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Desachy M, Alexandre F, Varray A, Molinier V, Four E, Charbonnel L, Héraud N. High Prevalence of Non-Responders Based on Quadriceps Force after Pulmonary Rehabilitation in COPD. J Clin Med 2023; 12:4353. [PMID: 37445388 DOI: 10.3390/jcm12134353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
Pulmonary rehabilitation (PR) in patients with COPD improves quality of life, dyspnea, and exercise tolerance. However, 30 to 50% of patients are "non-responders" (NRs) according to considered variables. Surprisingly, peripheral muscle force is never taken into account to attest the efficacy of PR, despite its major importance. Thus, we aimed to estimate the prevalence of force in NRs, their characteristics, and predictors of non-response. In total, 62 COPD patients were included in this retrospective study (May 2019 to December 2020). They underwent inpatient PR, and their quadriceps isometric maximal force (QMVC) was assessed. The PR program followed international guidelines. Patients with a QMVC increase <7.5 N·m were classified as an NR. COPD patients showed a mean improvement in QMVC after PR (10.08 ± 12.97 N·m; p < 0.001). However, 50% of patients were NRs. NRs had lower pre-PR values for body mass, height, body mass index, PaO2, and QMVC. Non-response can be predicted by low QMVC, high PaCO2, and gender (when male). This model has a sensitivity of 74% and specificity of 81%. The study highlights the considerable number of NRs and potential risk factors for non-response. To systematize the effects, it may be interesting to implement blood gas correction and/or optimize the programs to enhance peripheral and central effects.
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Affiliation(s)
- Marion Desachy
- EuroMov Digital Health in Motion, University Montpellier, IMT Mines Ales, Montpellier, France
- Direction de la Recherche et de l'Innovation en Santé (Research and Health Innovation Department), Clariane, France
| | - François Alexandre
- Direction de la Recherche et de l'Innovation en Santé (Research and Health Innovation Department), Clariane, France
| | - Alain Varray
- EuroMov Digital Health in Motion, University Montpellier, IMT Mines Ales, Montpellier, France
| | - Virginie Molinier
- Direction de la Recherche et de l'Innovation en Santé (Research and Health Innovation Department), Clariane, France
| | - Elodie Four
- Clinique du Souffle Les Clarines, Inicea, France
| | | | - Nelly Héraud
- Direction de la Recherche et de l'Innovation en Santé (Research and Health Innovation Department), Clariane, France
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Marco E, Sánchez-Rodríguez D, Meza D, Cruz-Jentoft AJ. [Evolution of the concept of sarcopenia. Rehabilitation perspectives]. Rehabilitacion (Madr) 2020; 54:75-78. [PMID: 32370831 DOI: 10.1016/j.rh.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/09/2020] [Indexed: 11/18/2022]
Affiliation(s)
- E Marco
- Servei de Medicina Física i Rehabilitació, Parc de Salut Mar, Barcelona, España; Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Grupo de Investigación en Rehabilitación, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España.
| | - D Sánchez-Rodríguez
- Grupo de Investigación en Rehabilitación, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España; WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Bélgica; Servei de Geriatria, Parc de Salut Mar, Barcelona, España; Departament de Ciències de la Salut, Universitat Pompeu Fabra, Barcelona, España
| | - D Meza
- Grupo de Investigación en Rehabilitación, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España
| | - A J Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, España
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Jung JH, Kim NS. Relative activity of respiratory muscles during prescribed inspiratory muscle training in healthy people. J Phys Ther Sci 2016; 28:1046-9. [PMID: 27134409 PMCID: PMC4842421 DOI: 10.1589/jpts.28.1046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 12/15/2015] [Indexed: 11/30/2022] Open
Abstract
[Purpose] This study aimed to determine the effects of different intensities of
inspiratory muscle training on the relative respiratory muscle activity in healthy adults.
[Subjects and Methods] Thirteen healthy male volunteers were instructed to perform
inspiratory muscle training (0%, 40%, 60%, and 80% maximal inspiratory pressure) on the
basis of their individual intensities. The inspiratory muscle training was performed in
random order of intensities. Surface electromyography data were collected from the
right-side diaphragm, external intercostal, and sternocleidomastoid, and pulmonary
functions (forced expiratory volume in 1 s, forced vital capacity, and their ratio; peak
expiratory flow; and maximal inspiratory pressure) were measured. [Results] Comparison of
the relative activity of the diaphragm showed significant differences between the 60% and
80% maximal inspiratory pressure intensities and baseline during inspiratory muscle
training. Furthermore, significant differences were found in sternocleidomastoid relative
activity between the 60% and 80% maximal inspiratory pressure intensities and baseline
during inspiratory muscle training. [Conclusion] During inspiratory muscle training in the
clinic, the patients were assisted (verbally or through feedback) by therapists to avoid
overactivation of their accessory muscles (sternocleidomastoid). This study recommends
that inspiratory muscle training be performed at an accurate and appropriate intensity
through the practice of proper deep breathing.
