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Pleguezuelos E, Del Carmen A, Moreno E, Miravitlles M, Serra M, Garnacho-Castaño MV. Effects of a telerehabilitation program and detraining on cardiorespiratory fitness in patients with post-COVID-19 sequelae: A randomized controlled trial. Scand J Med Sci Sports 2024; 34:e14543. [PMID: 38009852 DOI: 10.1111/sms.14543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 10/11/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND This study aimed to evaluate the effects of a 15-week telerehabilitation program and a detraining period on cardiorespiratory fitness and mechanical efficiency in patients with post-COVID-19 sequelae. METHODS 131 patients with post-COVID-19 sequelae were randomly assigned to one of two groups: patients who carried out the supervised telerehabilitation program (TRG, n = 66) and a control group (CG, n = 65). An incremental cardiopulmonary exercise testing (CPET) was performed on cycle ergometer to compare cardioventilatory responses between experimental groups. RESULTS A significant increase in the CPET duration, peak power output, and mechanical efficiency was observed in TRG compared to CG after the telerehabilitation program (p ≤ 0.001). A significant increase in the CPET duration, peak power output, and mechanical efficiency was verified at 3 months compared to the pretest and after detraining in TRG (p < 0.001). A significant increase in peak oxygen uptake (V̇O2peak ) was identified after the intervention and in the detraining period compared to the pretest in both experimental groups (p < 0.001). A higher ventilatory efficiency was observed after the telerehabilitation program (p = 0.021) than in pretest only in TRG. CONCLUSIONS A 15-week supervised home telerehabilitation program improved exercise capacity, power output, and mechanical efficiency in TRG compared to a CG. The telerehabilitation program was not more effective in improving V̇O2peak than the activities of the CG. However, ventilatory efficiency was improved only after the telerehabilitation program. The reported results after the detraining period highlight the need to maintain the rehabilitation program over time.
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Affiliation(s)
- Eulogio Pleguezuelos
- Physical Medicine and Rehabilitation Department, Hospital de Mataró, Barcelona, Spain
- Department of Experimental Science and Healthcare, Faculty of Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Amin Del Carmen
- Physical Medicine and Rehabilitation Department, Hospital de Mataró, Barcelona, Spain
| | - Eva Moreno
- Physical Medicine and Rehabilitation Department, Hospitalet General Hospital, Barcelona, Spain
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Mateu Serra
- Research Unit, Consorci Sanitari del Maresme, Barcelona, Spain
| | - Manuel V Garnacho-Castaño
- DAFNiS Research Group (Pain, Physical Activity, Nutrition and Health), Campus Docent Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
- Facultad de Ciencias de la Salud, Universidad Internacional de Valencia (VIU), Valencia, Spain
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Decker ST, Alexandrou-Majaj N, Layec G. Effects of acute cigarette smoke concentrate exposure on mitochondrial energy transfer in fast- and slow-twitch skeletal muscle. BIOCHIMICA ET BIOPHYSICA ACTA. BIOENERGETICS 2023; 1864:148973. [PMID: 36972770 DOI: 10.1016/j.bbabio.2023.148973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/26/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023]
Abstract
The mechanisms underlying cigarette smoke-induced mitochondrial dysfunction in skeletal muscle are still poorly understood. Accordingly, this study aimed to examine the effects of cigarette smoke on mitochondrial energy transfer in permeabilized muscle fibers from skeletal muscles with differing metabolic characteristics. The electron transport chain (ETC) capacity, ADP transport, and respiratory control by ADP were assessed in fast- and slow-twitch muscle fibers from C57BL/6 mice (n = 11) acutely exposed to cigarette smoke concentrate (CSC) using high-resolution respirometry. CSC decreased complex I-driven respiration in the white gastrocnemius (CONTROL:45.4 ± 11.2 pmolO2.s-1.mg-1 and CSC:27.5 ± 12.0 pmolO2.s-1.mg-1; p = 0.01) and soleus (CONTROL:63.0 ± 23.8 pmolO2.s-1.mg-1 and CSC:44.6 ± 11.1 pmolO2.s-1.mg-1; p = 0.04). In contrast, the effect of CSC on Complex II-linked respiration increased its relative contribution to muscle respiratory capacity in the white gastrocnemius muscle. The maximal respiratory activity of the ETC was significantly inhibited by CSC in both muscles. Furthermore, the respiration rate dependent on the ADP/ATP transport across the mitochondrial membrane was significantly impaired by CSC in the white gastrocnemius (CONTROL:-70 ± 18 %; CSC:-28 ± 10 %; p < 0.001), but not the soleus (CONTROL:47 ± 16 %; CSC:31 ± 7 %; p = 0.08). CSC also significantly impaired mitochondrial thermodynamic coupling in both muscles. Our findings underscore that acute CSC exposure directly inhibits oxidative phosphorylation in permeabilized muscle fibers. This effect was mediated by significant perturbations of the electron transfer in the respiratory complexes, especially at complex I, in both fast and slow twitch muscles. In contrast, CSC-induced inhibition of the exchange of ADP/ATP across the mitochondrial membrane was fiber-type specific, with a large effect on fast-twitch muscles.
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Affiliation(s)
- Stephen T Decker
- Department of Kinesiology, University of Massachusetts Amherst, USA
| | | | - Gwenael Layec
- Department of Kinesiology, University of Massachusetts Amherst, USA; Institute for Applied Life Science, University of Massachusetts Amherst, USA.
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3
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Wang Y, Li P, Cao Y, Liu C, Wang J, Wu W. Skeletal Muscle Mitochondrial Dysfunction in Chronic Obstructive Pulmonary Disease: Underlying Mechanisms and Physical Therapy Perspectives. Aging Dis 2023; 14:33-45. [PMID: 36818563 PMCID: PMC9937710 DOI: 10.14336/ad.2022.0603] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/03/2022] [Indexed: 11/18/2022] Open
Abstract
Skeletal muscle dysfunction (SMD) is a prevalent extrapulmonary complication and a significant independent prognostic factor in patients with chronic obstructive pulmonary disease (COPD). Mitochondrial dysfunction is one of the core factors that damage structure and function in COPD skeletal muscle and is closely related to smoke exposure, hypoxia, and insufficient physical activity. The currently known phenotypes of mitochondrial dysfunction are reduced mitochondrial content and biogenesis, impaired activity of mitochondrial respiratory chain complexes, and increased mitochondrial reactive oxygen species production. Significant progress has been made in research on physical therapy (PT), which has broad prospects for treating the abovementioned potential mitochondrial-function changes in COPD skeletal muscle. In terms of specific types of PT, exercise therapy can directly act on mitochondria and improve COPD SMD by increasing mitochondrial density, regulating mitochondrial biogenesis, upregulating mitochondrial respiratory function, and reducing oxidative stress. However, improvements in mitochondrial-dysfunction phenotype in COPD skeletal muscle due to different exercise strategies are not entirely consistent. Therefore, based on the elucidation of this phenotype, in this study, we analyzed the effect of exercise on mitochondrial dysfunction in COPD skeletal muscle and the regulatory mechanism thereof. We also provided a theoretical basis for exercise programs to rehabilitate this condition.
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Affiliation(s)
- Yingqi Wang
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China.
| | - Peijun Li
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China.
| | - Yuanyuan Cao
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China.
| | - Chanjing Liu
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China.
| | - Jie Wang
- School of Physical Education and Sport Training, Shanghai University of Sport, Shanghai, China.,Correspondence should be addressed to: Dr. Weibing Wu () and Dr. Jie Wang (), Shanghai University of Sport, Shanghai, China
| | - Weibing Wu
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China.,Correspondence should be addressed to: Dr. Weibing Wu () and Dr. Jie Wang (), Shanghai University of Sport, Shanghai, China
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Pleguezuelos E, Del Carmen A, Moreno E, Ortega P, Robles A, Serra-Prat M, Miravitlles M, Yebenes JC, Garnacho-Castaño MV. Impaired pulmonary and muscle function during moderate exercise in female patients recovered from SARS-CoV-2. Sci Rep 2022; 12:20943. [PMID: 36464697 PMCID: PMC9719894 DOI: 10.1038/s41598-022-24941-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022] Open
Abstract
This study aimed to assess pulmonary and muscle dysfunction by analyzing the slow component of oxygen uptake (VO2SC), and mechanical and ventilatory efficiency in adult women recovered from the severe acute respiratory syndrome coronavirus type II (SARS-CoV-2) during a constant load test. 32 women (N = 17 patients with SARS-CoV-2; N = 15 control group) performed two cardiopulmonary exercise tests (CPX) on a cycle ergometer. In the first test, the participants performed incremental CPX until extenuation. In the second test the participants performed a 10-min CPX at a constant load intensity (watts) corresponding to the first ventilatory threshold. There was a 48-72 h rest period between the two tests. There was a significant increase in the VO2SC in the patients recovered from SARS-CoV-2 (160.4 ± 60 mL min-1) in comparison with the healthy participants (59.6 ± 65 mL min-1) (P < 0.001). Mechanical efficiency significantly decreased in patients recovered from SARS-CoV-2 compared to the control group (P = 0.04). Ventilatory inefficiency significantly increased in the patients recovered from SARS-CoV-2 compared with the control group (P < 0.001). Adult women recovered from SARS-CoV-2 infection have important pulmonary and muscular dysfunction and fatigue which contributes to increasing the VO2SC and reducing mechanical and ventilatory efficiency during mild-moderate exercise at a constant load.
