51
|
Abstract
Symptoms utilized in the clinical care of heart failure as markers of disease severity include, dyspnea, insomnia, low energy, fatigue, poor appetite, and diminished memory. This is despite the fact that physiologic variables such as cardiac ejection fraction and oxygen consumption do not accurately predict functional state in individuals with congestive heart failure (CHF). Distress (anxiety and depression) may amplify symptom complaints without associated physiologic aberration. Personality traits and psychiatric illness, such as mood, anxiety, and psychotic illnesses may also alter perception of somatic symptoms that are associated with this chronic illness. The impact of distress and its treatment on functional performance and CHF symptom reporting deserve additional attention. The need to screen for distress in all with serious symptomatic heart failure is certain.
Collapse
|
52
|
Miller TL, Neri D, Extein J, Somarriba G, Strickman-Stein N. Nutrition in Pediatric Cardiomyopathy. PROGRESS IN PEDIATRIC CARDIOLOGY 2007; 24:59-71. [PMID: 18159216 PMCID: PMC2151740 DOI: 10.1016/j.ppedcard.2007.08.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Pediatric cardiomyopathies are heterogeneous groups of serious disorders of the heart muscle and are responsible for significant morbidity and mortality among children who have the disease. While enormous improvements have been made in the treatment and survival of children with congenital heart disease, parallel strides have not been made in the outcomes for cardiomyopathies. Thus, ancillary therapies, such as nutrition and nutritional interventions, that may not cure but may potentially improve cardiac function and quality of life, are imperative to consider in children with all types of cardiomyopathy. Growth failure is one of the most significant clinical problems of children with cardiomyopathy with nearly one-third of children with this disorder manifesting some degree of growth failure during the course of their illness. Optimal intake of macronutrients can help improve cardiac function. In addition, several specific nutrients have been shown to correct myocardial abnormalities that often occur with cardiomyopathy and heart failure. In particular, antioxidants that can protect against free radical damage that often occurs in heart failure and nutrients that augment myocardial energy production are important therapies that have been explored more in adults with cardiomyopathy than in the pediatric population. Future research directions should pay particular attention to the effect of overall nutrition and specific nutritional therapies on clinical outcomes and quality of life in children with pediatric cardiomyopathy.
Collapse
Affiliation(s)
- Tracie L Miller
- Division of Pediatric Clinical Research, Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, FL
| | | | | | | | | |
Collapse
|
53
|
Wouters EF, Celis MP, Breyer MK, Rutten EP, Graat-Verboom L, Spruit MA. Co-morbid manifestations in COPD. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.rmedu.2007.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
54
|
Strasser EM, Wessner B, Roth E. [Cellular regulation of anabolism and catabolism in skeletal muscle during immobilisation, aging and critical illness]. Wien Klin Wochenschr 2007; 119:337-48. [PMID: 17634890 DOI: 10.1007/s00508-007-0817-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Accepted: 05/16/2007] [Indexed: 12/13/2022]
Abstract
Skeletal muscle atrophy is associated with situations of acute and chronical illness, such as sepsis, surgery, trauma and immobility. Additionally, it is a common problem during the physiological process of aging. The myofibrillar proteins myosin and actin, which are essential for muscle contraction, are the major targets during the process of protein degradation. This leads to a general loss of muscle mass, muscle strength and to increased muscle fatigue. In critically ill or immobile patients skeletal muscle atrophy is accompanied by enhanced inflammation, reduced wound healing, weaning complications and difficulties in mobilisation. During aging it results in falls, fractures, physical injuries and loss of mobility. Relating to the primary stimulators - hormones, muscle lengthening, stress, inflammation, neuronal activity - research is now focusing on the investigation of the signal transduction pathways, which influence protein synthesis and protein degradation during skeletal muscle atrophy.
Collapse
Affiliation(s)
- Eva-Maria Strasser
- Chirurgische Forschungslaboratorien, Medizinische Universität Wien, Wien, Austria
| | | | | |
Collapse
|
55
|
van den Ham ECH, Kooman JP, Schols AMWJ, Nieman FHM, Does JD, Akkermans MA, Janssen PP, Gosker HR, Ward KA, MacDonald JH, Christiaans MHL, Leunissen KML, van Hooff JP. The functional, metabolic, and anabolic responses to exercise training in renal transplant and hemodialysis patients. Transplantation 2007; 83:1059-68. [PMID: 17452896 DOI: 10.1097/01.tp.0000259552.55689.fd] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Exercise intolerance is common in hemodialysis (HD) and renal transplant (RTx) patients and is related to muscle weakness. Its pathogenesis may vary between these groups leading to a different response to exercise. The aim of the study was to compare intrinsic muscular parameters between HD and RTx patients and controls, and to assess the response to exercise training on exercise capacity and muscular structure and function in these groups. METHODS Quadriceps function (isokinetic dynamometry), body composition (dual-energy x-ray absorptiometry), and vastus lateralis muscle biopsies were analyzed before and after a 12-week lasting training-program in 35 RTx patients, 16 HD patients, and 21 healthy controls. RESULTS At baseline, myosin heavy chain (MyHC) isoform composition and enzyme activities were not different between the groups. VO2peak and muscle strength improved significantly and comparably over the training-period in RTx, HD patients and controls (p(time)<0.05). The proportion of MyHC type I isoforms decreased (p(time)<0.001) and type IIa MyHC isoforms increased (p(time)<0.05). The 3-hydroxyacyl-CoA-dehydrogenase activity increased (p(time)=0.052). Intrinsic muscular changes were not significantly different between groups. In the HD group, changes in lean body mass were significantly related to changes in muscle insulin-like growth factor (IGF)-II and IGF binding protein-3. CONCLUSIONS Abnormalities in metabolic enzyme activities or muscle fiber redistribution do not appear to be involved in muscle dysfunction in RTx and HD patients. Exercise training has comparable beneficial effects on functional and intrinsic muscular parameters in RTx patients, HD patients, and controls. In HD patients, the anabolic response to exercise training is related to changes in the muscle IGF system.
