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      Enhanced External Counterpulsation Efficacy on Exercise Endurance in COPD Patients and Healthy Subjects: A Pilot Randomized Clinical Trial

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          Enhanced external counterpulsation (EECP) is popular in China for the treatment of coronary heart diseases, but it may be an effective treatment for other populations. This study aimed to explore the effect of EECP on exercise endurance of healthy people and chronic obstructive pulmonary disease (COPD) patients and provide intervention measures to improve their physical condition.

          Patients and methods

          Patients were enrolled in this pilot randomized controlled trial at Jiangbin Hospital, China, between March 1st and May 30th, 2018. They were randomly divided into the EECP and non-EECP groups. According to their maximal oxygen uptake, the volunteers were also sub-grouped into the normal, low exercise endurance, and COPD subgroups. Differences in exercise endurance were evaluated between the EECP and non-EECP groups before and after treatment. Cardiopulmonary exercise testng included anaerobic threshold oxygen uptake (AT-VO 2Kg), maximum oxygen uptake (Max-VO 2Kg), anaerobic threshold pulse (AT-O 2puls), anaerobic threshold metabolic equivalent (AT-Mets), and maximum metabolic equivalent (Max-Mets).


          72 volunteers were enrolled. The EECP and non-EECP groups were similar in terms of age, sex, body mass index, blood pressure, heart rate, breathing frequency, AT-VO 2Kg, Max-VO 2Kg, AT-O 2puls, AT-Mets, and Max-Mets (P > 0.05) before treatment. EECP significantly improved AT-VO 2Kg, Max-VO 2Kg, AT-O 2puls, AT-Mets, and Max-Mets compared with the non-EECP group (P<0.05). When analyzed according to sub-groups, the AT-VO 2Kg, Max-VO 2Kg, AT-O 2puls, AT-Mets, and Max-Mets of the normal, low exercise endurance, and COPD subgroups were all significantly increased after EECP (P<0.05).


          EECP significantly improved the exercise endurance of normal adults, low endurance adults, and COPD patients.

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          Most cited references 26

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          Exercise acts as a drug; the pharmacological benefits of exercise.

          The beneficial effects of regular exercise for the promotion of health and cure of diseases have been clearly shown. In this review, we would like to postulate the idea that exercise can be considered as a drug. Exercise causes a myriad of beneficial effects for health, including the promotion of health and lifespan, and these are reviewed in the first section of this paper. Then we deal with the dosing of exercise. As with many drugs, dosing is extremely important to get the beneficial effects of exercise. To this end, the organism adapts to exercise. We review the molecular signalling pathways involved in these adaptations because understanding them is of great importance to be able to prescribe exercise in an appropriate manner. Special attention must be paid to the psychological effects of exercise. These are so powerful that we would like to propose that exercise may be considered as a psychoactive drug. In moderate doses, it causes very pronounced relaxing effects on the majority of the population, but some persons may even become addicted to exercise. Finally, there may be some contraindications to exercise that arise when people are severely ill, and these are described in the final section of the review. Our general conclusion is that exercise is so effective that it should be considered as a drug, but that more attention should be paid to the dosing and to individual variations between patients. © 2012 The Authors. British Journal of Pharmacology © 2012 The British Pharmacological Society.
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            The multicenter study of enhanced external counterpulsation (MUST-EECP): effect of EECP on exercise-induced myocardial ischemia and anginal episodes.

            The purpose of this study was to assess safety and efficacy of enhanced external counterpulsation (EECP). Case series have shown that EECP can improve exercise tolerance, symptoms and myocardial perfusion in stable angina pectoris. A multicenter, prospective, randomized, blinded, controlled trial was conducted in seven university hospitals in 139 outpatients with angina, documented coronary artery disease (CAD) and positive exercise treadmill test. Patients were given 35 h of active counterpulsation (active CP) or inactive counterpulsation (inactive CP) over a four- to seven-week period. Outcome measures were exercise duration and time to > or =1-mm ST-segment depression, average daily anginal attack count and nitroglycerin usage. Exercise duration increased in both groups, but the between-group difference was not significant (p > 0.3). Time to > or =1-mm ST-segment depression increased significantly from baseline in active CP compared with inactive CP (p = 0.01). More active-CP patients saw a decrease and fewer experienced an increase in angina episodes as compared with inactive-CP patients (p 0.7). Enhanced external counterpulsation reduces angina and extends time to exercise-induced ischemia in patients with symptomatic CAD. Treatment was relatively well tolerated and free of limiting side effects in most patients.
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              Blood Flow Restriction Exercise Position Stand: Considerations of Methodology, Application, and Safety

              The current manuscript sets out a position stand for blood flow restriction (BFR) exercise, focusing on the methodology, application and safety of this mode of training. With the emergence of this technique and the wide variety of applications within the literature, the aim of this position stand is to set out a current research informed guide to BFR training to practitioners. This covers the use of BFR to enhance muscular strength and hypertrophy via training with resistance and aerobic exercise and preventing muscle atrophy using the technique passively. The authorship team for this article was selected from the researchers focused in BFR training research with expertise in exercise science, strength and conditioning and sports medicine.

                Author and article information

                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of Chronic Obstructive Pulmonary Disease
                07 January 2020
                : 15
                : 25-31
                [1 ]Department of Sports Medicine and Cardiopulmonary Rehabilitation Center, Jiangbin Hospital , Nanning, Guangxi, 530021, People’s Republic of China
                [2 ]Physical Fitness Surveillance and Health Management Association , Nanning, Guangxi, 530021, People’s Republic of China
                [3 ]Department of Intensive Medicine, Foshan Hospital of Traditional Chinese Medicine , Foshan 528000, People’s Republic of China
                Author notes
                Correspondence: Mingming Zhao; Caiyou Hu Department of Sports Medicine and Cardiopulmonary Rehabilitation Center, Jiangbin Hospital , Nanning, Guangxi530021, People’s Republic of ChinaTel +86077 1208 0038Fax +86 077 1208 0088 Email;

                These authors contributed equally to this work

                © 2020 Zhao et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (

                Page count
                Tables: 6, References: 28, Pages: 7
                Funded by: National Natural Science Foundation of China 10.13039/501100001809
                Award ID: 81460203
                Funded by: Medical and health Technologies of Guangxi Zhuang Autonomous Region
                Award ID: S2018116
                Funded by: Science and Technology Planning Project of Guangxi Zhuang Autonomous Region of China
                Award ID: GGK: Z20180824
                This study was funded by the Project for Guangxi Medical and Health Technologies (Grant Number: S2018116),Guangxi Health Commission Project (Grant Numbers: Z20190770, Z20190766), Science and Technology Foundation of Foshan City, China (Grant Number: 2017AG100061).
                Original Research


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