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Affiliation(s)
- Eulogio Pleguezuelos
- Physical Medicine and Rehabilitation Department, Hospital de Mataró, Barcelona, Spain
- Department of Experimental Science and Healthcare, Faculty of Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Amin Del Carmen
- Physical Medicine and Rehabilitation Department, Hospital de Mataró, Barcelona, Spain
| | - Eva Moreno
- Physical Medicine and Rehabilitation Department, Hospitalet General Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pilar Ortega
- Pneumology Department, Hospital de Mataró, Barcelona, Spain
| | | | - Mateo Serra-Prat
- Research Unit, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | | | - Manuel V Garnacho-Castaño
- Campus Docent Sant Joan de Déu, Fundación Privada, Universitat de Barcelona, Carrer de Miret i Sans, 10, 08034, Barcelona, Spain.
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5
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Gephine S, Mucci P, Bielmann M, Martin M, Bouyer L, Saey D, Maltais F. Quadriceps physiological response during the 1-min sit-to-stand test in people with severe COPD and healthy controls. Sci Rep 2022; 12:794. [PMID: 35039600 PMCID: PMC8764045 DOI: 10.1038/s41598-022-04820-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 12/13/2021] [Indexed: 11/17/2022] Open
Abstract
We compared quadriceps oxygenation and surface electromyography (sEMG) responses during the 1-min sit-to-stand (1STS) in 14 people with severe COPD and 12 controls, in whom cardiorespiratory response, near-infrared spectroscopy signals (oxy [Hb-Mb], deoxy [Hb-Mb], total [Hb-Mb], and SmO2) and sEMG signals of the quadriceps were recorded. Time duration of each sit-to-stand cycle and the total work performed during the 1STS were measured. The quadriceps oxygenation parameters were normalized by reporting their values according to the total work during 1STS. The rate of sit-to-stand maneuvers decelerated in people with COPD leading to smaller total work compared with controls. The pattern of quadriceps oxygenation response during 1STS was similar between groups. However, in COPD, the recovery after 1STS was characterized by larger overshoots in oxy [Hb-Mb], total [Hb-Mb], and SmO2. When corrected for the cumulative total work, the increase in muscle O2 extraction (deoxy [Hb-Mb]) during the first 30 s of recovery was greater in people with COPD compared to controls. Quadriceps sEMG changes suggestive of a fatiguing contraction pattern was observed only in people with COPD. All together, these results highlighted physiological misadaptation of people with severe COPD to the 1STS.
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Affiliation(s)
- Sarah Gephine
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, 2725 Chemin Sainte-Foy, Quebec, QC, G1V 4G5, Canada.,Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, F-59000, France
| | - Patrick Mucci
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, F-59000, France
| | - Mathieu Bielmann
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Quebec, Canada
| | - Mickael Martin
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, 2725 Chemin Sainte-Foy, Quebec, QC, G1V 4G5, Canada
| | - Laurent Bouyer
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Quebec, Canada
| | - Didier Saey
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, 2725 Chemin Sainte-Foy, Quebec, QC, G1V 4G5, Canada
| | - François Maltais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, 2725 Chemin Sainte-Foy, Quebec, QC, G1V 4G5, Canada.
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The Effects of Sodium Phosphate Supplementation on the Cardiorespiratory System and Gross Efficiency during Exercise under Hypoxia in Male Cyclists: A Randomized, Placebo-Controlled, Cross-Over Study. Nutrients 2021; 13:nu13103556. [PMID: 34684557 PMCID: PMC8538808 DOI: 10.3390/nu13103556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 12/19/2022] Open
Abstract
The main aim of this study was to evaluate the effects of six days of tri-sodium phosphate (SP) supplementation on the cardiorespiratory system and gross efficiency (GE) during exercise under hypoxia in cyclists. Twenty trained male cyclists received SP (50 mg·kg−1 of fat-free mass/day) or placebo for six days in a randomized, cross-over study, with a three-week washout period between supplementation phases. Before and after each supplementation phase, the subjects performed an incremental exercise test to exhaustion under normobaric hypoxia (FiO2 = 16%, ~2500 m). It was observed that short-term SP supplementation led to a decrease in heart rate, an increase in stroke volume, and an improvement in oxygen pulse (VO2/HR) during low and moderate-intensity exercise under hypoxia. These changes were accompanied by an increase in the serum inorganic phosphate level by 8.7% (p < 0.05). No significant changes were observed in serum calcium levels. GE at a given workload did not change significantly after SP supplementation. These results indicated that SP promotes improvements in the efficiency of the cardiorespiratory system during exercise in a hypoxic environment. Thus, SP supplementation may be beneficial for endurance exercise in hypoxia.
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7
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Pleguezuelos E, Del Carmen A, Llorensi G, Carcole J, Casarramona P, Moreno E, Ortega P, Serra-Prat M, Palomera E, Miravitlles MM, Yebenes JC, Boixeda R, Campins L, Villelabeitia-Jaureguizar K, Garnacho-Castaño MV. Severe loss of mechanical efficiency in COVID-19 patients. J Cachexia Sarcopenia Muscle 2021; 12:1056-1063. [PMID: 34102017 PMCID: PMC8242734 DOI: 10.1002/jcsm.12739] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/30/2021] [Accepted: 05/21/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND There is limited information about the impact of coronavirus disease (COVID-19) on the muscular dysfunction, despite the generalized weakness and fatigue that patients report after overcoming the acute phase of the infection. This study aimed to detect impaired muscle efficiency by evaluating delta efficiency (DE) in patients with COVID-19 compared with subjects with chronic obstructive pulmonary disease (COPD), ischaemic heart disease (IHD), and control group (CG). METHODS A total of 60 participants were assigned to four experimental groups: COVID-19, COPD, IHD, and CG (n = 15 each group). Incremental exercise tests in a cycle ergometer were performed to obtain peak oxygen uptake (VO2 peak). DE was obtained from the end of the first workload to the power output where the respiratory exchange ratio was 1. RESULTS A lower DE was detected in patients with COVID-19 and COPD compared with those in CG (P ≤ 0.033). However, no significant differences were observed among the experimental groups with diseases (P > 0.05). Lower VO2 peak, peak ventilation, peak power output, and total exercise time were observed in the groups with diseases than in the CG (P < 0.05). A higher VO2 , ventilation, and power output were detected in the CG compared with those in the groups with diseases at the first and second ventilatory threshold (P < 0.05). A higher power output was detected in the IHD group compared with those in the COVID-19 and COPD groups (P < 0.05) at the first and second ventilatory thresholds and when the respiratory exchange ratio was 1. A significant correlation (P < 0.001) was found between the VO2 peak and DE and between the peak power output and DE (P < 0.001). CONCLUSIONS Patients with COVID-19 showed marked mechanical inefficiency similar to that observed in COPD and IHD patients. Patients with COVID-19 and COPD showed a significant decrease in power output compared to IHD during pedalling despite having similar response in VO2 at each intensity. Resistance training should be considered during the early phase of rehabilitation.
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Affiliation(s)
- Eulogio Pleguezuelos
- Physical Medicine and Rehabilitation Department, Hospital de Mataró, Mataró, Spain.,Department of Experimental Science and Healthcare, Faculty of Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Amin Del Carmen
- Physical Medicine and Rehabilitation Department, Hospital de Mataró, Mataró, Spain
| | - Gemma Llorensi
- Physical Medicine and Rehabilitation Department, Hospital de Mataró, Mataró, Spain
| | - Jessica Carcole
- Physical Medicine and Rehabilitation Department, Hospital de Mataró, Mataró, Spain
| | - Paula Casarramona
- Physical Medicine and Rehabilitation Department, Hospital de Mataró, Mataró, Spain
| | - Eva Moreno
- Physical Medicine and Rehabilitation Department, Hospitalet General Hospital, L'Hospitalet de Llobregat, Spain
| | - Pilar Ortega
- Pneumology Department, Hospital de Mataró, Mataró, Spain
| | | | | | - Marc M Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | | | - Ramón Boixeda
- Department of Internal Medicine, Hospital de Mataró, CSDM, Mataró, Spain.,Grup d'Estudi al Maresme de la Pneumònia Adquirida en la Comunitat i la MPOC (GEMP@C), Mataró, Spain
| | - Lluis Campins
- Department of Pharmacy, Hospital de Mataró, CSdM, Mataró, Spain
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Witham MD, Clarke CL, Hutcheon A, Gingles C, Gandy S, Priba L, Nicholas RS, Cavin I, Sumukadas D, Struthers AD, George J. Effect of allopurinol on phosphocreatine recovery and muscle function in older people with impaired physical function: a randomised controlled trial. Age Ageing 2020; 49:1003-1010. [PMID: 32318695 PMCID: PMC7583523 DOI: 10.1093/ageing/afaa061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/19/2020] [Indexed: 01/22/2023] Open
Abstract
Background Allopurinol has vascular antioxidant effects and participates in purinergic signalling within muscle. We tested whether allopurinol could improve skeletal muscle energetics and physical function in older people with impaired physical performance. Methods We conducted a randomised, double blind, parallel group, placebo-controlled trial, comparing 20 weeks of allopurinol 600 mg once daily versus placebo. We recruited community-dwelling participants aged 65 and over with baseline 6-min walk distance of <400 m and no contraindications to magnetic resonance imaging scanning. Outcomes were measured at baseline and 20 weeks. The primary outcome was post-exercise phosphocreatine (PCr) recovery rate measured using 31P magnetic resonance spectroscopy of the calf. Secondary outcomes included 6-min walk distance, short physical performance battery (SPPB), lean body mass measured by bioimpedance, endothelial function and quality of life. Results In total, 124 participants were randomised, mean age 80 (SD 6) years. A total of 59 (48%) were female, baseline 6-min walk distance was 293 m (SD 80 m) and baseline SPPB was 8.5 (SD 2.0). Allopurinol did not significantly improve PCr recovery rate (treatment effect 0.10 units [95% CI, −0.07 to 0.27], P = 0.25). No significant changes were seen in endothelial function, quality of life, lean body mass or SPPB. Allopurinol improved 6-min walk distance (treatment effect 25 m [95% 4–46, P = 0.02]). This was more pronounced in those with high baseline oxidative stress and urate. Conclusion Allopurinol improved 6-min walk distance but not PCr recovery rate in older people with impaired physical function. Antioxidant strategies to improve muscle function for older people may need to be targeted at subgroups with high baseline oxidative stress.