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Affiliation(s)
- Ju-Hyeon Jung
- Department of Physical Therapy, Gimhae College, Republic of Korea
| | - Nan-Soo Kim
- Department of Physical Therapy, College of Health Sciences, Catholic University of Pusa, Republic of Korea
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Ramos D, Bertolini GN, Leite MR, Carvalho Junior LCS, da Silva Pestana PR, dos Santos VR, Fortaleza ACDS, Rodrigues FMM, Ramos EMC. Is dynamometry able to infer the risk of muscle mass loss in patients with COPD? Int J Chron Obstruct Pulmon Dis 2015; 10:1403-7. [PMID: 26229459 PMCID: PMC4516177 DOI: 10.2147/copd.s69829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Sarcopenia is characterized by a progressive and generalized decrease of strength and muscle mass. Muscle mass loss is prevalent in patients with chronic obstructive pulmonary disease (COPD) as a result of both the disease and aging. Some methods have been proposed to assess body composition (and therefore identify muscle mass loss) in this population. Despite the high accuracy of some methods, they require sophisticated and costly equipment. AIM The purpose of this study was to infer the occurrence of muscle mass loss measured by a sophisticated method (dual energy X-ray absorptiometry [DEXA]) using a more simple and affordable equipment (dynamometer). METHODS Fifty-seven stable subjects with COPD were evaluated for anthropometric characteristics, lung function, functional exercise capacity, body composition, and peripheral muscle strength. A binary logistic regression model verified whether knee-extension strength (measured by dynamometry) could infer muscle mass loss (from DEXA). RESULTS Patients with decreased knee-extension strength were 5.93 times more likely to have muscle mass loss, regardless of sex, disease stage, and functional exercise capacity (P=0.045). CONCLUSION Knee-extension dynamometry was able to infer muscle mass loss in patients with COPD.
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Affiliation(s)
- Dionei Ramos
- Department of Physiotherapy, São Paulo State University, Presidente Prudente, Brazil
| | | | - Marceli Rocha Leite
- Department of Physiotherapy, São Paulo State University, Presidente Prudente, Brazil
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Association between peripheral muscle strength and daily physical activity in patients with COPD: a systematic literature review and meta-analysis. J Cardiopulm Rehabil Prev 2014; 33:351-9. [PMID: 24142041 DOI: 10.1097/hcr.0000000000000022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease have skeletal muscle dysfunction and reduced daily physical activity (PA). Whether the reduction in quadriceps strength (QS) is directly linked to physical inactivity remains to be elucidated. METHODS A systematic review and a meta-analysis were conducted to determine the potential relationship between QS and the level of PA. The overall estimate of the correlation coefficient (r*) was calculated, and a subgroup analysis was conducted to analyze the association between QS and indices of PA separately. RESULTS A total of 8 studies were included in the meta-analysis. The overall association between QS and PA was low but highly significant (r * = 0.288, 95% CI = 0.180-0.389; P < .001). In the subgroup analysis, the association between QS and the number of steps per day was low (r = 0.260; 95% CI = 0.060-0.440) and the association between QS and the time spent walking was moderate (r = 0.418; 95% CI = 0.229-0.576). CONCLUSIONS Peripheral muscle strength is associated with PA as assessed by the number of steps per day and the time spent walking in patients with chronic obstructive pulmonary disease. The overall association between QS and PA was low to moderate and highly significant.
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Rausch-Osthoff AK, Kohler M, Sievi NA, Clarenbach CF, van Gestel AJ. Association between peripheral muscle strength, exercise performance, and physical activity in daily life in patients with Chronic Obstructive Pulmonary Disease. Multidiscip Respir Med 2014; 9:37. [PMID: 25013723 PMCID: PMC4091091 DOI: 10.1186/2049-6958-9-37] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 06/18/2014] [Indexed: 04/10/2023] Open
Abstract
BACKGROUND Resistance training of peripheral muscles has been recommended in order to increase muscle strength in patients with Chronic Obstructive Pulmonary Disease (COPD). However, whether peripheral muscle strength is associated with exercise performance (EP) and physical activity in daily life (PADL) in these patients needs to be investigated. The aim of this study is to evaluate whether strength of the quadriceps muscle (QS) is associated with EP and daily PADL in patients with COPD. METHODS We studied patients with COPD (GOLD A-D) and measured maximal isometric strength of the left QS. PADL was measured for 7 days with a SenseWear-Pro® accelerometer. EP was quantified by the 6-minute walk distance (6MWD), the number of stands in the Sit-to-Stand Test (STST), and the handgrip-strength. Univariate and multivariate analyses were used to examine possible associations between QS, PADL and EP. RESULTS In 27 patients with COPD with a mean (SD) FEV1 of 37.6 (17.6)% predicted, QS was associated with 6MWD, STST, and handgrip-strength but not with PADL. Multiple linear regression analyses showed that QS was independently associated with the 6MWD (β = 0.42, 95% CI 0.09 to 0.84, p = 0.019), STST (β = 0.50, 95% CI 0.11 to 0.86, p = 0.014) and with handgrip-strength (β = 0.45, 95% CI 0.05 to 0.84, p = 0.038). CONCLUSIONS Peripheral muscle strength may be associated with exercise performance but not with physical activity in daily life. This may be due to the fact that EP tests evaluate patients' true abilities while PADL accelerometers may not.