Collapse
Affiliation(s)
- Eugénie C H van den Ham
- Department of Internal Medicine, University Hospital Maastricht, Maastricht, the Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
56
|
Abstract
Cancer patients lose weight as a result of the anorexia-cachexia syndrome, and this weight loss is associated with significant morbidity and mortality. Thus, nutritional support to arrest or reverse weight loss is of paramount importance in the management of Cachexia cancer patients. Persistent tumour-induced metabolic changes result, however, in a suboptimal response to such support, making nutritional maintenance or improvement difficult targets to achieve. Mechanisms involved in the blockade to anabolism in cancer cachexia include alterations in skeletal muscle and hepatic protein metabolism, and reduced physical activity. Mediators underlying these mechanisms of weight loss include proinflammatory cytokines, tumour-specific cachectic factors, and neuroendocrine mediators of muscle catabolism. The complex mix of different mediators renders unimodal nutritional intervention a strategy that is unlikely to succeed completely. Therefore, clinical trials using combination therapies or immunonutrition are required for future success.
Collapse
Affiliation(s)
- Richard J E Skipworth
- Clinical and Surgical Sciences (Surgery), School of Clinical Sciences and Community Health, The University of Edinburgh, Royal Infirmary, Edinburgh, UK
| | | |
Collapse
|
57
|
van der Velden JLJ, Langen RCJ, Kelders MCJM, Willems J, Wouters EFM, Janssen-Heininger YMW, Schols AMWJ. Myogenic differentiation during regrowth of atrophied skeletal muscle is associated with inactivation of GSK-3β. Am J Physiol Cell Physiol 2007; 292:C1636-44. [PMID: 17166938 DOI: 10.1152/ajpcell.00504.2006] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Muscle atrophy contributes to morbidity and mortality in aging and chronic disease, emphasizing the need to gain understanding of the mechanisms involved in muscle atrophy and (re)growth. We hypothesized that the magnitude of muscle regrowth during recovery from atrophy determines whether myonuclear accretion and myogenic differentiation are required and that insulin-like growth factor (IGF)-I/Akt/glycogen synthase kinase (GSK)-3β signaling differs between regrowth responses. To address this hypothesis we subjected mice to hindlimb suspension (HS) to induce atrophy of soleus (−40%) and plantaris (−27%) muscle. Reloading-induced muscle regrowth was complete after 14 days and involved an increase in IGF-IEa mRNA expression that coincided with Akt phosphorylation in both muscles. In contrast, phosphorylation and inactivation of GSK-3β were observed during soleus regrowth only. Furthermore, soleus but not plantaris regrowth involved muscle regeneration based on a transient increase in expression of histone 3.2 and myosin heavy chain-perinatal, which are markers of myoblast proliferation and differentiation, and a strong induction of muscle regulatory factor (MRF) expression. Experiments in cultured muscle cells showed that IGF-I-induced MRF expression is facilitated by inactivation of GSK-3β and selectively occurs in the myoblast population. This study suggests that induction of IGF-I expression and Akt phosphorylation during recovery from muscle atrophy is independent of the magnitude of muscle regrowth. Moreover, our data demonstrate for the first time that the regenerative response characterized by myoblast proliferation, differentiation, and increased MRF expression in recovering muscle is associated with the magnitude of regrowth and may be regulated by inactivation of GSK-3β.
Collapse
Affiliation(s)
- Jos L J van der Velden
- Department of Respiratory Medicine, Maastricht University PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
58
|
Rabinovich RA, Ardite E, Mayer AM, Polo MF, Vilaró J, Argilés JM, Roca J. Training Depletes Muscle Glutathione in Patients with Chronic Obstructive Pulmonary Disease and Low Body Mass Index. Respiration 2006; 73:757-61. [PMID: 16825756 DOI: 10.1159/000094395] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2005] [Accepted: 03/18/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A physiological increase in muscle glutathione after training is not seen in patients with chronic obstructive pulmonary disease (COPD), indicating abnormal peripheral muscle adaptations to exercise. OBJECTIVE We hypothesized that oxidative stress is primarily associated with low body mass index (BMI). METHODS Eleven patients with preserved BMI (BMI(N): 28.2 +/- 1.2 kg.m(-2)), 9 patients with low BMI (BMI(L): 19.7 +/- 0.60 kg.m(-2)) and 5 age-matched controls (26.5 +/- 0.9 kg.m(-2)) were studied before and after 8 weeks of high-intensity endurance training. Reduced glutathione (GSH) and gamma-glutamyl cysteine synthase heavy-subunit chain mRNA expression (gammaGCS-HS mRNA) were measured in the vastus lateralis. RESULTS After training, exercise capacity increased (DeltaVO(2)PEAK, 13 +/- 5.2%; 10 +/- 5.6% and 15 +/- 4.3% in BMI(L), BMI(N) and controls, respectively; p < 0.05 each). GSH levels decreased in BMI(L) (from 5.2 +/- 0.7 to 3.7 +/- 0.8 nmol/mg protein, DeltaGSH -1.5 +/- 0.7 nmol/mg protein, p < 0.05); no changes were seen in BMI(N) (from 5.4 +/- 0.7 to 6.7 +/- 0.9 nmol/mg protein, DeltaGSH 1.3 +/- 0.9 nmol/mg protein), whereas GSH markedly increased in controls (from 4.6 +/- 1 to 8.7 +/- 0.4 nmol/mg protein, DeltaGSH 4.1 +/- 1 nmol/mg protein, p < 0.01). DeltaGSH in BMI(L) was different from DeltaGSH in BMI(N) and controls (p < 0.05, each). Consistent changes were observed in gammaGCS-HS mRNA expression. CONCLUSIONS GSH depletion after training in BMI(L) may suggest that oxidative stress plays a key role in muscle wasting in COPD patients.
