Exercise training is the cornerstone of pulmonary rehabilitation (PR) and the most effective means of combating peripheral muscle dysfunction in chronic obstructive pulmonary disease (COPD).1 Exertional dyspnoea, a primary symptom limiting exercise in COPD, reflects a progressive neuromechanical mismatch between rising neural respiratory drive and declining respiratory capacity. Patients with severe dyspnoea have significantly lower odds of enrolling in and completing PR, posing a serious obstacle to improving outcomes.2

Individuals who stand to benefit most from exercise training are often those least able to tolerate it. High-load resistance training (≥70% 1-repetition maximum (1RM)) is well-evidenced for improving muscle mass, strength, capillarisation, mitochondrial density and exercise capacity, yet many clinical populations (eg, orthopaedic populations) exhibit physiological or psychological intolerance to it.3 Here, 1RM is the maximum weight that can be lifted for a single repetition of a specific exercise with acceptable technique; for example, a patient…