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This is a Experimental Study study.

September 12, 2025Open Access

Muscle Unloading During Exercise: Comparative Effects of Conventional Oxygen, NIV and High-Flow Therapy on Neural Drive in Severe COPD

Key Points

NIV showed a 60% reduction in neural ventilatory drive compared to conventional oxygen therapy, indicating its superior efficiency.
During exercise, patients on NIV experienced a respiratory rate reduction of 4.2 breaths/min, leading to a lower perceived exertion level.
Electromyography measured neural respiratory drive under three treatments, revealing NIV's effectiveness in reducing effort during exercise in COPD patients.
This approach highlights the potential of NIV as a critical adjunct in pulmonary rehabilitation for individuals with severe COPD.

Abstract

Objectives: To evaluate how non-invasive ventilation (NIV) and high-flow nasal can-nula therapy (HFT) versus conventional oxygen therapy (COT) affect neural ventilatory drive during exercise in patients with severe chronic obstructive pulmonary disease (COPD). Methods Design: Experimental, controlled study with one arm and three dif-ferent conditions for the same cohort. After initial testing on conventional oxygen threapy (COT) patients performed in sequential days, in a random order, exercise under NIV and HFT. Participants: Twenty patients with severe COPD (30% women) on home NIV as a bridge to lung transplantation, with mean FEV₁ 19.78% predicted and marked hyperinflation. Protocol: Participants performed constant-load cycling exercises at 75% maximum tol-erated workload under three conditions: COT, NIV, and HFT. Neuro-respiratory drive (NRD) was measured using surface parasternal and sternocleidomastoid electromyog-raphy. Mixed ANOVA analyzed repeated measures across conditions. Results: 20 patients (age 60+- 3.9 years, 6 female) were included. NIV demonstrated superior performance with 60% lower NRD compared to COT (488.81 µV vs. 1180.63 µV, p 0.05). HFT showed intermediate effects (807.8 µV). NIV also achieved greater reduc-tion in respiratory rate (4.2 breaths/min), lower perceived exertion (Borg score decrease: 1.8 points), and more pronounced CO₂ reduction (5.3 mmHg) compared to both COT and HFT. Conclusions: NIV significantly reduces NRD during exercise in severe COPD patients compared to HFT and COT. This supports its use as a valuable adjunct to pulmonary rehabilitation in severe COPD

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