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Affiliation(s)
- Anne-Kathrin Rausch-Osthoff
- Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland ; Department of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland ; Zurich University of Applied Sciences, School of Health Professions, Department of Physiotherapy, Technikumstrasse 71, 8401 Winterthur, Switzerland
| | - Malcolm Kohler
- Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland ; Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland
| | | | - Arnoldus Jr van Gestel
- Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland ; Department of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
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Tonon J, Guarnier FA, Brunnquell CR, Bernardes SS, Cecchini AL, Cecchini R. Oxidative status and chymotrypsin-like activity in right and left ventricle hypertrophy in an experimental model of emphysema. PATHOPHYSIOLOGY 2013; 20:249-56. [DOI: 10.1016/j.pathophys.2013.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 05/11/2013] [Accepted: 08/09/2013] [Indexed: 10/26/2022] Open
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Quadriceps function assessment using an incremental test and magnetic neurostimulation: A reliability study. J Electromyogr Kinesiol 2013; 23:649-58. [DOI: 10.1016/j.jelekin.2012.11.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 09/18/2012] [Accepted: 11/12/2012] [Indexed: 01/18/2023] Open
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Remels AHV, Gosker HR, Langen RCJ, Schols AMWJ. The mechanisms of cachexia underlying muscle dysfunction in COPD. J Appl Physiol (1985) 2013; 114:1253-62. [DOI: 10.1152/japplphysiol.00790.2012] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Pulmonary cachexia is a prevalent, debilitating, and well-recognized feature of COPD associated with increased mortality and loss of peripheral and respiratory muscle function. The exact cause and underlying mechanisms of cachexia in COPD are still poorly understood. Increasing evidence, however, shows that pathological changes in intracellular mechanisms of muscle mass maintenance (i.e., protein turnover and myonuclear turnover) are likely involved. Potential factors triggering alterations in these mechanisms in COPD include oxidative stress, myostatin, and inflammation. In addition to muscle wasting, peripheral muscle in COPD is characterized by a fiber-type shift toward a more type II, glycolytic phenotype and an impaired oxidative capacity (collectively referred to as an impaired oxidative phenotype). Atrophied diaphragm muscle in COPD, however, displays an enhanced oxidative phenotype. Interestingly, intrinsic abnormalities in (lower limb) peripheral muscle seem more pronounced in either cachectic patients or weight loss-susceptible emphysema patients, suggesting that muscle wasting and intrinsic changes in peripheral muscle's oxidative phenotype are somehow intertwined. In this manuscript, we will review alterations in mechanisms of muscle mass maintenance in COPD and discuss the involvement of oxidative stress, inflammation, and myostatin as potential triggers of cachexia. Moreover, we postulate that an impaired muscle oxidative phenotype in COPD can accelerate the process of cachexia, as it renders muscle in COPD less energy efficient, thereby contributing to an energy deficit and weight loss when not dietary compensated. Furthermore, loss of peripheral muscle oxidative phenotype may increase the muscle's susceptibility to inflammation- and oxidative stress-induced muscle damage and wasting.
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Affiliation(s)
- A. H. V. Remels
- NUTRIM School for Nutrition, Toxicology and Metabolism, Department of Respiratory Medicine, Maastricht University Medical Centre +, Maastricht, the Netherlands
| | - H. R. Gosker
- NUTRIM School for Nutrition, Toxicology and Metabolism, Department of Respiratory Medicine, Maastricht University Medical Centre +, Maastricht, the Netherlands
| | - R. C. J. Langen
- NUTRIM School for Nutrition, Toxicology and Metabolism, Department of Respiratory Medicine, Maastricht University Medical Centre +, Maastricht, the Netherlands
| | - A. M. W. J. Schols
- NUTRIM School for Nutrition, Toxicology and Metabolism, Department of Respiratory Medicine, Maastricht University Medical Centre +, Maastricht, the Netherlands
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Silva MGF, Fernandes CP, Santos TCDS, Silva TLPD. Suplementação oral de L-carnitina associada ao treinamento físico e muscular respiratório na doença pulmonar obstrutiva crônica: estudo preliminar. FISIOTERAPIA E PESQUISA 2012. [DOI: 10.1590/s1809-29502012000400005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Avaliar os efeitos da suplementação oral de L-carnitina associada ao treinamento físico e muscular respiratório na doença pulmonar obstrutiva crônica (DPOC). Participaram 14 voluntários com idade de 65±10,4 anos e diagnóstico clínico de DPOC moderado, classificados de acordo com a espirometria prévia. Os voluntários foram divididos em grupo treino esteira (GTE) e grupo treino muscular respiratório (GTMR). Realizaram o teste de caminhada de seis minutos (TC6'), teste de caminhada com carga progressiva (TCP), avaliação nutricional do índice de massa corpórea (IMC), dose diária recomendada de L-carnitina, pressões inspiratórias (PImáx) e expiratórias máximas (PEmáx). Fizeram 30 min de caminhada em esteira, 3 vezes/semana por 10 semanas, e o GTMR realizou, ainda, 10 min de treinamento muscular inspiratório (Threshold® IMT) e 10 min de treinamento muscular expiratório (Threshold® PEP) à 50% da PImáx e PEmáx ajustados semanalmente. Após 10 semanas, foram reavaliados. No TC6' pré e pós-programa de treinamento físico, as variáveis alteradas foram: distância percorrida (DP), frequência cardíaca (FC) final, pressão arterial sistólica (PAS) final, pressão arterial diastólica (PAD) final e Borg final no GTMR, no GTE as variáveis alteradas foram FC repouso, FC final, PAS final, Borg repouso e DP. Comparando os grupos no TC6, o GTE apresentou FC final, PAD final e Borg final maiores do que o GTMR na reavaliação; já no TCP, a FC final, PAS final, Borg final foram maiores no GTE, e DP foi maior no GTMR. Na avaliação respiratória, a PEmáx foi maior no GTMR na reavaliação. O treino aeróbio e suplementação de L-carnitina na DPOC otimizou a performance, a capacidade física e a tolerância ao esforço.
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Effects of breathing maneuver and sitting posture on muscle activity in inspiratory accessory muscles in patients with chronic obstructive pulmonary disease. Multidiscip Respir Med 2012; 7:9. [PMID: 22958459 PMCID: PMC3436653 DOI: 10.1186/2049-6958-7-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 06/20/2012] [Indexed: 11/10/2022] Open
Abstract
Background To determine the influence of breathing maneuver and sitting posture on tidal volume (TV), respiratory rate (RR), and muscle activity of the inspiratory accessory muscles in patients with chronic obstructive pulmonary disease (COPD). Methods Twelve men with COPD participated in the study. Inductive respiratory plethysmography and surface electromyography were used to simultaneously measure TV, RR, and muscle activity of the inspiratory accessory muscles [the scalenus (SM), sternocleidomastoid (SCM), and pectoralis major (PM) muscles] during quiet natural breathing (QB) and pursed-lips breathing (PLB) in three sitting postures: neutral position (NP), with armm support (WAS), and with arm and head support (WAHS). Results Two-way repeated-measures analysis of variance was employed. In a comparison of breathing patterns, PLB significantly increased TV and decreased RR compared to QB. Muscle activity in the SM and SCM increased significantly in PLB compared to QB. In a comparison of sitting postures, the muscle activity of the SM, SCM, and PM increased in the forward-leaning position. Conclusions The results suggest that in COPD, PLB induced a favorable breathing pattern (increased TV and reduced RR) compared to QB. Additionally, WAS and WAHS positions increased muscle activity of the inspiratory accessory muscles during inspiration versus NP. Differential involvement of accessory respiratory muscles can be readily studied in COPD patients, allowing monitoring of respiratory load during pulmonary rehabilitation.