Collapse
|
59
|
Ulubay G, Akman B, Sezer S, Calik K, Eyuboglu Oner F, Ozdemir N, Haberal M. Factors Affecting Exercise Capacity in Renal Transplantation Candidates on Continuous Ambulatory Peritoneal Dialysis Therapy. Transplant Proc 2006; 38:401-5. [PMID: 16549131 DOI: 10.1016/j.transproceed.2005.12.107] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
It is well known that reduced peak oxygen uptake (peak VO2) is a predictor for mortality in several chronic diseases and during the preoperative period. The aim of this study was to investigate the factors that influence peak VO2 in renal transplant candidates receiving continuous ambulatory peritoneal dialysis (CAPD) therapy. We included 22 chronic renal failure patients (12 men, 10 women; ages 29.64 +/- 8.29 years; CAPD duration, 37.35 +/- 7.15 months) in this study. Pulmonary function tests and symptom-limited cardiopulmonary exercise tests were administered to all patients. Cardiopulmonary exercise tests were performed on a cycle ergometry at the same time of day for all patients. We analyzed the exercise duration, maximum work rate, and peak VO2 level during cycle ergometry. Serum hemoglobin, hematocrit, total cholesterol, triglyceride, blood urea nitrogen, creatinine, albumin, prealbumin, C-reactive protein, sedimentation rate, ferritin, sodium, potassium, parathyroid hormone, calcium, and phosphorus levels were analyzed from samples. Mean values of exercise duration (6.86 +/- 1.56 minutes), peak VO2 (17.20 +/- 4.91 mL/min/kg), and maximum work rate (77.09 +/- 26.09 watts) were lower when we compared them with predicted values for a healthy population. Peak VO2 was well correlated with serum phosphorus levels (4.51 +/- 1.28 mg/dL, r = .592, P = .004). Test duration was correlated with peak VO2 (r = .489, P = .025) and serum phosphorus levels (r = .530, P = .024). There were no significant correlations with other factors. As a component of ATP, phosphorus is at the hub of the energy-related mechanisms operative in muscles of the respiratory and musculoskeletal systems. Therefore, we suggest that low exercise capacity might be related to low serum phosphorus levels, and that optimal control of serum phosphorus therapy would increase exercise capacity, exercise duration, and oxygen consumption resulting in a decrease of postoperative mortality in renal transplantation candidates.
Collapse
Affiliation(s)
- G Ulubay
- Department of Pulmonary Disease, Baskent University, Faculty of Medicine, Ankara, Turkey
| | | | | | | | | | | | | |
Collapse
|
60
|
Adachi J, Kudo R, Asano M, Ueno Y, Hunter R, Rajendram R, Martin C, Preedy VR. Skeletal muscle and liver oxysterols during fasting and alcohol exposure. Metabolism 2006; 55:119-27. [PMID: 16324930 DOI: 10.1016/j.metabol.2005.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2004] [Accepted: 08/02/2005] [Indexed: 11/16/2022]
Abstract
Oxysterols are cytotoxic agents that have a range of cellular actions, including impairment of albumin synthesis, cell differentiation, and induction of apoptosis. Their regulations by nutritional factors are poorly described. Our objective was to test the hypothesis that the imposition of food withdrawal and alcohol exposure increases tissue oxysterol concentrations. We measured the concentrations of the oxysterols 7alpha-hydroxycholest-5-en-3beta-ol (7alpha-OH), 7beta-hydroxycholest-5-en-3beta-ol (7beta-OH), and 3beta-hydroxycholest-5-en-7-one (7-keto) in liver and skeletal muscle of fed and fasted (food withdrawal for 1 and 2 days) male Wistar rats. Both oxidative (type I; soleus) and glycolytic (type II; plantaris) muscles were analyzed. We also investigated the effects of a nutritional perturbant induced by a short-term bolus of ethanol (75 mmol/kg weight IP administered 2.5 hours before sacrifice). The results showed that in response to fasting there were significant increases in 7alpha-OH, 7beta-OH, and 7-keto in liver and both type I and II skeletal muscle (P < .001 in all instances). For skeletal muscle, the increases were blunted or ameliorated after 2 days when compared with data from rats starved for 1 day. In contrast, the increases in liver after 1 day's fasting were relatively sustained at 2 days. Short-term ethanol increased 7alpha-OH, 7beta-OH, and 7-keto in type I muscle of fed animals only (P < .001 in all instances) with a significant interaction between fasting and alcohol (P < .001 in all instances). For the first time, we have shown that oxysterols can increase in muscle and liver in response to food withdrawal and in response to an immediately imposed nutritional perturbant (ie, alcohol). Increased oxysterols represent elevated oxidative stress and/or disturbances in their formation or clearance. Because of the reported cytotoxic properties of oxysterols, these data are important in understanding cellular pathology because episodic anorexia and/or oxidative stress occur in a variety of disease conditions including sepsis, cancer cachexia, ischemia, and hormonal imbalance.