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Affiliation(s)
- Miles D Witham
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals Trust, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle, UK
| | - Clare L Clarke
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Anita Hutcheon
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Christopher Gingles
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Stephen Gandy
- Department of Medical Physics, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Lukasz Priba
- Department of Medical Physics, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Richard S Nicholas
- Department of Medical Physics, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Ian Cavin
- Department of Medical Physics, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Deepa Sumukadas
- Department of Medicine for the Elderly, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Allan D Struthers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Jacob George
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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Ives SJ, Layec G, Hart CR, Trinity JD, Gifford JR, Garten RS, Witman MAH, Sorensen JR, Richardson RS. Passive leg movement in chronic obstructive pulmonary disease: evidence of locomotor muscle vascular dysfunction. J Appl Physiol (1985) 2020; 128:1402-1411. [PMID: 32324478 DOI: 10.1152/japplphysiol.00568.2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD), characterized by pulmonary dysfunction, is now also recognized to be associated with free radical-mediated vascular dysfunction. However, as previous investigations have utilized the brachial artery flow-mediated dilation technique, whether such vascular dysfunction exists in the locomotor muscle of patients with COPD remains unclear. Therefore, in patients with COPD (n = 13, 66 ± 6 yr) and healthy age- and sex-matched control subjects (n = 12, 68 ± 6 yr), second-by-second measurements of leg blood flow (LBF) (ultrasound Doppler), mean arterial pressure (MAP) (Finapres), and leg vascular conductance (LVC) were recorded before and during both 2 min of continuous upright seated continuous-movement passive leg movement (PLM) and a single-movement PLM (sPLM). In response to PLM, both peak change in LBF (COPD 321 ± 54, Control 470 ± 55 ∆mL/min) and LVC (COPD 3.0 ± 0.5, Control 5.4 ± 0.5 ∆mL·min-1·mmHg-1) were significantly attenuated in patients with COPD compared with control subjects (P < 0.05). This attenuation in the patients with COPD was also evident in response to sPLM, with peak change in LBF tending to be lower (COPD 142 ± 26, Control 169 ± 14 ∆mL/min) and LVC being significantly lower (P < 0.05) in the patients than the control subjects (COPD 1.6 ± 0.4, Control 2.5 ± 0.3 ∆mL·min-1·mmHg-1). Therefore, utilizing both PLM and sPLM, this study provides evidence of locomotor muscle vascular dysfunction in patients with COPD, perhaps due to redox imbalance and reduced nitric oxide bioavailability, which is in agreement with an increased cardiovascular disease risk in this population. This locomotor muscle vascular dysfunction, in combination with the clearly dysfunctional lungs, may contribute to the exercise intolerance associated with COPD.NEW & NOTEWORTHY Utilizing both the single and continuous passive leg movement (PLM) models, which induce nitric oxide (NO)-dependent hyperemia, this study provides evidence of vascular dysfunction in the locomotor muscle of patients with chronic obstructive pulmonary disease (COPD), independent of central hemodynamics. This impaired hyperemia may be the result of an oxidant-mediated attenuation in NO bioavailability. In addition to clearly dysfunctional lungs, vascular dysfunction in locomotor muscle may contribute to the exercise intolerance associated with COPD and increased cardiovascular disease risk.
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Affiliation(s)
- Stephen J Ives
- Geriatric Research, Education, and Clinical Center, George E. Whalen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah.,Health and Human Physiological Sciences Department, Skidmore College, Saratoga Springs, New York
| | - Gwenael Layec
- Geriatric Research, Education, and Clinical Center, George E. Whalen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Corey R Hart
- Geriatric Research, Education, and Clinical Center, George E. Whalen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Joel D Trinity
- Geriatric Research, Education, and Clinical Center, George E. Whalen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Jayson R Gifford
- Geriatric Research, Education, and Clinical Center, George E. Whalen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah.,Department of Exercise Sciences, Brigham Young University, Provo, Utah
| | - Ryan S Garten
- Geriatric Research, Education, and Clinical Center, George E. Whalen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah.,Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Melissa A H Witman
- Geriatric Research, Education, and Clinical Center, George E. Whalen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah.,Department of Kinesiology and Applied Physiology, University of Delaware, Wilmington, Delaware
| | - Jacob R Sorensen
- Department of Exercise Sciences, Brigham Young University, Provo, Utah
| | - Russell S Richardson
- Geriatric Research, Education, and Clinical Center, George E. Whalen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah.,Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
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Broxterman RM, Hoff J, Wagner PD, Richardson R. Determinants of the diminished exercise capacity in patients with chronic obstructive pulmonary disease: looking beyond the lungs. J Physiol 2020; 598:599-610. [PMID: 31856306 PMCID: PMC6995414 DOI: 10.1113/jp279135] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/06/2019] [Indexed: 12/21/2022] Open
Abstract
KEY POINTS Peak oxygen uptake, a primary determinant of prognosis, mortality and quality of life, is diminished in patients with chronic obstructive pulmonary disease (COPD), with mounting evidence supporting an important role for peripheral dysfunction, particularly within skeletal muscle. In patients with severe COPD and activity-matched controls, muscle oxygen transport and utilization were assessed at peak effort during single-leg knee-extensor exercise (KE), where ventilation is assumed to be submaximal. This strategy removes ventilation as the major constraint to exercise capacity in COPD, allowing maximal muscle function to be attained and evaluated. During maximal KE, both convective arterial oxygen delivery to the skeletal muscle microvasculature and subsequent diffusive oxygen delivery to the mitochondria were diminished in patients with COPD compared to control subjects. These findings emphasize the importance of factors, beyond the lungs, that influence exercise capacity in this patient population and may, ultimately, influence the prognosis, mortality and quality of life for patients with COPD. ABSTRACT Peak oxygen uptake ( V ̇ O 2 peak ), a primary determinant of prognosis, mortality and quality of life, is diminished in patients with chronic obstructive pulmonary disease (COPD). Mounting evidence supports an important role of the periphery, particularly skeletal muscle, in the diminished V ̇ O 2 peak with COPD. However, the peripheral determinants of V ̇ O 2 peak have not been comprehensively assessed in this cohort. Thus, the hypothesis was tested that both muscle convective and diffusive oxygen (O2 ) transport, and therefore skeletal muscle peak O2 uptake ( V ̇ M O 2 peak ), are diminished in patients with COPD compared to matched healthy controls, even when ventilatory limitations (i.e. attainment of maximal ventilation) are minimized by using small muscle mass exercise. Muscle O2 transport and utilization were assessed at peak exercise from femoral arterial and venous blood samples and leg blood flow (by thermodilution) in eight patients with severe COPD (forced expiratory volume in 1s (FEV1 ) ± SEM = 0.9 ± 0.1 l, 30% of predicted) and eight controls during single-leg knee-extensor exercise. Both muscle convective O2 delivery (0.44 ± 0.06 vs. 0.69 ± 0.07 l min-1 , P < 0.05) and muscle diffusive O2 conductance (6.6 ± 0.8 vs. 10.4 ± 0.9 ml min-1 mmHg-1 , P < 0.05) were ∼1/3 lower in patients with COPD than controls, resulting in an attenuated V ̇ M O 2 peak in the patients (0.27 ± 0.04 vs. 0.42 ± 0.05 l min-1 , P < 0.05). When cardiopulmonary limitations to exercise are minimized, the convective and diffusive determinants of V ̇ M O 2 peak , at the level of the skeletal muscle, are greatly attenuated in patients with COPD. These findings emphasize the importance of factors, beyond the lungs, that may ultimately influence this population's prognosis, mortality and quality of life.