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Vonbank K, Strasser B, Mondrzyk J, Marzluf BA, Richter B, Losch S, Nell H, Petkov V, Haber P. Strength training increases maximum working capacity in patients with COPD--randomized clinical trial comparing three training modalities. Respir Med 2011; 106:557-63. [PMID: 22119456 DOI: 10.1016/j.rmed.2011.11.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 11/07/2011] [Accepted: 11/09/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND AND OBJECTIVE Skeletal muscle dysfunction contributes to exercise limitation in patients with chronic obstructive pulmonary disease (COPD). Strength training increases muscle strength and muscle mass, but there is an ongoing debate on the additional effect concerning the exercise capacity. The purpose of this study was to compare the effects of three different exercise modalities in patients with COPD including endurance training (ET), progressive strength training (ST) and the combination of strength training and endurance training (CT). DESIGN A prospective randomized trial. METHODS Thirty-six patients with COPD were randomly allocated either to ET, ST, or CT. Muscle strength, cardiopulmonary exercise testing, lung function testing and quality of life were assessed before and after a 12-week training period. RESULTS Exercise capacity (Wmax) increased significantly in all three training groups with increase of peak oxygen uptake (VO2peak) in all three groups, reaching statistical significance in the ET group and the CT group. Muscle strength (leg press, bench press, bench pull) improved in all three training groups, with a higher improvement in the ST (+39.3%, +20.9%, +20.3%) and the CT group (+43.3%, +18.1%, +21.6%) compared to the ET group (+20.4%, +6.4%, +12.1%). CONCLUSIONS Progressive strength training alone increases not only muscle strength and quality of life, but also exercise capacity in patients with COPD, which may have implications in prescription of training modality. CLINICALTRIALS.GOV IDENTIFIER: NCT01091623.
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Affiliation(s)
- Karin Vonbank
- Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
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de Souza GF, Castro AAM, Velloso M, Silva CR, Jardim JR. Lactic acid levels in patients with chronic obstructive pulmonary disease accomplishing unsupported arm exercises. Chron Respir Dis 2010; 7:75-82. [DOI: 10.1177/1479972310361833] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) may suffer dyspnea when performing unsupported arm exercises (UAE). However, some factors related to the tolerance of the upper limbs during these exercises are not well understood. Our investigation was to determine if an unsupported arm exercise test in patients with COPD accomplishing diagonal movements increases lactic acid levels; also, we assessed the metabolic, ventilatory and cardiovascular responses obtained from the unsupported arm exercise test. The study used results of maximal symptom limited tests with unsupported arms and legs performed on 16 patients with COPD. In order to do the test, some metabolic, respiratory and cardiovascular parameters such as oxygen uptake (VO2), carbon dioxide production (VCO2), respiratory rate (RR), pulmonary ventilation (VE), heart rate (HR) and blood pressure (BP) were measured during the exercise tests. Furthermore, blood lactate concentration was measured during the arm test. We detected a significant increase in the mean blood lactate concentration, VO2, VCO 2, VE and RR from the resting to the peak phase of the UAE test. The mean values of VO2, VCO2 and VE obtained at the peak of the UAE test corresponded to 52.5%, 50.0% and 61.2%, respectively, of the maximal values obtained at the peak of the leg exercise test. In comparison, the mean heart rate and systolic arterial blood pressure were significantly lower at the peak of the UAE test than at the peak leg exercise test and corresponded to 76.2% and 83.0%, respectively. Unsupported incremental arm exercises in patients with COPD increases blood lactic acid levels.
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Affiliation(s)
- Gérson F de Souza
- Pulmonary Rehabilitation Center, Federal University of São Paulo, Unifesp, Brazil, Nove de Julho University and the Monte Serrat University, Brazil
| | - Antonio AM Castro
- Pulmonary Rehabilitation Center, Federal University of São Paulo, Unifesp, Brazil, and Adventist University, Unasp, Brazil
| | - Marcelo Velloso
- Pulmonary Rehabilitation Center, Federal University of São Paulo, Unifesp, Brazil
| | | | - José R Jardim
- Respiratory Division, Pulmonary Rehabilitation Center, Unifesp, Brazil,
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The pathophysiology of cachexia in chronic obstructive pulmonary disease. Curr Opin Support Palliat Care 2009; 3:282-7. [DOI: 10.1097/spc.0b013e328331e91c] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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15
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Wüst RCI, Jaspers RT, van Heijst AF, Hopman MTE, Hoofd LJC, van der Laarse WJ, Degens H. Region-specific adaptations in determinants of rat skeletal muscle oxygenation to chronic hypoxia. Am J Physiol Heart Circ Physiol 2009; 297:H364-74. [PMID: 19429822 DOI: 10.1152/ajpheart.00272.2009] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Chronic exposure to hypoxia is associated with muscle atrophy (i.e., a reduction in muscle fiber cross-sectional area), reduced oxidative capacity, and capillary growth. It is controversial whether these changes are muscle and fiber type specific. We hypothesized that different regions of the same muscle would also respond differently to chronic hypoxia. To investigate this, we compared the deep (oxidative) and superficial (glycolytic) region of the plantaris muscle of eight male rats exposed to 4 wk of hypobaric hypoxia (410 mmHg, Po(2): 11.5 kPa) with those of nine normoxic rats. Hematocrit was higher in chronic hypoxic than control rats (59% vs. 50%, P < 0.001). Using histochemistry, we observed 10% fiber atrophy (P < 0.05) in both regions of the muscle but no shift in the fiber type composition and myoglobin concentration of the fibers. In hypoxic rats, succinate dehydrogenase (SDH) activity was elevated in fibers of each type in the superficial region (25%, P < 0.05) but not in the deep region, whereas in the deep region but not the superficial region the number of capillaries supplying a fiber was elevated (14%, P < 0.05). Model calculations showed that the region-specific alterations in fiber size, SDH activity, and capillary supply to a fiber prevented the occurrence of anoxic areas in the deep region but not in the superficial region. Inclusion of reported acclimatization-induced increases in mean capillary oxygen pressure attenuated the development of anoxic tissue areas in the superficial region of the muscle. We conclude that the determinants of tissue oxygenation show region-specific adaptations, resulting in a marked differential effect on tissue Po(2).
