not yet been included in any standard rehabilitation program.
Successively, the patients were filtered on the basis of the
inclusion and exclusion criteria and motivation to participate
in the study. Twenty-eight participants met all these criteria.
These participants carried out the physical interventions from
September 1 to September 26, 2014, and they performed both
the pre- and post-assessments. During the interventions, no
dropouts occurred. More details about the recruitment and
intervention timeline are reported in Figure 1.
The patients were randomized into two groups of equal
numerosity (characteristics are shown in Table 1): the first
group, called CT (n=14), performed a training protocol
composed by high-intensity aerobic and resistance exercises,
associated with respiratory, balance, and mobility exercises;
and the second group, called AT (n=14), performed a training
protocol composed by high-intensity aerobic exercises, associated
with respiratory, balance, and mobility exercises.
Both groups performed two training sessions per day, the
first one in the morning and the second one in the afternoon,
for 5 days/wk, for a total of ten training sessions per week, for
4 weeks. The duration of each session was 30 minutes. Before
and after the 30 minutes, the patients performed 5 minutes
of warm-up (walking on the treadmill at 35% VO2
max) and
cooldown (stretching exercises), respectively. The description
of the exercises and their progression of two protocols
are reported in Table 2.
The patients in both groups were tested, before and after
the intervention period, on their cognitive performance with
a battery of neurocognitive tests. These tests were chosen for
their high reliability and reproducibility and because they
have been already used in COPD population.20
The tests are described as follows, starting from those
whose results were considered as primary outcomes:
Rey 15-item memory test (or Rey test) is used to assess
verbal memory.21 In this test, the examiner reads 15 words,
and the patients are told to remember all the 15 presented
words, independently from their order. The 15 words are read
again, and the patients are required to say all the words that
they remember for the second time. This sequence of listening
and repeating is performed five times, and one point is
assigned for each remembered word during each sequence,
for a maximum score of 75 points (Rey-immediate recall).
After the last sequence, the patients are distracted for 15 minutes,
and then they are required to say all the words that they
remember in order to evaluate the long-term memory performance.
One point is assigned for each remembered word for
a maximum of 15 points (Rey-delayed recall [DR]).
Drawing copy test is used to evaluate praxis abilities.22
In the first part of the test (drawing test I), the patient must