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Affiliation(s)
- Ryan M. Broxterman
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Salt Lake City, Utah
| | - Jan Hoff
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Peter D. Wagner
- Department of Medicine, University of California, San Diego, La Jolla, California
| | - Russell.S. Richardson
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Salt Lake City, Utah
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
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Marchioro J, Gazzotti MR, Moreira GL, Manzano BM, Menezes AMB, Perez-Padilla R, Jardim JR, Nascimento OA. Anthropometric status of individuals with COPD in the city of São Paulo, Brazil, over time - analysis of a population-based study. ACTA ACUST UNITED AC 2019; 45:e20170157. [PMID: 31365731 PMCID: PMC6715159 DOI: 10.1590/1806-3713/e20170157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/18/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the anthropometric data obtained for residents of the city of São Paulo, Brazil, in a study of Latin America conducted in two phases (baseline, in 2003, and follow-up, in 2012). METHODS This was an analysis of data obtained for São Paulo residents in a two-phase population-based study evaluating the prevalence of COPD and its relationship with certain risk factors among individuals ≥ 40 years of age. The anthropometric data included values for weight, height, body mass index (BMI), and waist circumference. In the follow-up phase of that study, the same variables were evaluated in the same population sample as that of the baseline phase. RESULTS Of the 1,000 São Paulo residents enrolled in the baseline phase of that study, 587 participated in the follow-up phase, and 80 (13.6%) of those 587 subjects had COPD. Comparing the baseline and follow-up phases, we found increases in all anthropometric measures in both groups (COPD and non-COPD), although the differences were significant only in the non-COPD group. The subjects with mild COPD showed increases in weight and BMI (Δweight = 1.6 ± 5.7 and ΔBMI = 0.7 ± 2.2), whereas those with moderate or severe COPD showed reductions (Δweight = -1.7 ± 8.1 and ΔBMI = -0.4 ± 3.0), as did those with severe or very severe COPD (Δweight = -0.5 ± 5.4 and ΔBMI = -0.8 ± 3.3). CONCLUSIONS Between the two phases of the study, the subjects with mild COPD showed increases in weight and BMI, whereas those with a more severe form of the disease showed reductions.
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Affiliation(s)
- Josiane Marchioro
- . Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo - EPM/UNIFESP - São Paulo (SP) Brasil
| | - Mariana Rodrigues Gazzotti
- . Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo - EPM/UNIFESP - São Paulo (SP) Brasil
| | - Graciane Laender Moreira
- . Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo - EPM/UNIFESP - São Paulo (SP) Brasil
| | - Beatriz Martins Manzano
- . Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo - EPM/UNIFESP - São Paulo (SP) Brasil
| | | | | | - José Roberto Jardim
- . Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo - EPM/UNIFESP - São Paulo (SP) Brasil
| | - Oliver Augusto Nascimento
- . Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo - EPM/UNIFESP - São Paulo (SP) Brasil.,. Faculdade de Medicina São Leopoldo Mandic, Campinas (SP) Brasil
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12
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13
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The Relevance of Limb Muscle Dysfunction in Chronic Obstructive Pulmonary Disease. Clin Chest Med 2019; 40:367-383. [DOI: 10.1016/j.ccm.2019.02.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Jabbour G, Majed L. Mechanical Efficiency at Different Exercise Intensities Among Adolescent Boys With Different Body Fat Levels. Front Physiol 2019; 10:265. [PMID: 30930799 PMCID: PMC6428771 DOI: 10.3389/fphys.2019.00265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 02/28/2019] [Indexed: 11/20/2022] Open
Abstract
This study investigated the mechanical efficiency (ME) and associated factors in obese, overweight, and normal-weight adolescent boys during incremental cycle exercise test to exhaustion. Forty-five sedentary adolescent boys (13–14 years old) were separated in three groups according to the percentage of fat mass as follows: 15 normal-weight (NW) (body fat: 16.0 ± 1.9%), 15 overweight (OW) (body fat: 24.0 ± 1.6%), and 15 obese (OB) (body fat: 31.0 ± 3.0%). All groups completed an incremental cycle exercise to exhaustion in which energy consumption (E, W), ME (%), lipid oxidation rate (LO, %), plasma epinephrine and norepinephrine concentrations were determined consecutively at rest and at three intensity levels corresponding to 50 and 75% of each participant’s maximal heart rate (50%HRmax and 75%HRmax) and peak oxygen consumption (V˙O2peak). During the incremental cycle exercise test, plasma epinephrine, and norepinephrine responses as well as ME determined at 50%HRmax, 75%HRmax, and at VO2peak stages were significantly lower in OB compared to NW and OW individuals (ps < 0.01). Multiple linear regressions showed that body weight (ß = -0.64, p < 0.001), energy consumption (ß = -0.24, p < 0.05) and lipid oxidation (ß = 0.69, p < 0.01) were significant predictors of ME at 50%HRmax. However, at 75%HRmax and V˙O2peak, significant predictors of ME were epinephrine (ß = 0.34, ß = 0.49, respectively, ps = 0.01), norepinephrine (ß = 0.26, ß = 0.60, respectively, ps < 0.05) and power output (ß = 0.62, ß = 0.71, respectively, ps < 0.01). These findings suggest that excess in body weight exerts a negative effect on ME at a low intensity by increasing energy consumption for obese and overweight adolescent boys, while at higher intensities (75%HRmax and VO2peak) the lower ME could be better explained by the lower power output and catecholamine responses that were attenuated among obese and overweight adolescent boys.
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Affiliation(s)
- Georges Jabbour
- Sport Science Program, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Lina Majed
- Sport Science Program, College of Arts and Sciences, Qatar University, Doha, Qatar
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15
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Ribeiro F, Oueslati F, Saey D, Lépine PA, Chambah S, Coats V, Maltais F. Cardiorespiratory and Muscle Oxygenation Responses to Isokinetic Exercise in Chronic Obstructive Pulmonary Disease. Med Sci Sports Exerc 2018; 51:841-849. [PMID: 30531487 DOI: 10.1249/mss.0000000000001856] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to describe cardiorespiratory, quadriceps oxygenation, and muscle fatigue responses during a one-legged quadriceps isokinetic endurance exercise in chronic obstructive pulmonary disease (COPD) and control subjects. METHODS Fourteen patients with COPD and 14 control subjects performed a cardiopulmonary cycling exercise test to exhaustion to assess peak oxygen consumption (V˙O2peak), minute ventilation (V˙Epeak), and heart rate (HRpeak). They also performed a quadriceps isokinetic endurance exercise consisting in 30 maximal knee extensions at 90°·s with continuous monitoring of expired gases, cardiac output, and oxygenation of the quadriceps by near-infrared spectroscopy. Total muscle work and fatigue index were also quantified. RESULTS The total muscle work developed during the quadriceps isokinetic endurance exercise was 2.25 ± 0.57 kJ in COPD and 3.12 ± 0.60 kJ in controls, P < 0.001. In absolute terms, there were no between-group differences in V˙O2, V˙E, cardiac output, and HR at the end of quadriceps isokinetic endurance exercise. However, V˙E and HR reported that a fraction of their respective peak values during cardiopulmonary cycling exercise test were higher in COPD (V˙E/V˙Epeak, 69% ± 3%; HR/HRpeak, 82% ± 15%) compared with controls (V˙E/V˙Epeak, 45% ± 2%; HR/HRpeak, 71% ± 13%), all P < 0.05. During quadriceps isokinetic endurance exercise, quadriceps deoxyhemoglobin increased by 47% ± 31% in patients versus 33% ± 41% in controls (P < 0.05 from rest values) with a significant between-group differences (P = 0.025). The fatigue index during the quadriceps exercise was higher in COPD compared with controls. CONCLUSIONS Although one-legged quadriceps isokinetic endurance exercise resulted in substantial central cardiorespiratory demands in COPD, this exercise was nevertheless associated with muscle overload as evidenced by muscle deoxygenation and higher muscle fatigue index in COPD compared with controls. These findings may have implications of the design of exercise training programs in COPD.