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Affiliation(s)
- R C I Wüst
- Institute for Biomedical Research into Human Movement and Health, Manchester Metropolitan University, Manchester, UK.
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16
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Roig M, Reid WD. Electrical stimulation and peripheral muscle function in COPD: A systematic review. Respir Med 2009; 103:485-95. [DOI: 10.1016/j.rmed.2008.11.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Revised: 11/10/2008] [Accepted: 11/12/2008] [Indexed: 11/17/2022]
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17
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Abnormal pulmonary arterial pressure limits exercise capacity in patients with COPD. Wien Klin Wochenschr 2008; 120:749-55. [DOI: 10.1007/s00508-008-1103-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Accepted: 10/13/2008] [Indexed: 10/21/2022]
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Roig M, Shadgan B, Reid WD. Eccentric exercise in patients with chronic health conditions: a systematic review. Physiother Can 2008; 60:146-60. [PMID: 20145778 DOI: 10.3138/physio.60.2.146] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The capacity of eccentric actions to produce muscle hypertrophy, strength gains, and neural adaptations without stressing the cardiopulmonary system has led to the prescription of eccentric training programmes in patients with low tolerance to exercise, such as elders or those with chronic health conditions. The purpose of this systematic review was to analyze the evidence regarding the effectiveness and suitability of eccentric training to restore musculoskeletal function in patients with chronic diseases. SUMMARY OF KEY POINTS Relevant articles were identified from nine databases and from the reference lists of key articles. Articles were assessed to determine level of evidence and scientific rigour. Nine studies met the inclusion criteria. According to Sackett's levels of evidence, 7 studies were graded at level IIb, 1 study at level IV, and the remaining study at level V. Articles were also graded for scientific rigour according to the PEDro scale. One study was rated as high quality, 4 studies were rated as moderate, and 2 studies were graded as poor quality. CONCLUSIONS Eccentric training may be safely used to restore musculoskeletal function in patients with some specific chronic conditions. However, the heterogeneity of diseases makes it very difficult to extrapolate results and to standardize clinical recommendations for adequate implementation of this type of exercise. More studies are needed to establish the potential advantages of eccentric training in chronic conditions.
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Affiliation(s)
- Marc Roig
- Marc Roig, BSc, PT, MSc, PhD candidate : Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia; Muscle Biophysics Laboratory, Vancouver Coastal Health Research Institute, Vancouver, British Columbia
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Brun JF, Bordenave S, Mercier J, Jaussent A, Picot MC, Préfaut C. Cost-sparing effect of twice-weekly targeted endurance training in type 2 diabetics: a one-year controlled randomized trial. DIABETES & METABOLISM 2008; 34:258-65. [PMID: 18468933 DOI: 10.1016/j.diabet.2008.01.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Revised: 12/20/2007] [Accepted: 01/09/2008] [Indexed: 01/22/2023]
Abstract
OBJECTIVE We evaluated the effects of targeted, moderate endurance training on healthcare cost, body composition and fitness in type 2 diabetes patients routinely followed within the French healthcare system. DESIGN AND METHODS A total of 25 type 2 diabetic patients was randomly assigned to one of two groups: 13 underwent a training programme (eight sessions, followed by training twice a week for 30-45 minutes at home at the level of the ventilatory threshold [V(T)]); and 12 received their usual routine treatment. Both groups were followed for one year to evaluate healthcare costs, exercise effectiveness and a six-minute walking test. RESULTS The training prevented loss of maximum aerobic capacity, which decreased slightly in the untrained group (P=0.014), and resulted in a higher maximum power output (P=0.041) and six-minute walking distance (P=0.020). The Voorrips activity score correlated with both V(O2max) (r=0.422, P<0.05) and six-minute walking distance (r=0.446, P<0.05). Changes in V(O2max) were negatively correlated with changes in body weight (r=0.608, P<0.01). Training decreased the insulin-resistance index (HOMA-IR) by 26% (P<0.05). Changes in percentages of fat were correlated to changes in waist circumference (r=0.436, P<0.05). The total healthcare cost was reduced by 50% in the trained group (euro 1.65+/-1 per day versus euro 3.00+/-1.47 per day in the untrained group; P<0.02) due to fewer hospitalizations (P=0.05) and less use of sulphonylureas (P<0.05). CONCLUSION Endurance training at V(T) level prevented the decline in aerobic working capacity seen in untrained diabetics over the study period, and resulted in a marked reduction in healthcare costs due to less treatments and fewer hospitalizations.
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Affiliation(s)
- J-F Brun
- ERI 25, Inserm, 34000 Montpellier, France.