Collapse
Affiliation(s)
- Junko Adachi
- Department of Legal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
61
|
Schulze PC, Späte U. Insulin-like growth factor-1 and muscle wasting in chronic heart failure. Int J Biochem Cell Biol 2005; 37:2023-35. [PMID: 15964237 DOI: 10.1016/j.biocel.2005.04.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2004] [Revised: 04/05/2005] [Accepted: 04/08/2005] [Indexed: 01/19/2023]
Abstract
Chronic heart failure is a clinical syndrome of cardiac origin, which affects various organ systems. It is associated with metabolic abnormalities leading to a catabolic syndrome in advanced stages of the disease. As in several other chronic diseases, skeletal muscle dysfunction and structural muscle abnormalities result in progressive muscle wasting and cachexia. These changes are accompanied by increased expression of proinflammatory cytokines, increased rate of apoptosis and activation of the proteolytic ubiquitin-proteasome pathway. Further, reduced expression of the local anabolic insulin-like growth factor-1 has been demonstrated in skeletal muscle of animals and patients with chronic heart failure. This suppression occurs in the presence of normal serum levels of insulin-like growth factor-1. In addition to catabolic effects of proinflammatory cytokines, these recent findings are consistent with reduced anabolism involving altered local insulin-like growth factor-1 levels in progressive muscle atrophy in chronic heart failure. This article describes local effects of insulin-like growth factor-1 on skeletal muscle function and morphology, its role in stem cell recruitment and muscle regeneration as well as its regulation in circumstances of muscle inflammation and wasting.
Collapse
Affiliation(s)
- P Christian Schulze
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02139, USA.
| | | |
Collapse
|
62
|
Middlekauff HR. How Does Cardiac Resynchronization Therapy Improve Exercise Capacity in Chronic Heart Failure? J Card Fail 2005; 11:534-41. [PMID: 16198250 DOI: 10.1016/j.cardfail.2005.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2004] [Revised: 02/28/2005] [Accepted: 03/03/2005] [Indexed: 11/25/2022]
Abstract
BACKGROUND Studies have shown that neither ejection fraction nor hemodynamic abnormalities during exercise in chronic heart failure (HF) correlate with symptoms of fatigue and exhaustion. The concept that exercise limitation in patients with chronic HF is due to abnormal hemodynamics during exercise has been revised to acknowledge that the skeletal myopathy of chronic HF contributes significantly to exercise dysfunction in heart failure. Why then does cardiac resynchronization therapy (CRT), a therapy that improves abnormalities of cardiac function, such as cardiac output and ejection fraction, produce a consistent, measurable, irrefutable increase in exercise capacity? METHODS AND RESULTS In this review I will (1) review the mechanisms of exercise dysfunction in chronic HF, with special attention to the concept of "coordinated adaptation"; (2) analyze the effects of CRT on autonomic dysfunction in HF; and (3) propose a unifying hypothesis to understand how a therapy that improves cardiac function can improve exercise dysfunction attributable to a skeletal myopathy. Specifically, I will review evidence that CRT improves exercise capacity by attenuating the chronic sympathetic activation of HF. CONCLUSION The decrease in sympathetic activation, and perhaps inflammation, during CRT likely reverses many features of the skeletal myopathy, leading to improved exercise capacity.
Collapse
Affiliation(s)
- Holly R Middlekauff
- David Geffen School of Medicine at UCLA, Department of Medicine (Cardiology), Los Angeles, California 90095, USA
| |
Collapse
|
63
|
Ottenheijm CAC, Heunks LMA, Geraedts MCP, Dekhuijzen PNR. Hypoxia-induced skeletal muscle fiber dysfunction: role for reactive nitrogen species. Am J Physiol Lung Cell Mol Physiol 2005; 290:L127-35. [PMID: 16113049 DOI: 10.1152/ajplung.00073.2005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Hypoxia impairs skeletal muscle function, but the precise mechanisms are incompletely understood. In hypoxic rat diaphragm muscle, generation of peroxynitrite is elevated. Peroxynitrite and other reactive nitrogen species have been shown to impair contractility of skinned muscle fibers, reflecting contractile protein dysfunction. We hypothesized that hypoxia induces contractile protein dysfunction and that reactive nitrogen species are involved. In addition, we hypothesized that muscle reoxygenation reverses contractile protein dysfunction. In vitro contractility of rat soleus muscle bundles was studied after 30 min of hyperoxia (Po2 approximately 90 kPa), hypoxia (Po2 approximately 5 kPa), hypoxia + 30 microM N(G)-monomethyl-L-arginine (L-NMMA, a nitric oxide synthase inhibitor), hyperoxia + 30 microM L-NMMA, and hypoxia (30 min) + reoxygenation (15 min). One part of the muscle bundle was used for single fiber contractile measurements and the other part for nitrotyrosine detection. In skinned single fibers, maximal Ca2+-activated specific force (Fmax), fraction of strongly attached cross bridges (alphafs), rate constant of force redevelopment (ktr), and myofibrillar Ca2+ sensitivity were determined. Thirty minutes of hypoxia reduced muscle bundle contractility. In the hypoxic group, single fiber Fmax, alphafs, and ktr were significantly reduced compared with hyperoxic, L-NMMA, and reoxygenation groups. Myofibrillar Ca2+ sensitivity was not different between groups. Nitrotyrosine levels were increased in hypoxia compared with all other groups. We concluded that acute hypoxia induces dysfunction of skinned muscle fibers, reflecting contractile protein dysfunction. In addition, our data indicate that reactive nitrogen species play a role in hypoxia-induced contractile protein dysfunction. Reoxygenation of the muscle bundle partially restores bundle contractility but completely reverses contractile protein dysfunction.