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Affiliation(s)
- Fernanda Ribeiro
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Québec, CANADA
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De Benedetto F, Pastorelli R, Ferrario M, de Blasio F, Marinari S, Brunelli L, Wouters EFM, Polverino F, Celli BR. Supplementation with Qter ® and Creatine improves functional performance in COPD patients on long term oxygen therapy. Respir Med 2018; 142:86-93. [PMID: 30170808 DOI: 10.1016/j.rmed.2018.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/01/2018] [Accepted: 08/05/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Skeletal muscle dysfunction and poor functional capacity are important extra-pulmonary manifestations of chronic obstructive pulmonary disease (COPD), especially in COPD patients on long-term O2 therapy (LTOT). Beside the role of pulmonary rehabilitation, the effect of nutritional interventions is still controversial, and there are knowledge gaps on the effective role of nutraceutical supplementation on hard endpoints. The aim of this study was to investigate the effects of nutritional supplementation with Coenzyme Q10 (QTer®) - a powerful antioxidant with the potential to reduce oxidative stress and improve mitochondrial function - and Creatine on functional, nutritional, and metabolomic profile in COPD patients on long-term O2 therapy. METHODS One-hundred and eight patients with COPD from 9 Italian hospitals were enrolled in this double-blinded randomized placebo-controlled clinical study. At baseline and after 2 months of therapy, the patients underwent spirometry, 6-minute walk test (6MWT), bioelectrical impedance analysis, and activities of daily living questionnaire (ADL). Also, dyspnea scores and BODE index were calculated. At both time points, plasma concentration of CoQ10 and metabolomic profiling were measured. FINDINGS Ninety patients, who randomly received supplementation with QTer® and Creatine or placebo, completed the study. Compared with placebo, supplemented patients showed improvements in 6MWT (51 ± 69 versus 15 ± 91 m, p < 0.05), body cell mass and phase angle, sodium/potassium ratio, dyspnea indices and ADL score. The CoQ10 plasma concentration increased in the supplementation group whereas it did not change in the placebo group. The metabolomics profile also differed between groups. Adverse events were similar in both groups. INTERPRETATION These results show that in patients with COPD, dietary supplementation with CoQ10 and Creatine improves functional performance, body composition and perception of dyspnea. A systemic increase in some anti-inflammatory metabolites supports a pathobiological mechanism as a reason for these benefits. Further trials should help clarifying the role of QTer® and Creatine supplementation in patients with COPD.
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Affiliation(s)
| | - Roberta Pastorelli
- Department of Environmental Health Science, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
| | - Manuela Ferrario
- Department of Electronics, Information, and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
| | | | | | - Laura Brunelli
- Department of Environmental Health Science, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
| | - Emiel F M Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | | | - Bartolome R Celli
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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Villelabeitia-Jaureguizar K, Vicente-Campos D, Berenguel Senen A, Hernández Jiménez V, Ruiz Bautista L, Barrios Garrido-Lestache ME, López Chicharro J. Mechanical efficiency of high versus moderate intensity aerobic exercise in coronary heart disease patients: A randomized clinical trial. Cardiol J 2018; 26:130-137. [PMID: 29745970 DOI: 10.5603/cj.a2018.0052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 02/21/2018] [Accepted: 03/01/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Mechanical efficiency (ME) refers to the ability of an individual to transfer energy consumed by external work. A decreased ME, could represent an increased energy cost during exercise and may, therefore, be limited in terms of physical activity. This study aimed to compare the influence of two different exercise protocols: moderate continuous training (MCT) versus high intensity interval training (HIIT), as part of a cardiac rehabilitation program on ME values among coronary patients. METHODS One hundred and ten coronary patients were assigned to either HIIT or MCT groups for 8 weeks. Incremental exercise tests in a cycle ergometer were performed to obtain VO2peak. Net energy expenditure (EE) and ME were obtained at intensities corresponding to the first (VT1) and second (VT2) ventilatory thresholds, and at VO2peak. RESULTS Both exercise programs significantly increase VO2peak with a higher increase in the HIIT group (2.96 ± 2.33 mL/kg/min vs. 3.88 ± 2.40 mL/kg/min, for patients of the MCT and HIIT groups, respectively, p < 0.001). The ME at VO2peak and VT2 only significantly increased in the HIIT group. At VT1, ME significantly increased in both groups, with a greater increase in the HIIT group (2.20 ± ± 6.25% vs. 5.52 ± 5.53%, for patients of the MCT and HIIT groups, respectively, p < 0.001). CONCLUSIONS The application of HIIT to patients with chronic ischemic heart disease of low risk re- sulted in a greater improvement in VO2peak and in ME at VT1, than when MCT was applied. Moreover, only the application of HIIT brought about a significant increase in ME at VT2 and at VO2peak.
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Affiliation(s)
| | - Davinia Vicente-Campos
- Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, UFV, Polideportivo, Ctra. M-515 Pozuelo-Majadahonda km.1,800, 28223 Pozuelo de Alarcón, Madrid, Spain
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18
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Gifford JR, Trinity JD, Kwon OS, Layec G, Garten RS, Park SY, Nelson AD, Richardson RS. Altered skeletal muscle mitochondrial phenotype in COPD: disease vs. disuse. J Appl Physiol (1985) 2018; 124:1045-1053. [PMID: 29357496 PMCID: PMC5972462 DOI: 10.1152/japplphysiol.00788.2017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 11/22/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) exhibit an altered skeletal muscle mitochondrial phenotype, which often includes reduced mitochondrial density, altered respiratory function, and elevated oxidative stress. As this phenotype may be explained by the sedentary lifestyle that commonly accompanies this disease, the aim of this study was to determine whether such alterations are still evident when patients with COPD are compared to control subjects matched for objectively measured physical activity (PA; accelerometry). Indexes of mitochondrial density [citrate synthase (CS) activity], respiratory function (respirometry in permeabilized fibers), and muscle oxidative stress [4-hydroxynonenal (4-HNE) content] were assessed in muscle fibers biopsied from the vastus lateralis of nine patients with COPD and nine PA-matched control subjects (CON). Despite performing similar levels of PA (CON: 18 ± 3, COPD: 20 ± 7 daily minutes moderate-to-vigorous PA; CON: 4,596 ± 683, COPD: 4,219 ± 763 steps per day, P > 0.70), patients with COPD still exhibited several alterations in their mitochondrial phenotype, including attenuated skeletal muscle mitochondrial density (CS activity; CON 70.6 ± 3.8, COPD 52.7 ± 6.5 U/mg, P < 0.05), altered mitochondrial respiration [e.g., ratio of complex I-driven state 3 to complex II-driven state 3 (CI/CII); CON: 1.20 ± 0.11, COPD: 0.90 ± 0.05, P < 0.05), and oxidative stress (4-HNE; CON: 1.35 ± 0.19, COPD: 2.26 ± 0.25 relative to β-actin, P < 0.05). Furthermore, CS activity ( r = 0.55), CI/CII ( r = 0.60), and 4-HNE ( r = 0.49) were all correlated with pulmonary function, assessed as forced expiratory volume in 1 s ( P < 0.05), but not PA ( P > 0.05). In conclusion, the altered mitochondrial phenotype in COPD is present even in the absence of differing levels of PA and appears to be related to the disease itself. NEW & NOTEWORTHY Chronic obstructive pulmonary disease (COPD) is associated with debilitating alterations in the function of skeletal muscle mitochondria. By comparing the mitochondrial phenotype of patients with COPD to that of healthy control subjects who perform the same amount of physical activity each day, this study provides evidence that many aspects of the dysfunctional mitochondrial phenotype observed in COPD are not merely due to reduced physical activity but are likely related to the disease itself.