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Clinical value of anthropometric estimates of leg lean volume in nutritionally depleted and non-depleted patients with chronic obstructive pulmonary disease. Br J Nutr 2008; 100:380-6. [PMID: 18184453 DOI: 10.1017/s0007114507886399] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study aimed to investigate the clinical usefulness of an anthropometrically based method for estimating leg lean volume (LLV) in patients with chronic obstructive pulmonary disease (COPD) who presented or not with nutritional depletion. We prospectively evaluated a group of forty-eight patients (thirty-eight males) with moderate to severe COPD (Global Initiative for Chronic Obstructive Lung disease stages II-IV) who underwent a 6 min walking test and knee isokinetic dynamometry. Leg lean mass (muscle mass plus bone) was determined by dual-energy X-ray absorptiometry (DEXA) with derivation of its respective volume: these values were compared with those obtained by the truncated cones method first described by Jones and Pearson in 1969. As expected, depleted patients (n 19) had reduced exercise capacity and impaired muscle performance as compared to non-depleted subjects (P < 0.01). The mean bias of the LLV differences between anthropometry and DEXA were 0.40 litre (95 % CI - 0.59, 1.39) and 0.50 litre (95 % CI - 1.08, 2.08) for depleted and non-depleted patients, respectively. Anthropometrically and DEXA-based estimates correlated similarly with muscle functional attributes. A ROC curve analysis revealed that leg height-corrected LLV values had acceptable sensitivity and specificity to identify depleted patients (area under the curve 0.93 (range 0.86-1.00); P < 0.001). Moreover, patients with LLV <or= 9.2 litres/m (the best cut-off value according to the ROC curve) had significantly lower exercise capacity and muscle performance than their counterparts (P < 0.05). In conclusion, an anthropometrically based method of estimating LLV (Jones and Pearson method) was shown to present with clinically acceptable accuracy and external validity in depleted and non-depleted patients with stable COPD.
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Hamaoka T, McCully KK, Quaresima V, Yamamoto K, Chance B. Near-infrared spectroscopy/imaging for monitoring muscle oxygenation and oxidative metabolism in healthy and diseased humans. JOURNAL OF BIOMEDICAL OPTICS 2007; 12:062105. [PMID: 18163808 DOI: 10.1117/1.2805437] [Citation(s) in RCA: 222] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Near-infrared spectroscopy (NIRS) was initiated in 1977 by Jobsis as a simple, noninvasive method for measuring the presence of oxygen in muscle and other tissues in vivo. This review honoring Jobsis highlights the progress that has been made in developing and adapting NIRS and NIR imaging (NIRI) technologies for evaluating skeletal muscle O(2) dynamics and oxidative energy metabolism. Development of NIRS/NIRI technologies has included novel approaches to quantification of the signal, as well as the addition of multiple source detector pairs for imaging. Adaptation of NIRS technology has focused on the validity and reliability of NIRS measurements. NIRS measurements have been extended to resting, ischemic, localized exercise, and whole body exercise conditions. In addition, NIRS technology has been applied to the study of a number of chronic health conditions, including patients with chronic heart failure, peripheral vascular disease, chronic obstructive pulmonary disease, varying muscle diseases, spinal cord injury, and renal failure. As NIRS technology continues to evolve, the study of skeletal muscle function with NIRS first illuminated by Jobsis continues to be bright.
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Affiliation(s)
- Takafumi Hamaoka
- National Institute of Fitness and Sports, Department of Exercise Science, Shiromizu 1, Kanoya, 891-2393 Japan.
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Réentraînement des maladies métaboliques ciblé individuellement par la calorimétrie d'effort. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.annrmp.2007.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Brun JF, Jean E, Ghanassia E, Flavier S, Mercier J. Metabolic training: new paradigms of exercise training for metabolic diseases with exercise calorimetry targeting individuals. ACTA ACUST UNITED AC 2007; 50:528-34, 520-7. [PMID: 17521770 DOI: 10.1016/j.annrmp.2007.04.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Accepted: 04/05/2007] [Indexed: 11/30/2022]
Abstract
For patients with metabolic diseases, as with other diseases, exercise training is a fully recognized therapy. Such training helps obese patients stabilize weight after slimming. For patients with type 2 diabetics, it is both a prevention and a glucose-lowering treatment and reduces health care costs. We propose a targeted training for individuals at the level of maximal lipid oxidation (LIPOXmax) with a protocol of exercise calorimetry (four 6-min workloads) based on Brooks and Mercier's crossover concept. Calorimetric interpretation of gas exchange at the fifth and sixth minutes of each stage shows a bell-shaped curve for lipid oxidation that peaks at LIPOXmax, a point that varies considerably among individuals. As well, glucose oxidation is a linear function of power (carbohydrate cost of the watt). Such a calculation predicts fairly actual lipid oxidation over 45 min at the same level. Other protocols, with 3-min workloads used in sports medicine, are not reliable for patients with metabolic diseases. For obese adults and teenagers, as well as those with type 2 diabetes, 2 months' training at the LIPOXmax (three sessions at 45 min per week) results in a net loss of fat mass, with preserved fat-free mass, and increased ability to oxidize lipids. At the end of this period, training can be "re-targeted" to be more effective and, possibly, associated with other strategies with stronger exercise intensities. Therefore, metabolic training is a viable option for patients with metabolic diseases, but the full concept is still evolving. However, the major challenge remains to transform inactive individuals into active ones.
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Affiliation(s)
- J-F Brun
- Inserm ERI 25 Muscle et Pathologies, laboratoire de physiologie des interactions, UFR de médecine, institut de biologie de Montpellier, université Montpellier-I, boulevard Henri-IV, 34062 Montpellier, France.
