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Background: Extrapulmonary manifestations including cognitive impairment, reduced muscle and cardiovascular function is common in COPD. While high-intensity exercise offers extrapulmonary benefits, its implementation in COPD is challenging. This randomised cross-over trial examined the feasibility and physiological responses of a novel supramaximal high-intensity interval-training (SupraHIIT) protocol compared to moderate-intensity continuous training (MICT) in people with COPD and matched healthy controls (HCs).

Methods: Sixteen people with COPD and 16 HCs performed SupraHIIT and MICT. SupraHIIT consisted of 10x6 sec intervals at ≈150% and ≈200% of maximum aerobic power (MAP), while MICT was performed for 20 min at 60% of MAP. Outcomes were exercise intensity, change in exerkines, feasibility, and cardiorespiratory demand of the modalities.

Results: SupraHIIT was feasible and enabled up to a 3.5-fold increase in external exercise intensity compared to MICT (184±66 and 245±88 watt versus 71±22 watt in COPD, p<0.001). All participants could complete SupraHIIT which was the preferred modality in both groups (p<0.01) while 5/16 participants with COPD interrupted MICT due to intolerable dyspnea or exhaustion (p=0.005). Both modalities increased plasma brain-derived neurotrophic factor (pBDNF) by an average of 59% (range 30%-87%, p<0.05). When normalised for duration at target power, SupraHIIT produced a 5–10-fold greater increase than MICT. Both modalities lead to a variable response in other exerkines including clusterin, lactate, hepatocyte growth factor and interleukin-6.

Conclusion: In COPD, short duration SupraHIIT is more feasible and enables markedly higher external exercise intensities than MICT. By elevating pBDNF and other potentially beneficial exerkines, it shows potential for extrapulmonary benefits.