Collapse
Affiliation(s)
- Coen A C Ottenheijm
- Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | | | | |
Collapse
|
64
|
Franssen FME, Broekhuizen R, Janssen PP, Wouters EFM, Schols AMWJ. Limb Muscle Dysfunction in COPD: Effects of Muscle Wasting and Exercise Training. Med Sci Sports Exerc 2005; 37:2-9. [PMID: 15632660 DOI: 10.1249/01.mss.0000150082.59155.4f] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Lower-limb muscle weakness has often been reported in COPD, and contributes to exercise intolerance. Controversial information is available regarding upper-limb muscle adaptations and the influence of muscle wasting on muscle weakness. We investigated leg and arm muscle function in 59 stable COPD patients (GOLD stage III) with preserved fat-free mass (FFM) and in 28 patients with reduced FFM relative to age- and sex-matched healthy control subjects and studied the effects of 8 wk of whole-body exercise training. METHODS FFM was measured with bioelectrical impedance analysis. Isokinetic quadriceps (F-leg) and biceps strength (F-arm), as well as quadriceps (E-leg) and biceps endurance (E-arm) were determined with a Biodex dynamometer. Exercise training consisted of cycle ergometry, treadmill walking, weight training, and gymnastics during 5 d.wk. RESULTS F-leg (76.2 +/- 3.6 vs 118.2 +/- 6.3 N.m, P < 0.001) and F-arm (25.6 +/- 1.3 vs 38.1 +/- 2.1 N.m, P < 0.001) were significantly and similarly reduced in the COPD patient group compared with controls. Also, E-leg (-2.13 +/- 0.12 vs -1.61 +/- 0.11, P < 0.01), but not E-arm (-2.72 +/- 0.11 and -2.47 +/- 0.13 NS), was decreased in patients. F-leg (62.4 +/- 4.3 vs 82.8 +/- 4.7 N.m, P < 0.01), but not F-arm or muscle endurance, was reduced in FFM-depleted compared with non-FFM-depleted patients. Whereas after training F-leg and E-leg significantly increased by 20% in the whole COPD group, biceps muscle function remained unchanged. CONCLUSION Lower- and upper-limb muscle dysfunction was observed in COPD patients, irrespective of the presence of FFM depletion. Generalized muscle weakness suggests systemic muscular involvement, although the preserved arm endurance and the poor response of arm performance to exercise training is indicative for intrinsic differences in muscular adaptations between leg and arm muscles.
Collapse
Affiliation(s)
- Frits M E Franssen
- Department of Respiratory Medicine, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
| | | | | | | | | |
Collapse
|
65
|
Schulze PC, Linke A, Schoene N, Winkler SM, Adams V, Conradi S, Busse M, Schuler G, Hambrecht R. Functional and morphological skeletal muscle abnormalities correlate with reduced electromyographic activity in chronic heart failure. ACTA ACUST UNITED AC 2004; 11:155-61. [PMID: 15187820 DOI: 10.1097/01.hjr.0000124327.85096.a5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Exercise intolerance and early muscle fatigue are key symptoms in patients with chronic heart failure (CHF). In advanced stages of the disease, profound metabolic abnormalities have been described finally leading to a catabolic state with progressive loss of muscle bulk. The aim of this study was to investigate morphological, functional and electromyographical parameters of the skeletal muscle in CHF. METHODS We included 17 patients with CHF and 12 age-matched healthy controls (left ventricular ejection fraction 25+/-2 versus 68+/-1%, body mass index 26.6+/-0.8 versus 28.0+/-1.0 kg/m2; P=NS) in this study. Cross-sectional area (CSA) of the thigh was assessed by computed tomography. Under electromyographical control, maximal and submaximal (30%) isometric strength as well as the relative decrease of muscle strength of the quadriceps muscle over a period of 20 s were determined. RESULTS Patients with CHF showed a significant reduction of muscle CSA (134.8+/-5.3 versus 165.2+/-7.4 cm2, P=0.002) as compared with healthy controls. The maximal quadriceps muscle strength was found to be significantly reduced in patients with CHF (226.7+/-22.3 versus 286.9+/-17.1 N, P<0.05) who also exhibited a higher extent of muscular fatigability (-2.18+/-0.33 versus -0.54+/-0.20 N/s, P<0.01). Electromyographic activity at 30% submaximal contraction showed a lower increase in patients with CHF (66+/-22 versus 114+/-36%; P<0.05) indicating impaired muscle fibre recruitment. Furthermore, a significant correlation between muscular fatigability and reduced electromyographic activity was found in CHF (r=0.84; P<0.001). CONCLUSIONS Our findings demonstrate an impaired electromyographic activity and muscular function in patients with CHF suggesting a new pathomechanism contributing to functional abnormalities of the skeletal muscle in advanced stages of this disease.