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Lerario MC, Sachs A, Lazaretti-Castro M, Saraiva LG, Jardim JR. Body composition in patients with chronic obstructive pulmonary disease: which method to use in clinical practice? Br J Nutr 2006; 96:86-92. [PMID: 16869995 DOI: 10.1079/bjn20061798] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The objective of the present study was to compare anthropometry with bioelectrical impedance (BIA) in relation to densitometry (dual-energy X-ray absorptiometry; DEXA) as methods of nutritional assessment and body composition in out-patients with chronic pulmonary obstructive disease (COPD). We conducted a cross-sectional clinical study with sixty-one patients with COPD (forty-two men and nineteen women), mean age of 66.5 (sd 7.9) years and forced expiratory volume in 1 s of 1.3 (sd 0.6) litres (52.2 (sd 19.8) % predicted), referred to the Pulmonary Rehabilitation Center. The patients were evaluated regarding nutrition status and body composition as determined by anthropometry, BIA and DEXA. In the results, 34.4 % showed mild obstruction, 31.2 %, moderate and 34.4 %, severe obstruction. According to the BMI (mean 24.5 (sd 4.5) kg/m2), 45.9 % of the patients exhibited normal weight, while 27.9 % were underweight and 26.2 % were obese. Related to fat-free mass (FFM), anthropometry and BIA compared with DEXA presented high correlations (r 0.96 and 0.95 respectively; P < 0.001) and high reliability between the methods (alpha 0.98; P < 0.001). Agreement analysis between the methods shows that anthropometry overestimates (0.62 (sd of the difference 2.89) kg) while BIA underestimates FFM (0.61 (sd of the difference 2.82) kg) compared with DEXA. We concluded that according to the nutritional diagnosis, half of our population of patients with COPD showed normal weight, while the other half comprised equal parts obese and underweight patients. Body composition estimated by BIA and anthropometry presented good reliability and correlation with DEXA; the three methods presented satisfactory clinical accuracy despite the great disparity of the limits of agreement.
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Affiliation(s)
- M C Lerario
- Respiratory Division, Pulmonary Rehabilitation Center, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
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Dourado VZ, Antunes LCDO, Tanni SE, de Paiva SAR, Padovani CR, Godoy I. Relationship of Upper-Limb and Thoracic Muscle Strength to 6-min Walk Distance in COPD Patients. Chest 2006; 129:551-7. [PMID: 16537851 DOI: 10.1378/chest.129.3.551] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES This study was developed to investigate the influence of thoracic and upper-limb muscle function on 6-min walk distance (6MWD) in patients with COPD. DESIGN A prospective, cross-sectional study. SETTING The pulmonary rehabilitation center of a university hospital. PATIENTS Thirty-eight patients with mild to very severe COPD were evaluated. MEASUREMENTS AND RESULTS Pulmonary function and baseline dyspnea index (BDI) were assessed, handgrip strength, maximal inspiratory pressure (Pimax), and 6MWD were measured, and the one-repetition maximum (1RM) was determined for each of four exercises (bench press, lat pull down, leg extension, and leg press) performed on gymnasium equipment. Quality of life was assessed using the St. George Respiratory Questionnaire (SGRQ). We found statistically significant positive correlations between 6MWD and body weight (r = 0.32; p < 0.05), BDI (r = 0.50; p < 0.01), FEV(1) (r = 0.33; p < 0.05), Pimax (r = 0.53; p < 0.01), and all values of 1RM. A statistically significant negative correlation was observed between 6MWD and dyspnea at the end of the 6-min walk test (r = - 0.29; p < 0.05), as well as between 6MWD and the SGRQ activity domain (r = - 0.45; p < 0.01) and impact domain (r = - 0.34; p < 0.05) and total score (r = - 0.40; p < 0.01). Multiple regression analysis selected body weight, BDI, Pimax, and lat pull down 1RM as predictive factors for 6MWD (R(2) = 0.589). CONCLUSIONS The results of this study showed the importance of the skeletal musculature of the thorax and upper limbs in submaximal exercise tolerance and could open new perspectives for training programs designed to improve functional activity in COPD patients.
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Affiliation(s)
- Victor Zuniga Dourado
- Department of Physiotherapy, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, #70 Rua Antônio Sabino Santa Rosa, Apto. 13-C, Vila Santana, Botucatu CEP: 18606-140, Brazil.
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de Andrade AD, Silva TNS, Vasconcelos H, Marcelino M, Rodrigues-Machado MG, Filho VCG, Moraes NH, Marinho PEM, Amorim CF. Inspiratory muscular activation during threshold® therapy in elderly healthy and patients with COPD. J Electromyogr Kinesiol 2005; 15:631-9. [PMID: 16051499 DOI: 10.1016/j.jelekin.2005.06.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
UNLABELLED Inspiratory muscles training in COPD is controversial not only in relation to the load level required to produce muscular conditioning effects but also in relation to the group of patients benefiting from the training. Consequently, inspiratory muscular response assessment during Threshold therapy may help optimizing training strategy. The objective of this study was to evaluate the participation of the diaphragm and the sternocleidomastoid (SMM) muscle to overcome with a 30% Threshold load using surface electromyography (sEMG) and to analyze the correlation between SMM activation, maximum strength level of inspiratory muscles (MIP) and obstruction degree in COPD patients (FEV1). We studied seven healthy elderly subjects, mean age of 68+/-4 years and seven COPD patients, FEV1 45+/-17% of the predicted value, with mean age 66+/-8 years. sEMG analysis of SMM muscles and diaphragm were obtained through RMS (root-mean-square) during three stages: pre-loading, loading and post-loading. RESULTS In the COPD group, the RMS of the SMM increased 28% during load (p<0.05) while the RMS of the diaphragm remained constant. In the elderly there was a trend of a 11% increase in diaphragm activity and of 7% in SMM activity but, without reaching significance levels. SMM activity demonstrated good correlation with the obstruction level (r=-0.537). CONCLUSION To overcome the load required by Threshold therapy, COPD patients demonstrated an increase of accessory muscles activity, represented by SMM. For the same relative load this increase seems to be proportional to the degree of pulmonary obstruction.