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Affiliation(s)
- Jayson R Gifford
- Department of Exercise Sciences, Brigham Young University , Provo, Utah
- Geriatric Research, Education, and Clinical Center, Salt Lake City Department of Veterans Medical Center , Salt Lake City, Utah
- Department of Internal Medicine, University of Utah , Salt Lake City, Utah
| | - Joel D Trinity
- Geriatric Research, Education, and Clinical Center, Salt Lake City Department of Veterans Medical Center , Salt Lake City, Utah
- Department of Internal Medicine, University of Utah , Salt Lake City, Utah
| | - Oh-Sung Kwon
- Geriatric Research, Education, and Clinical Center, Salt Lake City Department of Veterans Medical Center , Salt Lake City, Utah
- Department of Internal Medicine, University of Utah , Salt Lake City, Utah
| | - Gwenael Layec
- Geriatric Research, Education, and Clinical Center, Salt Lake City Department of Veterans Medical Center , Salt Lake City, Utah
- Department of Internal Medicine, University of Utah , Salt Lake City, Utah
| | - Ryan S Garten
- Department of Exercise Science, Health, and Movement Science, Virginia Commonwealth University , Richmond, Virginia
| | - Song-Young Park
- School of Health and Kinesiology, University of Nebraska , Omaha, Nebraska
| | - Ashley D Nelson
- Geriatric Research, Education, and Clinical Center, Salt Lake City Department of Veterans Medical Center , Salt Lake City, Utah
- Department of Internal Medicine, University of Utah , Salt Lake City, Utah
| | - Russell S Richardson
- Geriatric Research, Education, and Clinical Center, Salt Lake City Department of Veterans Medical Center , Salt Lake City, Utah
- Department of Internal Medicine, University of Utah , Salt Lake City, Utah
- Department of Nutrition and Integrative Physiology, University of Utah , Salt Lake City, Utah
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Nyberg A, Saey D, Martin M, Maltais F. Cardiorespiratory and muscle oxygenation responses to low-load/high-repetition resistance exercises in COPD and healthy controls. J Appl Physiol (1985) 2018; 124:877-887. [DOI: 10.1152/japplphysiol.00447.2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Single-limb exercises have been used as a strategy to improve aerobic exercise tolerance in patients with chronic obstructive pulmonary disease (COPD) by alleviating the cardiopulmonary demand. We asked whether this strategy would also apply to cardiorespiratory demand and amount of work performed during single-limb and two-limb low-load/high-repetition resistance exercises in 20 patients with COPD [forced expiratory volume in 1 s (FEV1) = 1.0 liters, 38% of predicted] and 15 age-, sex-, and activity-matched healthy controls. Peak ventilation, peak oxygen consumption (V̇o2), and peak heart rate (HR) were assessed to document cardiorespiratory demand during shoulder flexion and knee extension exercises while exercise tolerance was assessed by the total amount of work achieved. In addition, changes in myoglobin-deoxyhemoglobin level (Δdeoxy-[Hb/Mb]) were measured during single-limb knee extension. In COPD, single-limb shoulder flexion and knee extension elicited higher localized workloads than two-limb exercises (21 and 24% higher workloads for the former exercise) while cardiopulmonary demand was 8–16% higher during two-limb exercises. When expressed as a percentage of peak values achieved during incremental cycle ergometry, peak V̇O2 and HR were similarly high during single-limb shoulder flexion and knee extension exercises, representing 90% of peak HR and 60% of peak V̇O2. Apart from single-limb knee extension, cardiorespiratory demand per kilogram work during low-load/high-repetition knee extension and shoulder flexion exercises was higher in patients with COPD than in healthy controls (range 27–122%, P < 0.0125). Δdeoxy-[Hb/Mb] of the quadriceps during knee extension was similar between the two groups, while Δdeoxy-[Hb/Mb] per kilogram work was higher in patients with COPD. We conclude that 1) in patients with COPD, single-limb exercises resulted in lower peak cardiorespiratory demand as well as higher localized workloads compared with two-limb exercises; 2) compared with healthy controls, the cardiorespiratory demand, either expressed per unit of work or relative to peak capacity, was higher in patients with COPD than in controls during low-load/high-repetition resistance exercises, irrespective of the involvement of one or two limbs or of the upper or lower extremity; 3) quadriceps muscle deoxygenation per unit of work during low-load/high-repetition knee extension was increased in COPD compared with controls; and 4) single- and two-limb low-load/high-repetition knee extension and shoulder flexion resistance exercises imposed a similar burden on the cardiorespiratory system, resulting in a higher cardiorespiratory demand per kilogram work performed during shoulder flexion compared with knee extension, in both COPD and healthy controls. NEW & NOTEWORTHY In chronic obstructive pulmonary disease (COPD), single-limb knee extension and shoulder flexion resulted in a lower peak cardiorespiratory response as well as larger localized exercise workloads compared with two-limb exercises. Cardiorespiratory and quadriceps deoxygenation cost per kilogram work was greater in COPD compared with healthy controls, despite similar acute responses. Compared with knee extension, shoulder flexion imposed a similar burden on the cardiorespiratory system in patients with COPD and healthy controls.
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Affiliation(s)
- André Nyberg
- Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec, Canada
| | - Didier Saey
- Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec, Canada
- Faculté de Médicine, Université Laval, Quebec, Canada
| | - Mickaël Martin
- Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec, Canada
| | - François Maltais
- Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec, Canada
- Faculté de Médicine, Université Laval, Quebec, Canada
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Layec G, Hart CR, Trinity JD, Kwon OS, Rossman MJ, Broxterman RM, Le Fur Y, Jeong EK, Richardson RS. Oxygen delivery and the restoration of the muscle energetic balance following exercise: implications for delayed muscle recovery in patients with COPD. Am J Physiol Endocrinol Metab 2017; 313:E94-E104. [PMID: 28292763 PMCID: PMC6109703 DOI: 10.1152/ajpendo.00462.2016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/03/2017] [Accepted: 03/13/2017] [Indexed: 11/22/2022]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) experience a delayed recovery from skeletal muscle fatigue following exhaustive exercise that likely contributes to their progressive loss of mobility. As this phenomenon is not well understood, this study sought to examine postexercise peripheral oxygen (O2) transport and muscle metabolism dynamics in patients with COPD, two important determinants of muscle recovery. Twenty-four subjects, 12 nonhypoxemic patients with COPD and 12 healthy subjects with a sedentary lifestyle, performed dynamic plantar flexion exercise at 40% of the maximal work rate (WRmax) with phosphorus magnetic resonance spectroscopy (31P-MRS), near-infrared spectroscopy (NIRS), and vascular Doppler ultrasound assessments. The mean response time of limb blood flow at the offset of exercise was significantly prolonged in patients with COPD (controls: 56 ± 27 s; COPD: 120 ± 87 s; P < 0.05). In contrast, the postexercise time constant for capillary blood flow was not significantly different between groups (controls: 49 ± 23 s; COPD: 51 ± 21 s; P > 0.05). The initial postexercise convective O2 delivery (controls: 0.15 ± 0.06 l/min; COPD: 0.15 ± 0.06 l/min) and the corresponding oxidative adenosine triphosphate (ATP) demand (controls: 14 ± 6 mM/min; COPD: 14 ± 6 mM/min) in the calf were not significantly different between controls and patients with COPD (P > 0.05). The phosphocreatine resynthesis time constant (controls: 46 ± 20 s; COPD: 49 ± 21 s), peak mitochondrial phosphorylation rate, and initial proton efflux were also not significantly different between groups (P > 0.05). Therefore, despite perturbed peripheral hemodynamics, intracellular O2 availability, proton efflux, and aerobic metabolism recovery in the skeletal muscle of nonhypoxemic patients with COPD are preserved following plantar flexion exercise and thus are unlikely to contribute to the delayed recovery from exercise in this population.
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Affiliation(s)
- Gwenael Layec
- Department of Medicine, Division of Geriatrics, University of Utah, Salt Lake City, Utah;
- Geriatric Research, Education, and Clinical Center, George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | - Corey R Hart
- Geriatric Research, Education, and Clinical Center, George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah
- Department of Exercise and Sport Science, University of Utah, Salt Lake City, Utah
| | - Joel D Trinity
- Department of Medicine, Division of Geriatrics, University of Utah, Salt Lake City, Utah
- Geriatric Research, Education, and Clinical Center, George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | - Oh-Sung Kwon
- Department of Medicine, Division of Geriatrics, University of Utah, Salt Lake City, Utah
- Geriatric Research, Education, and Clinical Center, George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Matthew J Rossman
- Geriatric Research, Education, and Clinical Center, George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah
- Department of Exercise and Sport Science, University of Utah, Salt Lake City, Utah
| | - Ryan M Broxterman
- Department of Medicine, Division of Geriatrics, University of Utah, Salt Lake City, Utah
- Geriatric Research, Education, and Clinical Center, George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Yann Le Fur
- Centre de Résonance Magnétique Biologique et Médicale, Aix-Marseille Universite, Centre National de la Recherche Scientifique, Marseille, France; and
| | - Eun-Kee Jeong
- Department of Radiology and Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, Utah
| | - Russell S Richardson
- Department of Medicine, Division of Geriatrics, University of Utah, Salt Lake City, Utah
- Geriatric Research, Education, and Clinical Center, George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
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Azevedo DDP, Medeiros WM, de Freitas FFM, Ferreira Amorim C, Gimenes ACO, Neder JA, Chiavegato LD. High oxygen extraction and slow recovery of muscle deoxygenation kinetics after neuromuscular electrical stimulation in COPD patients. Eur J Appl Physiol 2016; 116:1899-910. [PMID: 27468840 DOI: 10.1007/s00421-016-3442-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 07/22/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE It was hypothesized that patients with chronic obstructive pulmonary disease (COPD) would exhibit a slow muscle deoxygenation (HHb) recovery time when compared with sedentary controls. METHODS Neuromuscular electrical stimulation (NMES 40 and 50 mA, 50 Hz, 400 µs) was employed to induce isometric contraction of the quadriceps. Microvascular oxygen extraction (µO2EF) and HHb were estimated by near-infrared spectroscopy (NIRS). Recovery kinetic was characterized by measuring the time constant Tau (HHb-τ). Torque and work were measured by isokinetic dynamometry in 13 non-hypoxaemic patients with moderate-to-severe COPD [SpO2 = 94.1 ± 1.6 %; FEV1 (% predict) 48.0 ± 9.6; GOLD II-III] and 13 age- and sex-matched sedentary controls. RESULTS There was no desaturation in either group during NMES. Torque and work were reduced in COPD versus control for 40 and 50 mA [torque (Nm) 50 mA = 28.9 ± 6.9 vs 46.1 ± 14.2; work (J) 50 mA = 437.2 ± 130.0 vs. 608.3 ± 136.8; P < 0.05 for all]. High µO2EF values were observed in the COPD group at both NMES intensities (corrected by muscle mass 50 mA = 6.18 ± 1.1 vs. 4.68 ± 1.0 %/kg; corrected by work 50 mA = 0.12 ± 0.05 vs. 0.07 ± 0.02 %/J; P < 0.05 for all). Absolute values of HHb-τ (50 mA = 31.11 ± 9.27 vs. 18.08 ± 10.70 s), corrected for muscle mass (50 mA 3.80 ± 1.28 vs. 2.05 ± 1.45 s/kg) and corrected for work (50 mA = 0.08 ± 0.04 vs. 0.03 ± 0.02 s/J) were reduced in COPD (P < 0.05 for all). The variables behaviour for 40 mA was similar to those of 50 mA. CONCLUSIONS COPD patients exhibited a slower muscle deoxygenation recovery time after NMES. The absence of desaturation, low torque and work, high µO2EF and high values for recovery time corrected by muscle mass and work suggest that intrinsic muscle dysfunction has an impact on muscle recovery capacity.
