dioxide output (V\u0307CO\u2082), heart rate and ratings of perceived exertion (RPE) were measured throughout. Linear mixed models with participant-level random intercepts were used to compare responses between conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>LL-BFR resulted in lower V\u0307E (\u22122.2 L\/min), VT (\u22120.08 L), V\u0307O\u2082 (\u22120.04 L\/min) and V\u0307CO\u2082 (\u22120.07 L\/min) compared with HL-TRA. Heart rate and breathing rate were similar across both conditions. Dyspnoea was significantly reduced (RPE \u22120.7), while leg effort increased (RPE +0.7). LL-BFR was well tolerated, with no adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Compared with HL-TRA, LL-BFR was associated with lower ventilatory and metabolic demands and lower perceived dyspnoea despite higher perceived leg exertion. These findings suggest that LL-BFR may represent a useful resistance training strategy for patients with COPD who are primarily limited by dyspnoea during exercise.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT05163600\">NCT05163600<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/thorax-2026-225047","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T17:20:32Z","timestamp":1787764832000},"page":"thorax-2026-225047","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Acute cardiorespiratory responses to low-load blood-flow restriction vs high-load resistance exercise in COPD: a randomised crossover trial"],"prefix":"10.1136","clinical-trial-number":[{"clinical-trial-number":"nct05163600","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct05163600","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct05163600","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1483-1318","authenticated-orcid":false,"given":"Manuel","family":"Kuhn","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Zurich, Z\u00fcrich, Switzerland"},{"name":"Department of Pulmonology, University Hospital Zurich, Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian F","family":"Clarenbach","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Zurich, Z\u00fcrich, Switzerland"},{"name":"Department of Pulmonology, University Hospital Zurich, Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Kl\u00e4y","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Zurich, Z\u00fcrich, Switzerland"},{"name":"Department of Pulmonology, University Hospital Zurich, Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malcolm","family":"Kohler","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Zurich, Z\u00fcrich, Switzerland"},{"name":"Department of Pulmonology, University Hospital Zurich, Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1486-3603","authenticated-orcid":false,"given":"Diego M","family":"Baur","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Zurich, Z\u00fcrich, Switzerland"},{"name":"Department of Pulmonology, University Hospital Zurich, Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Senn","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Zurich, Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Radtke","sequence":"additional","affiliation":[{"name":"Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah R","family":"Haile","sequence":"additional","affiliation":[{"name":"Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura C","family":"Mayer","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Zurich, Z\u00fcrich, Switzerland"},{"name":"Department of Pulmonology, University Hospital Zurich, Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1758-4586","authenticated-orcid":false,"given":"Noriane A","family":"Sievi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Zurich, Z\u00fcrich, Switzerland"},{"name":"Department of Pulmonology, University Hospital Zurich, Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6674-5193","authenticated-orcid":false,"given":"Dario","family":"Kohlbrenner","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Zurich, Z\u00fcrich, Switzerland"},{"name":"Department of Pulmonology, University Hospital Zurich, Z\u00fcrich, Switzerland"},{"name":"Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"2026082610202492000_thorax-2026-225047v1.1","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/S2213-2600(24)00339-4","article-title":"The global burden of COPD: epidemiology and effect of prevention strategies","volume":"13","author":"de Oca","year":"2025","journal-title":"Lancet Respir Med"},{"key":"2026082610202492000_thorax-2026-225047v1.2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201510-1966ST"},{"key":"2026082610202492000_thorax-2026-225047v1.3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1843.2010.01849.x"},{"key":"2026082610202492000_thorax-2026-225047v1.4","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201309-1634ST"},{"key":"2026082610202492000_thorax-2026-225047v1.