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Degens H, Sanchez Horneros JM, Heijdra YF, Dekhuijzen PNR, Hopman MTE. Skeletal muscle contractility is preserved in COPD patients with normal fat-free mass. ACTA ACUST UNITED AC 2005; 184:235-42. [PMID: 15954991 DOI: 10.1111/j.1365-201x.2005.01447.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Peripheral muscle dysfunction often occurs in patients with chronic obstructive pulmonary disease (COPD). The muscle dysfunction may be caused by a loss of force-generating capacity, resulting from a loss of muscle mass, as well as by other alterations in contractile properties of skeletal muscle. METHODS The maximal isometric voluntary strength and fatigability were determined in hand-grip and quadriceps muscles from nine male COPD patients (FEV(1) 30-50% predicted) and control subjects matched for fat-free mass (FFM), physical activity level and age. Contractile properties and fatigability of the quadriceps muscle were also studied with electrically evoked isometric contractions. RESULTS The maximal voluntary force (MVC) and fatigability of the handgrip muscle did not differ between the COPD patients and control subjects. Also the MVC of the quadriceps muscle and the rate of force rise, contraction time, force-frequency relationship and fatigability, as determined with electrically evoked contractions, were similar in patients with COPD and control subjects. CONCLUSION Skeletal muscle strength, contractile properties and fatigability are preserved in patients with moderate COPD and a normal FFM and activity level. This suggests that skeletal muscle dysfunction does not take place during moderate COPD until cachexia and/or a decline in physical activity occur.
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Affiliation(s)
- H Degens
- Department of Physiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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O'Shea SD, Taylor NF, Paratz J. Peripheral muscle strength training in COPD: a systematic review. Chest 2004; 126:903-14. [PMID: 15364773 DOI: 10.1378/chest.126.3.903] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Skeletal muscle weakness, and the associated impact on exercise tolerance, provides a strong theoretical rationale for strength training intervention for people with COPD. AIM The purpose of this review was to examine systematically the current evidence for peripheral muscle strength training in people with COPD. METHOD Empirical trials and reviews relating to strength training in COPD were obtained by searching electronic databases and citation tracking, using the keywords of COPD with strength/resistance training and skeletal muscle. Two reviewers completed data extraction and quality assessment independently, using the PEDro (physiotherapy evidence database) scale and a checklist for review articles. Effect sizes and 95% confidence intervals were determined for empiric trials and metaanalysis used where appropriate. RESULTS The search strategy yielded 13 articles (9 empirical trials and 4 reviews). Strength training was found to have strong evidence for improving upper body and leg strength. However, no strong evidence for strength training was found for other outcome measures. CONCLUSIONS Further research is required to investigate the effects of strength training on functional activities, such as balance, upper limb function, self care, and participation in daily life.
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Affiliation(s)
- Simone D O'Shea
- BPthy (Hons), Wodonga Regional Health Service, PO Box 156, Wodonga, VIC, 3689, Australia.
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O’shea S, Taylor N, Paratz J. Treino de força dos músculos periféricos na DPOC. Revisão sistemática. REVISTA PORTUGUESA DE PNEUMOLOGIA 2004. [DOI: 10.1016/s0873-2159(15)30608-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Yquel R, Pillet O, Manier G. Assessment of muscle function in patients with COPD: preliminary results. Sci Sports 2003. [DOI: 10.1016/s0765-1597(02)00063-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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McCully K, Mancini D, Levine S. Nuclear magnetic resonance spectroscopy: its role in providing valuable insight into diverse clinical problems. Chest 1999; 116:1434-41. [PMID: 10559109 DOI: 10.1378/chest.116.5.1434] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Skeletal muscle plays an important role in respiratory and cardiovascular physiology. The ability to measure metabolic changes in skeletal muscle has been enhanced with the advent of magnetic resonance spectroscopy (MRS). MRS measurements have been used to understand the metabolic control of respiration and to evaluate metabolic changes in the muscle in patients with respiratory and cardiac diseases. The key to the respiratory control measurements is the ability to measure intracellular pH with MRS. Muscle oxidative metabolism has been measured in two ways: during steady-state exercise and using recovery kinetics. The similarities in the metabolic findings for pulmonary and coronary disease suggest the potential for some interesting common pathways.
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Affiliation(s)
- K McCully
- Department of Exercise Science, Ramsey Student Center, University of Georgia, Athens, GA 30602-3654, USA.
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Kaelin ME, Swank AM, Adams KJ, Barnard KL, Berning JM, Green A. Cardiopulmonary responses, muscle soreness, and injury during the one repetition maximum assessment in pulmonary rehabilitation patients. JOURNAL OF CARDIOPULMONARY REHABILITATION 1999; 19:366-72. [PMID: 10609187 DOI: 10.1097/00008483-199911000-00008] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The safety of one repetition maximum (1RM) testing for patients with chronic obstructive pulmonary disease (COPD) has not been determined. Therefore, this study was conducted to determine the prevalence of abnormal cardiopulmonary responses, muscle soreness, and muscle injury of patients with moderate to severe COPD in response to 1RM testing. METHODS Twenty pulmonary rehabilitation patients (11 women and 9 men) with moderate or severe COPD participated in this investigation. The 1RM testing was performed using the parallel squat and incline press. Blood pressure, heart rate dyspnea ratings, and oxygen saturation responses were measured immediately following the 1RM procedure. Ratings of muscle soreness and injury were measured immediately after 1RM testing and on days 2 and 7. RESULTS No injury, significant muscle soreness, or abnormal cardiopulmonary responses occurred as a result of 1RM testing. No gender differences were found for any variable measured in response to 1RM testing. CONCLUSIONS A properly supervised and screened pulmonary rehabilitation population can be 1RM tested without significant muscle soreness, injury, or abnormal cardiopulmonary responses.
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Affiliation(s)
- M E Kaelin
- Southern Indiana Rehabilitation Hospital, New Albany, Indiana, USA
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