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Affiliation(s)
- Diego de Paiva Azevedo
- Master's and Doctoral Program in Physical Therapy, Universidade de São Paulo (UNICID), Sao Paulo, SP, Brazil
| | - Wladimir Musetti Medeiros
- Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Medicine, Federal University of Sao Paulo (UNIFESP), Rua Professor Francisco de Castro 54, Vila Clementino, Sao Paulo, CEP 04020-050, Brazil
| | | | - Cesar Ferreira Amorim
- Master's and Doctoral Program in Physical Therapy, Universidade de São Paulo (UNICID), Sao Paulo, SP, Brazil
| | - Ana Cristina Oliveira Gimenes
- Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Medicine, Federal University of Sao Paulo (UNIFESP), Rua Professor Francisco de Castro 54, Vila Clementino, Sao Paulo, CEP 04020-050, Brazil
| | - Jose Alberto Neder
- Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Medicine, Federal University of Sao Paulo (UNIFESP), Rua Professor Francisco de Castro 54, Vila Clementino, Sao Paulo, CEP 04020-050, Brazil
| | - Luciana Dias Chiavegato
- Master's and Doctoral Program in Physical Therapy, Universidade de São Paulo (UNICID), Sao Paulo, SP, Brazil. .,Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Medicine, Federal University of Sao Paulo (UNIFESP), Rua Professor Francisco de Castro 54, Vila Clementino, Sao Paulo, CEP 04020-050, Brazil.
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Gifford JR, Trinity JD, Layec G, Garten RS, Park SY, Rossman MJ, Larsen S, Dela F, Richardson RS. Quadriceps exercise intolerance in patients with chronic obstructive pulmonary disease: the potential role of altered skeletal muscle mitochondrial respiration. J Appl Physiol (1985) 2015; 119:882-8. [PMID: 26272320 PMCID: PMC4610006 DOI: 10.1152/japplphysiol.00460.2015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/11/2015] [Indexed: 11/22/2022] Open
Abstract
This study sought to determine if qualitative alterations in skeletal muscle mitochondrial respiration, associated with decreased mitochondrial efficiency, contribute to exercise intolerance in patients with chronic obstructive pulmonary disease (COPD). Using permeabilized muscle fibers from the vastus lateralis of 13 patients with COPD and 12 healthy controls, complex I (CI) and complex II (CII)-driven State 3 mitochondrial respiration were measured separately (State 3:CI and State 3:CII) and in combination (State 3:CI+CII). State 2 respiration was also measured. Exercise tolerance was assessed by knee extensor exercise (KE) time to fatigue. Per milligram of muscle, State 3:CI+CII and State 3:CI were reduced in COPD (P < 0.05), while State 3:CII and State 2 were not different between groups. To determine if this altered pattern of respiration represented qualitative changes in mitochondrial function, respiration states were examined as percentages of peak respiration (State 3:CI+CII), which revealed altered contributions from State 3:CI (Con 83.7 ± 3.4, COPD 72.1 ± 2.4%Peak, P < 0.05) and State 3:CII (Con 64.9 ± 3.2, COPD 79.5 ± 3.0%Peak, P < 0.05) respiration, but not State 2 respiration in COPD. Importantly, a diminished contribution of CI-driven respiration relative to the metabolically less-efficient CII-driven respiration (CI/CII) was also observed in COPD (Con 1.28 ± 0.09, COPD 0.81 ± 0.05, P < 0.05), which was related to exercise tolerance of the patients (r = 0.64, P < 0.05). Overall, this study indicates that COPD is associated with qualitative alterations in skeletal muscle mitochondria that affect the contribution of CI and CII-driven respiration, which potentially contributes to the exercise intolerance associated with this disease.
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Affiliation(s)
- Jayson R Gifford
- Geriatric Research, Education, and Clinical Center, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah; Department of Exercise and Sport Science, University of Utah, Salt Lake City, Utah
| | - Joel D Trinity
- Geriatric Research, Education, and Clinical Center, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah; Department of Internal Medicine, University of Utah, Salt Lake City, Utah; and
| | - Gwenael Layec
- Geriatric Research, Education, and Clinical Center, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah; Department of Internal Medicine, University of Utah, Salt Lake City, Utah; and
| | - Ryan S Garten
- Geriatric Research, Education, and Clinical Center, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah; Department of Internal Medicine, University of Utah, Salt Lake City, Utah; and
| | - Song-Young Park
- Geriatric Research, Education, and Clinical Center, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah; Department of Exercise and Sport Science, University of Utah, Salt Lake City, Utah
| | - Matthew J Rossman
- Geriatric Research, Education, and Clinical Center, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah; Department of Exercise and Sport Science, University of Utah, Salt Lake City, Utah
| | - Steen Larsen
- Xlab, Center for Healthy Aging, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Dela
- Xlab, Center for Healthy Aging, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Russell S Richardson
- Geriatric Research, Education, and Clinical Center, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah; Department of Exercise and Sport Science, University of Utah, Salt Lake City, Utah; Department of Internal Medicine, University of Utah, Salt Lake City, Utah; and
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Medeiros WM, Fernandes MCT, Azevedo DP, de Freitas FFM, Amorim BC, Chiavegato LD, Hirai DM, O'Donnell DE, Neder JA. Oxygen delivery-utilization mismatch in contracting locomotor muscle in COPD: peripheral factors. Am J Physiol Regul Integr Comp Physiol 2014; 308:R105-11. [PMID: 25477423 DOI: 10.1152/ajpregu.00404.2014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Central cardiorespiratory and gas exchange limitations imposed by chronic obstructive pulmonary disease (COPD) impair ambulatory skeletal muscle oxygenation during whole body exercise. This investigation tested the hypothesis that peripheral factors per se contribute to impaired contracting lower limb muscle oxygenation in COPD patients. Submaximal neuromuscular electrical stimulation (NMES; 30, 40, and 50 mA at 50 Hz) of the quadriceps femoris was employed to evaluate contracting skeletal muscle oxygenation while minimizing the influence of COPD-related central cardiorespiratory constraints. Fractional O₂ extraction was estimated by near-infrared spectroscopy (deoxyhemoglobin/myoglobin concentration; deoxy-[Hb/Mb]), and torque output was measured by isokinetic dynamometry in 15 nonhypoxemic patients with moderate-to-severe COPD (SpO2 = 94 ± 2%; FEV₁ = 46.4 ± 10.1%; GOLD II and III) and in 10 age- and gender-matched sedentary controls. COPD patients had lower leg muscle mass than controls (LMM = 8.0 ± 0.7 kg vs. 8.9 ± 1.0 kg, respectively; P < 0.05) and produced relatively lower absolute and LMM-normalized torque across the range of NMES intensities (P < 0.05 for all). Despite producing less torque, COPD patients had similar deoxy-[Hb/Mb] amplitudes at 30 and 40 mA (P > 0.05 for both) and higher deoxy-[Hb/Mb] amplitude at 50 mA (P < 0.05). Further analysis indicated that COPD patients required greater fractional O₂ extraction to produce torque (i.e., ↑Δdeoxy-[Hb/Mb]/torque) relative to controls (P < 0.05 for 40 and 50 mA) and as a function of NMES intensity (P < 0.05 for all). The present data obtained during submaximal NMES of small muscle mass indicate that peripheral abnormalities contribute mechanistically to impaired contracting skeletal muscle oxygenation in nonhypoxemic, moderate-to-severe COPD patients.
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Affiliation(s)
- Wladimir M Medeiros
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division, Department of Medicine, School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Mari C T Fernandes
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division, Department of Medicine, School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Diogo P Azevedo
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division, Department of Medicine, School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Flavia F M de Freitas
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division, Department of Medicine, School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Beatriz C Amorim
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division, Department of Medicine, School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Luciana D Chiavegato
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division, Department of Medicine, School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Daniel M Hirai
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division, Department of Medicine, School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil; Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, Canada; and
| | - Denis E O'Donnell
- Respiratory Investigation Unit (RIU), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, Canada
| | - J Alberto Neder
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division, Department of Medicine, School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil; Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, Canada; and
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Shields GS, Coissi GS, Jimenez-Royo P, Gambarota G, Dimber R, Hopkinson NS, Matthews PM, Brown AP, Polkey MI. Bioenergetics and intermuscular fat in chronic obstructive pulmonary disease-associated quadriceps weakness. Muscle Nerve 2014; 51:214-21. [PMID: 24831173 DOI: 10.1002/mus.24289] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2014] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is associated with metabolic abnormalities in muscles of the lower limbs, but it is not known whether these abnormalities are generalized or limited to specific muscle groups, nor is there an easy way of predicting their presence. METHODS Metabolism in the quadriceps and biceps of 14 COPD patients and controls was assessed during sustained contraction using 31-phosphorus magnetic resonance spectroscopy ((31) P MRS). T1 MRI was used to measure quadriceps intermuscular adipose tissue (IMAT). RESULTS COPD patients had prolonged quadriceps phosphocreatine time (patients: 38.8 ± 12.7 s; controls: 25.2 ± 10.6 s; P = 0.006) and a lower pH (patents: 6.88 ± 0.1; controls: 6.99 ± 0.06; P = 0.002). Biceps measures were not significantly different. IMAT was associated with a nadir pH <7.0 (area under the curve = 0.84). CONCLUSIONS Anaerobic metabolism during contraction was characteristic of quadriceps, but not biceps, muscles of patients with COPD and was associated with increased IMAT. Because IMAT can be assessed quickly by conventional MRI, it may be a useful approach for identifying patients with abnormal muscle bioenergetics.