Collapse
Affiliation(s)
- P Christian Schulze
- University of Leipzig, Heart Center, Department of Cardiology, Strümpellstrasse 39, 04289 Leipzig, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
66
|
Lassen KO, Kruse F, Bjerrum M, Jensen L, Hermansen K. Nutritional care of Danish medical inpatients: effect on dietary intake and the occupational groups' perspectives of intervention. Nutr J 2004; 3:12. [PMID: 15363101 PMCID: PMC521697 DOI: 10.1186/1475-2891-3-12] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2004] [Accepted: 09/13/2004] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many patients do not eat and drink sufficiently during hospitalisation. The clinical consequences of this under nutrition include lassitude, an increased risk of complications and prolonged convalescence. The aim of the study was 1) to introduce intervention targeting nutritional care for medical inpatients, 2) to investigate the effect of this intervention, and 3) to investigate the occupational groups' attitudes towards nutritional intervention and nutritional care in general. METHODS The design was to determinate the extent to which the protein and energy requirements of medical inpatients were met before and after intervention. Dietary protein and energy intakes were assessed by 72-hour weighed food records. A total number of 108 medical patients at four bed sections and occupational groups in the two intervention bed sections, Aarhus University Hospital, Denmark participated. The intervention included introduction and implementation of nursing procedures targeting nutritional care during a five-month investigation period using standard food produced at the hospital. The effect of intervention for independent groups of patients were tested by one-way analysis of variance. After the intervention occupational groups were interviewed in focus groups. RESULTS Before the intervention hospital food on average met 72% of the patients' protein requirement and 85% of their energy requirement. After intervention hospital food satisfied 85% of the protein and 103% of the energy requirements of 14 patients in one intervention section and 56% of the protein and 76% of the energy requirement of 17 patients in the other intervention section. Hospital food satisfied 61% of the protein and 75% of the energy requirement in a total of 29 controls. From the occupational groups' point of view lack of time, lack of access to food, and lack of knowledge of nutritional care for patients were identified as barriers to better integration of nutritional care into the overall care provision. CONCLUSION There was ample room for improving the extent to which standard hospital food satisfies patients' protein and energy requirements, but implementation of procedures addressing nutritional care were difficult, especially at bed sections with a large staff turnover.
Collapse
Affiliation(s)
- Karin O Lassen
- Department of Endocrinology and Metabolism, Aarhus Sygehus, Aarhus University Hospital and University of Aarhus, Aarhus, Denmark
| | - Filip Kruse
- State and University Library, University of Aarhus, Aarhus, Denmark
| | - Merete Bjerrum
- Department of Nursing Science, Faculty of Health Sciences, University of Aarhus, Denmark
| | - Lillian Jensen
- Department of Endocrinology and Metabolism, Aarhus Sygehus, Aarhus University Hospital and University of Aarhus, Aarhus, Denmark
| | - Kjeld Hermansen
- Department of Endocrinology and Metabolism, Aarhus Sygehus, Aarhus University Hospital and University of Aarhus, Aarhus, Denmark
| |
Collapse
|
67
|
Franssen FME, Broekhuizen R, Janssen PP, Wouters EFM, Schols AMWJ. Effects of Whole-Body Exercise Training on Body Composition and Functional Capacity in Normal-Weight Patients With COPD. Chest 2004; 125:2021-8. [PMID: 15189917 DOI: 10.1378/chest.125.6.2021] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Skeletal muscle wasting is related to muscle dysfunction, exercise intolerance, and increased mortality risk in patients with COPD. STUDY OBJECTIVES The aims of this study were to investigate the effects of whole-body exercise training on body composition in normal-weight patients with COPD, and to study the relationship between changes in body composition and functional capacity. SETTING AND PARTICIPANTS Fifty patients with COPD (FEV(1), 39% of predicted [SD, 16]) admitted to the pulmonary rehabilitation center at Hornerheide, and 36 healthy age-matched control subjects (for baseline comparison) were included. INTERVENTIONS Patients participated in a standardized inpatient exercise training program consisting of daily submaximal cycle ergometry, treadmill walking, weight training, and gymnastics during 8 weeks. MEASUREMENTS Fat-free mass (FFM) was measured by bioelectrical impedance analysis. None of the patients met the criteria for nutritional supplementation (body mass index </= 21, or FFM index </= 15 kg/m(2) in women and </= 16 kg/m(2) in men). Exercise capacity was measured using incremental cycle ergometry. Isokinetic quadriceps strength was measured with a Biodex dynamometer (Biodex Medical Corporation; Shirley, NY). RESULTS At baseline, patients were characterized by a significantly lower FFM than the control subjects. Age and FFM were independent predictors of skeletal muscle function and exercise capacity in patients. After rehabilitation, weight (72.4 +/- 9.8 to 73.0 +/- 9.4 kg, p < 0.05) significantly increased, as a result of increased FFM (52.4 +/- 7.3 to 53.4 +/- 7.7 kg, p < 0.05), while fat mass (20.0 +/- 6.1 to 19.6 +/- 5.7 kg) tended to decrease. Peak work rate (63 +/- 29 to 84 +/- 42 W, p < 0.001), maximal oxygen consumption (O(2)max) [1,028 +/- 307 to 1,229 +/- 421 mL/min, p < 0.001], and isokinetic quadriceps strength (82.5 +/- 36.4 to 90.3 +/- 34.9 Newton-meters, p < 0.05) all improved. Changes in FFM were proportionally smaller than functional improvements, and were related to changes in O(2)max (r = 0.361, p < 0.05), but not to other changes in functional capacity. CONCLUSIONS Intensive exercise training per se is able to induce an anabolic response in normal-weight patients with COPD classified into Global Initiative for Chronic Obstructive Lung Disease stages III-IV. Improvements in exercise performance and muscle function are proportionally larger than increases in FFM.
