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Background  Strength training and neuromuscular electrical stimulation (NMES) are effective training modalities for improving muscle function, exercise performance and health status in individuals with COPD. The aim of the present study was to analyze the metabolic load of these training modalities at baseline, half-way, and at the end of an eight-week interdisciplinary pulmonary rehabilitation program in a subgroup of individuals with COPD of the   DICES   trial.    Methods  Of 24 individuals with COPD (FEV 1 : 34 ± 2% predicted, men: 58%, age: 66 (61–68) years), peak oxygen uptake (VO 2 ), peak minute ventilation (V E ), heart rate, oxygen saturation and symptom scores were assessed during HF-NMES (75 Hz), LF-NMES (15 Hz) and strength training at three moments during their pulmonary rehabilitation program.    Results  Intervention-related peak VO 2  did not change over time during HF-NMES, LF-NMES or strength training. Intervention-related peak V E  did not change over time during strength training or LF-NMES and increased slightly, but significantly over time during HF-NMES. Peak VO 2  and V E  were significantly higher during strength training compared to HF-NMES or LF-NMES. Oxygen saturation significantly decreased after the first measurements during HF-NMES and strength training group to baseline, while no significant changes in oxygen saturation were observed during the other measurements. Heart rate significantly increased compared to baseline in all groups at all moments and was significantly higher after strength training compared to HF-NMES or LF-NMES. Median end scores (points) for dyspnea, fatigue and muscle pain ranged from 1 to 3, from 0.5 to 2 and from 0 to 6 after HF-NMES, from 2 to 3, from 2 to 5 and from 0 to 9 after LF-NMES and from 2 to 5, from 1.5 to 4 and from 0 to 28 after strength training respectively.    Conclusions  To conclude, the metabolic load and symptom scores remain acceptable low over time with increasing training loads during HF-NMES, LF-NMES or strength training.    Trial registration   Trial registration:  NTR2322

Metabolic load during strength training or NMES in individuals with COPD: results from the DICEStrial