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.arbres.2016.06.010"},{"key":"2026082610202492000_thorax-2026-225047v1.6","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-018-0994-1"},{"key":"2026082610202492000_thorax-2026-225047v1.7","doi-asserted-by":"publisher","DOI":"10.1007\/s00421-011-2167-x"},{"key":"2026082610202492000_thorax-2026-225047v1.8","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1007\/s40279-017-0795-y","article-title":"Magnitude of Muscle Strength and Mass Adaptations Between High-Load Resistance Training Versus Low-Load Resistance Training Associated with Blood-Flow Restriction: A Systematic Review and Meta-Analysis","volume":"48","author":"Lixandr\u00e3o","year":"2018","journal-title":"Sports Med"},{"key":"2026082610202492000_thorax-2026-225047v1.9","doi-asserted-by":"crossref","first-page":"1848","DOI":"10.1016\/j.apmr.2021.12.015","article-title":"Effectiveness of Blood Flow Restriction Training on Muscle Strength and Physical Performance in Older Adults: A Systematic Review and Meta-analysis","volume":"103","author":"Labata-Lezaun","year":"2022","journal-title":"Arch Phys Med Rehabil"},{"key":"2026082610202492000_thorax-2026-225047v1.10","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1111\/sms.13632","article-title":"Effect of blood-flow restricted vs heavy-load strength training on muscle strength: Systematic review and meta-analysis","volume":"30","author":"Gr\u00f8nfeldt","year":"2020","journal-title":"Scand J Med Sci Sports"},{"key":"2026082610202492000_thorax-2026-225047v1.11","doi-asserted-by":"crossref","DOI":"10.1111\/apha.14030","article-title":"Hormonal, immune, and oxidative stress responses to blood flow-restricted exercise","volume":"239","author":"Hjortshoej","year":"2023","journal-title":"Acta Physiol (Oxf)"},{"key":"2026082610202492000_thorax-2026-225047v1.12","doi-asserted-by":"crossref","DOI":"10.14814\/phy2.70968","article-title":"The acute respiratory response to blood-flow restriction resistance exercise in healthy adults: A randomized crossover trial","volume":"14","author":"Kuhn","year":"2026","journal-title":"Physiol Rep"},{"key":"2026082610202492000_thorax-2026-225047v1.13","doi-asserted-by":"crossref","unstructured":"Kohlbrenner D , Kuhn M , Manettas A , et al . Low-load blood-flow restriction strength training in patients with copd: a randomised controlled pilot study. ERS International Congress 2023 abstracts; September 9, 2023:thorax\u20132023. doi:10.1183\/13993003.congress-2023.OA3255","DOI":"10.1183\/13993003.congress-2023.OA3255"},{"key":"2026082610202492000_thorax-2026-225047v1.14","doi-asserted-by":"crossref","first-page":"1779","DOI":"10.1002\/j.2040-4603.2012.tb00444.x","article-title":"Factors limiting exercise tolerance in chronic lung diseases","volume":"2","author":"Vogiatzis","year":"2012","journal-title":"Compr Physiol"},{"key":"2026082610202492000_thorax-2026-225047v1.15","first-page":"187","article-title":"Pathogenesis of hyperinflation in chronic obstructive pulmonary disease","volume":"9","author":"Gagnon","year":"2014","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"2026082610202492000_thorax-2026-225047v1.16","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-019-01128-9"},{"key":"2026082610202492000_thorax-2026-225047v1.17","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201402-0373ST"},{"key":"2026082610202492000_thorax-2026-225047v1.18","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0048-2016"},{"key":"2026082610202492000_thorax-2026-225047v1.19","unstructured":"Declaration of Helsinki."},{"key":"2026082610202492000_thorax-2026-225047v1.20","unstructured":"Human research act (HRA)."},{"key":"2026082610202492000_thorax-2026-225047v1.21","unstructured":"Ordinance on human research with the exception of clinical trials (HRO). n.d. Available: https:\/\/www.admin.ch\/opc\/en\/classified-compilation\/20121177\/index.html"},{"key":"2026082610202492000_thorax-2026-225047v1.22","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.l4378","article-title":"CONSORT 2010 statement: extension to randomised crossover trials","volume":"366","author":"Dwan","year":"2019","journal-title":"BMJ"},{"key":"2026082610202492000_thorax-2026-225047v1.23","unstructured":"(GOLD), G.I.f.C.O.L.D . Global strategy for the diagnosis, management, and prevention of copd: 2024 report. 2024."},{"key":"2026082610202492000_thorax-2026-225047v1.24","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0054-2016"},{"key":"2026082610202492000_thorax-2026-225047v1.25","unstructured":"Snow G . Blockrand: randomization for block random clinical trials_. r package version 1.5 and."},{"key":"2026082610202492000_thorax-2026-225047v1.26","doi-asserted-by":"crossref","DOI":"10.1183\/16000617.0101-2018","article-title":"ERS statement on standardisation of cardiopulmonary exercise testing in chronic lung diseases","volume":"28","author":"Radtke","year":"2019","journal-title":"Eur Respir Rev"},{"key":"2026082610202492000_thorax-2026-225047v1.27","doi-asserted-by":"crossref","DOI":"10.1186\/s40798-020-00260-z","article-title":"Test-Retest Reliability of the One-Repetition Maximum (1RM) Strength Assessment: a Systematic Review","volume":"6","author":"Grgic","year":"2020","journal-title":"Sports Med Open"},{"key":"2026082610202492000_thorax-2026-225047v1.28","unstructured":"Dohoney P . Prediction of one repetition maximum (1-rm) strength from a 4-6 rm and a 7-10 rm submaximal strength test in healthy young adult males. 