Collapse
Affiliation(s)
- Frits M E Franssen
- Department of Respiratory Medicine, University Hospital Maastricht, Maastricht, Germany.
| | | | | | | | | |
Collapse
|
68
|
Abstract
PURPOSE OF REVIEW Metabolic abnormalities leading to a catabolic syndrome with progressive muscular atrophy are a common final stage of various chronic diseases. Proinflammatory cytokines have been suggested both to induce and mediate local catabolic mechanisms. This review focuses on the role of proinflammatory cytokines in the development of muscular abnormalities resulting in a loss of muscle mass and function. In addition, the underlying molecular signaling pathways, their transcriptional regulation, and the cellular systems contributing to enhanced muscular protein breakdown are discussed. RECENT FINDINGS Using transcriptional screening techniques, specific changes in gene expression have been identified that are characteristic of muscular wasting processes. Of particular interest is the atrophy-related and cytokine-inducible expression of a number of E3 ligases (e.g. atrogin-1, muscle ring finger protein 1), highly specific regulators of the ubiquitin-proteasome pathway, which target proteins for proteolytic breakdown by the proteasome. Furthermore, the activity of several transcription factors (e.g. nuclear factor kappa B) has been involved in specific transcriptional mechanisms of local inflammation and muscular atrophy. Finally, proinflammatory cytokines suppress the expression and function of the local anabolic growth factor insulin-like growth factor 1. SUMMARY Pronounced catabolic effects of proinflammatory cytokines in various tissues contribute to local catabolism, with progressive atrophic alterations of the skeletal muscle in chronic disease states. Recent developments in this field have explored the underlying pathways of muscular wasting and have already resulted in the description of new molecular targets that might lead to new therapeutic options for the treatment of muscular atrophy.
Collapse
Affiliation(s)
- Ulrike Späte
- The Forsyth Institute, Department of Cytokine Biology, Boston, Massachusetts, USA
| | | |
Collapse
|
69
|
Nagai T, Okita K, Yonezawa K, Yamada Y, Hanada A, Ohtsubo M, Morita N, Murakami T, Nishijima H, Kitabatake A. Comparisons of the Skeletal Muscle Metabolic Abnormalities in the Arm and Leg Muscles of Patients With Chronic Heart Failure. Circ J 2004; 68:573-9. [PMID: 15170095 DOI: 10.1253/circj.68.573] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND It has been suspected for some time that patients with chronic heart failure (CHF) have abnormal muscle metabolism, so in the present study the muscle metabolism of the arm and leg were compared by (31)P magnetic resonance spectroscopy ((31)P-MRS) to examine the relationship to exercise tolerance. METHODS AND RESULTS The study group comprised 13 patients and 11 normal controls. Calf-plantar and forearm-wrist flexion were performed to evaluate the metabolic capacity assessed as the phosphocreatine breakdown rate (PCr-slope) and muscle pH at a submaximal (70% peak) work rate (submax-pH). Exercise of both the arm and leg resulted in an earlier decrease in PCr and muscle pH in patients with CHF compared with controls. There were significant correlations between peak oxygen uptake (peak V(O2)) and the PCr-slope in both limbs in patients with CHF (forearm: r=0.63, p<0.05; calf: r=0.60, p<0.05), but no correlations in normal controls. There was a close correlation between the ventilatory anaerobic threshold (AT) and the PCr-slope in the calf (r=0.85, p<0.01), but not in the forearm in patients with CHF. Submax-pH in both upper and lower limbs was not significantly correlated to peak V(O2) or AT in either patients with CHF or controls. CONCLUSIONS Although metabolic abnormalities during exercise are seen in both arms and legs, leg muscle abnormalities, in particular, are closely related to systemic exercise intolerance in patients with CHF.
Collapse
Affiliation(s)
- Tatsuya Nagai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
70
|
Man WDC, Soliman MGG, Nikoletou D, Harris ML, Rafferty GF, Mustfa N, Polkey MI, Moxham J. Non-volitional assessment of skeletal muscle strength in patients with chronic obstructive pulmonary disease. Thorax 2003; 58:665-9. [PMID: 12885979 PMCID: PMC1746754 DOI: 10.1136/thorax.58.8.665] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Although quadriceps weakness is well recognised in chronic obstructive pulmonary disease (COPD), the aetiology remains unknown. In disabled patients the quadriceps is a particularly underused muscle and may not reflect skeletal muscle function as a whole. Loss of muscle function is likely to be equally distributed if the underlying pathology is a systemic abnormality. Conversely, if deconditioning and disuse are the principal aetiological factors, weakness would be most marked in the lower limb muscles. METHODS The non-volitional technique of supramaximal magnetic stimulation was used to assess twitch tensions of the adductor pollicis, quadriceps, and diaphragm muscles (TwAP, TwQ, and TwPdi) in 22 stable non-weight losing COPD patients and 18 elderly controls. RESULTS Mean (SD) TwQ tension was reduced in the COPD patients (7.1 (2.2) kg v 10.0 (2.7) kg; 95% confidence intervals (CI) -4.4 to -1.4; p<0.001). Neither TwAP nor TwPdi (when corrected for lung volume) differed significantly between patients and controls (mean (SD) TwAP 6.52 (1.90) N for COPD patients and 6.80 (1.99) N for controls (95% CI -1.5 to 0.97, p=0.65; TwPdi 23.0 (5.6) cm H(2)O for COPD patients and 23.5 (5.2) cm H(2)O for controls (95% CI -4.5 to 3.5, p=0.81). CONCLUSIONS The strength of the adductor pollicis muscle (and the diaphragm) is normal in patients with stable COPD whereas quadriceps strength is substantially reduced. Disuse may be the principal factor in the development of skeletal muscle weakness in COPD, but a systemic process preferentially affecting the proximal muscles cannot be excluded.
Collapse
Affiliation(s)
- W D-C Man
- Respiratory Muscle Laboratory, Guy's, King's and St Thomas' School of Medicine, King's College Hospital, London, UK.
| | | | | | | | | | | | | | | |
Collapse
|
71
|
Stein TP, Wade CE. Protein turnover in atrophying muscle: from nutritional intervention to microarray expression analysis. Curr Opin Clin Nutr Metab Care 2003; 6:95-102. [PMID: 12496686 DOI: 10.1097/00075197-200301000-00014] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW In response to decreased usage, skeletal muscle undergoes adaptive reductive remodeling due to the decrease in tension on the weight bearing components of the musculo-skeletal system. This response occurs with uncomplicated disuse (e.g. bed rest, space flight), as a secondary consequence of several widely prevalent chronic diseases for which activity is reduced (e.g. chronic obstructive pulmonary disease and chronic heart failure) and is part of the aging process. The problem is therefore one of considerable clinical importance. RECENT FINDINGS The impaired function and exercise intolerance is related more to the associated muscle wasting rather than to the specific organ system primarily impacted by the disease. Progress has continued in describing the use of anabolic drugs and dietary manipulation. The major advance in the field has been: (i) the discovery of the atrogin-1 gene and (ii) the application of microarray expression analysis and proteomics with the objectives of obtaining comprehensive understanding of the pathways changed with disuse atrophy. SUMMARY Disuse atrophy is a common clinical problem. There is a need for therapeutic interventions that do not involve exercise. A better understanding of the changes, particularly at the molecular level, could indicate hitherto unsuspected sites for nutritional and pharmacological intervention.
Collapse
Affiliation(s)
- T Peter Stein
- Department of Surgery, University of Medicine and Dentistry of New Jersey - SOM, 2 Medical Center Drive, Stratford, NJ 08084, USA.
| | | |
Collapse
|
72
|
Franssen FME, Wouters EFM, Baarends EM, Akkermans MA, Schols AMWJ. Arm mechanical efficiency and arm exercise capacity are relatively preserved in chronic obstructive pulmonary disease. Med Sci Sports Exerc 2002; 34:1570-6. [PMID: 12370557 DOI: 10.1097/00005768-200210000-00007] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Previous studies indicate that energy expenditure related to physical activity is enhanced and that mechanical efficiency of leg exercise is reduced in patients with chronic obstructive pulmonary disease (COPD). However, it is yet unclear whether an inefficient energy expenditure is also present during other activities in COPD. This study was carried out to examine arm efficiency and peak arm exercise performance relative to leg exercise in 33 (23 male) patients with COPD ((mean +/- SEM) age: 61 +/- 2 yr; FEV : 40 +/- 2% of predicted) and 20 sex- and age-matched healthy controls. METHODS Body composition, pulmonary function, resting energy expenditure (REE), and peak leg and arm exercise performance were determined. To calculate mechanical efficiency, subjects performed submaximal leg and arm ergometry at 50% of achieved peak loads. During exercise testing, metabolic and ventilatory parameters were measured. RESULTS In contrast to a reduced leg mechanical efficiency in patients compared with controls (15.6 +/- 0.6% and 22.5 +/- 0.6%, respectively; < 0.001), arm mechanical efficiency was comparable in both groups (COPD: 18.3 +/- 0.9%, controls: 21.0 +/- 1.2%; NS). Arm efficiency was not related to leg efficiency, pulmonary function, work of breathing, or REE. Also, arm exercise capacity was relatively preserved in patients with COPD (ratio arm peak work rate/leg peak work rate in patients: 89% vs 53% in controls; < 0.001). CONCLUSION Mechanical efficiency and exercise capacity of the upper and lower limbs are not homogeneously affected in COPD, with a relative preservation of the upper limbs. This may have implications for screening of exercise tolerance and prescription of training interventions in patients with COPD. Future studies need to elucidate the mechanism behind this observation.
Collapse
Affiliation(s)
- Frits M E Franssen
- Department of Pulmonology, University Hospital Maastricht, The Netherlands.
| | | | | | | | | |
Collapse
|