2002."},{"key":"2026082610202492000_thorax-2026-225047v1.29","unstructured":"Liguori G . American college of sports medicine\u2019s guidelines for exercise testing and prescription. In: ACSM\u2019s Guidelines for Exercise Testing and Prescription. 11th edn. Philadelphia: Wolters Kluwer, 2021."},{"key":"2026082610202492000_thorax-2026-225047v1.30","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsams.2007.10.007"},{"key":"2026082610202492000_thorax-2026-225047v1.31","doi-asserted-by":"crossref","unstructured":"Holland AE , Corso SD , Spruit MA , eds. Pulmonary Rehabilitation.2021:362.","DOI":"10.1183\/2312508X.erm9321"},{"key":"2026082610202492000_thorax-2026-225047v1.32","doi-asserted-by":"crossref","DOI":"10.3389\/fphys.2019.00533","article-title":"Blood Flow Restriction Exercise: Considerations of Methodology, Application, and Safety","volume":"10","author":"Patterson","year":"2019","journal-title":"Front Physiol"},{"key":"2026082610202492000_thorax-2026-225047v1.33","doi-asserted-by":"crossref","unstructured":"Kuhn M , Kohlbrenner D , Kl\u00e4y A , et al . The acute cardiorespiratory response to blood flow restriction strength exercise in healthy individuals: a randomized crossover trial. ERS Congress 2024 abstracts; September 14, 2024:A524. doi:10.1183\/13993003.congress-2024.PA524","DOI":"10.1183\/13993003.congress-2024.PA524"},{"key":"2026082610202492000_thorax-2026-225047v1.34","doi-asserted-by":"crossref","first-page":"2338","DOI":"10.1519\/JSC.0b013e31827de07d","article-title":"The Valsalva maneuver: its effect on intra-abdominal pressure and safety issues during resistance exercise","volume":"27","author":"Hackett","year":"2013","journal-title":"J Strength Cond Res"},{"key":"2026082610202492000_thorax-2026-225047v1.35","doi-asserted-by":"crossref","first-page":"104423","DOI":"10.1016\/j.resp.2025.104423","article-title":"Pathophysiological mechanisms of exertional dyspnea in people with cardiopulmonary disease: Recent advances","volume":"336","author":"James","year":"2025","journal-title":"Respir Physiol Neurobiol"},{"key":"2026082610202492000_thorax-2026-225047v1.36","doi-asserted-by":"crossref","DOI":"10.1080\/15412555.2023.2301549","article-title":"Beyond Spirometry: Linking Wasted Ventilation to Exertional Dyspnea in the Initial Stages of COPD","volume":"21","author":"Neder","year":"2024","journal-title":"COPD"},{"key":"2026082610202492000_thorax-2026-225047v1.37","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1080\/15412555.2019.1606189","article-title":"The Integrative Physiology of Exercise Training in Patients with COPD","volume":"16","author":"Neder","year":"2019","journal-title":"COPD"},{"key":"2026082610202492000_thorax-2026-225047v1.38","doi-asserted-by":"publisher","DOI":"10.1007\/s004240100706"},{"key":"2026082610202492000_thorax-2026-225047v1.39","doi-asserted-by":"crossref","DOI":"10.1111\/sms.70157","article-title":"Local and Systemic Responses to Low\u2010Intensity Cycling With Blood Flow Restriction Compared to High\u2010Intensity Cycling: A Randomized Crossover Study","volume":"35","author":"Ji","year":"2025","journal-title":"Scandinavian Med Sci Sports"},{"key":"2026082610202492000_thorax-2026-225047v1.40","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.90368.2008"},{"key":"2026082610202492000_thorax-2026-225047v1.41","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00464.2021"},{"key":"2026082610202492000_thorax-2026-225047v1.42","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1177\/19417381221131533","article-title":"Acute Effect of Resistance Training With Blood Flow Restriction on Perceptual Responses: A Systematic Review and Meta-Analysis","volume":"15","author":"de Queiros","year":"2023","journal-title":"Sports Health"},{"key":"2026082610202492000_thorax-2026-225047v1.43","doi-asserted-by":"publisher","DOI":"10.1519\/JSC.0b013e3181bc1c2a"},{"key":"2026082610202492000_thorax-2026-225047v1.44","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2009.01.010"},{"key":"2026082610202492000_thorax-2026-225047v1.45","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00462.2010"},{"key":"2026082610202492000_thorax-2026-225047v1.46","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2005.02.005"}],"container-title":["Thorax"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/thorax-2026-225047","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T17:20:37Z","timestamp":1787764837000},"score":1,"resource":{"primary":{"URL":"https:\/\/thorax.bmj.com\/lookup\/doi\/10.1136\/thorax-2026-225047"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,26]]},"references-count":46,"alternative-id":["10.1136\/thorax-2026-225047"],"URL":"https:\/\/doi.org\/10.1136\/thorax-2026-225047","relation":{},"ISSN":["0040-6376","1468-3296"],"issn-type":[{"value":"0040-6376","type":"print"},{"value":"1468-3296","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,26]]}}}