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Affiliation(s)
- Gregory Samuel Shields
- Clinical Imaging Centre, GlaxoSmithKline Research and Development, Hammersmith Hospital, London, UK
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Schols AM, Ferreira IM, Franssen FM, Gosker HR, Janssens W, Muscaritoli M, Pison C, Rutten-van Mölken M, Slinde F, Steiner MC, Tkacova R, Singh SJ. Nutritional assessment and therapy in COPD: a European Respiratory Society statement. Eur Respir J 2014; 44:1504-20. [PMID: 25234804 DOI: 10.1183/09031936.00070914] [Citation(s) in RCA: 184] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Nutrition and metabolism have been the topic of extensive scientific research in chronic obstructive pulmonary disease (COPD) but clinical awareness of the impact dietary habits, nutritional status and nutritional interventions may have on COPD incidence, progression and outcome is limited. A multidisciplinary Task Force was created by the European Respiratory Society to deliver a summary of the evidence and description of current practice in nutritional assessment and therapy in COPD, and to provide directions for future research. Task Force members conducted focused reviews of the literature on relevant topics, advised by a methodologist. It is well established that nutritional status, and in particular abnormal body composition, is an important independent determinant of COPD outcome. The Task Force identified different metabolic phenotypes of COPD as a basis for nutritional risk profile assessment that is useful in clinical trial design and patient counselling. Nutritional intervention is probably effective in undernourished patients and probably most when combined with an exercise programme. Providing evidence of cost-effectiveness of nutritional intervention is required to support reimbursement and thus increase access to nutritional intervention. Overall, the evidence indicates that a well-balanced diet is beneficial to all COPD patients, not only for its potential pulmonary benefits, but also for its proven benefits in metabolic and cardiovascular risk.
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Affiliation(s)
- Annemie M Schols
- NUTRIM School for Nutrition, Toxicology and Metabolism, Dept of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ivone M Ferreira
- Asthma and Airways Centre, Toronto Western Hospital, Toronto, Canada Dept of Respiratory Medicine, McMaster University, Hamilton, Canada
| | - Frits M Franssen
- Program Development Centre, CIRO+ (Centre of Expertise for Chronic Organ Failure), Horn, The Netherlands
| | - Harry R Gosker
- NUTRIM School for Nutrition, Toxicology and Metabolism, Dept of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Wim Janssens
- Laboratory of Respiratory Medicine, Katholieke Universiteit, Leuven, Belgium
| | | | - Christophe Pison
- Clinique Universitaire de Pneumologie, Institut du Thorax, CHU Grenoble, Grenoble, France Inserm U1055, Grenoble, France Université Joseph Fourier, Grenoble, France European Institute for Systems Biology and Medicine, Lyon, France
| | - Maureen Rutten-van Mölken
- Erasmus University Rotterdam, Institute of Health Policy and Management, Rotterdam The Netherlands Erasmus University Rotterdam, Institute of Medical Technology Assessment, Rotterdam, The Netherlands
| | - Frode Slinde
- Dept of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Michael C Steiner
- Centre for Exercise and Rehabilitation Science, Leicester Respiratory Biomedical Research Unit, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - Ruzena Tkacova
- Dept of Respiratory Medicine, Faculty of Medicine, P.J. Safarik University, Kosice, Slovakia L. Pasteur University Hospital, Kosice, Slovakia
| | - Sally J Singh
- Centre for Exercise and Rehabilitation Science, Leicester Respiratory Biomedical Research Unit, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
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Maltais F, Decramer M, Casaburi R, Barreiro E, Burelle Y, Debigaré R, Dekhuijzen PNR, Franssen F, Gayan-Ramirez G, Gea J, Gosker HR, Gosselink R, Hayot M, Hussain SNA, Janssens W, Polkey MI, Roca J, Saey D, Schols AMWJ, Spruit MA, Steiner M, Taivassalo T, Troosters T, Vogiatzis I, Wagner PD. An official American Thoracic Society/European Respiratory Society statement: update on limb muscle dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2014; 189:e15-62. [PMID: 24787074 DOI: 10.1164/rccm.201402-0373st] [Citation(s) in RCA: 683] [Impact Index Per Article: 68.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Limb muscle dysfunction is prevalent in chronic obstructive pulmonary disease (COPD) and it has important clinical implications, such as reduced exercise tolerance, quality of life, and even survival. Since the previous American Thoracic Society/European Respiratory Society (ATS/ERS) statement on limb muscle dysfunction, important progress has been made on the characterization of this problem and on our understanding of its pathophysiology and clinical implications. PURPOSE The purpose of this document is to update the 1999 ATS/ERS statement on limb muscle dysfunction in COPD. METHODS An interdisciplinary committee of experts from the ATS and ERS Pulmonary Rehabilitation and Clinical Problems assemblies determined that the scope of this document should be limited to limb muscles. Committee members conducted focused reviews of the literature on several topics. A librarian also performed a literature search. An ATS methodologist provided advice to the committee, ensuring that the methodological approach was consistent with ATS standards. RESULTS We identified important advances in our understanding of the extent and nature of the structural alterations in limb muscles in patients with COPD. Since the last update, landmark studies were published on the mechanisms of development of limb muscle dysfunction in COPD and on the treatment of this condition. We now have a better understanding of the clinical implications of limb muscle dysfunction. Although exercise training is the most potent intervention to address this condition, other therapies, such as neuromuscular electrical stimulation, are emerging. Assessment of limb muscle function can identify patients who are at increased risk of poor clinical outcomes, such as exercise intolerance and premature mortality. CONCLUSIONS Limb muscle dysfunction is a key systemic consequence of COPD. However, there are still important gaps in our knowledge about the mechanisms of development of this problem. Strategies for early detection and specific treatments for this condition are also needed.
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In vivo evidence of an age-related increase in ATP cost of contraction in the plantar flexor muscles. Clin Sci (Lond) 2014; 126:581-92. [PMID: 24224517 DOI: 10.1042/cs20130442] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Impaired skeletal muscle efficiency potentially contributes to the age-related decline in exercise capacity and may explain the altered haemodynamic response to exercise in the elderly. Thus we examined whether (i) the ATP cost of contraction increases with age, and (ii) this results in altered convective O(2) delivery to maintain microvascular oxygenation in the calf muscle. To this aim, we used an integrative experimental approach combining (31)P-MRS (magnetic resonance spectroscopy), Doppler ultrasound imaging and NIRS (near-IR spectroscopy) during dynamic plantar flexion exercise at 40% of WR(max) (maximal power output) in 20 healthy young and 20 older subjects matched for physical activity. The ATP cost of contraction was significantly higher in the old (7.2±4.1 mM/min per W) compared with the young (2.4±1.9 mM/min per W; P<0.05) and this was only significantly correlated with the plantar flexion WR(max) value in the old subjects (r=-0.52; P<0.05). Even when differences in power output were taken into account, end-exercise blood flow (old, 259±168 ml/min per W and young, 134±40 ml/min per W; P<0.05) and convective O(2) delivery (old, 0.048±0.031 l/min per W and young, 0.026±0.008 l/min per W; P<0.05) were greater in the old in comparison with the young subjects. In contrast, the NIRS oxyhaemoglobin, deoxyhaemoglobin and microvascular oxygenation indices were not significantly different between the groups (P>0.05). Therefore the present study reveals that, although the peripheral haemodynamic responses to plantar flexion exercise appear to be appropriate, the elevated energy cost of contraction and associated reduction in the WR(max) value in this muscle group may play a role in limiting exercise capacity with age.
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Slot IGM, van den Borst B, Hellwig VACV, Barreiro E, Schols AMWJ, Gosker HR. The muscle oxidative regulatory response to acute exercise is not impaired in less advanced COPD despite a decreased oxidative phenotype. PLoS One 2014; 9:e90150. [PMID: 24587251 PMCID: PMC3938598 DOI: 10.1371/journal.pone.0090150] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 01/28/2014] [Indexed: 12/31/2022] Open
Abstract
Already in an early disease stage, patients with chronic obstructive pulmonary disease (COPD) are confronted with impaired skeletal muscle function and physical performance due to a loss of oxidative type I muscle fibers and oxidative capacity (i.e. oxidative phenotype; Oxphen). Physical activity is a well-known stimulus of muscle Oxphen and crucial for its maintenance. We hypothesized that a blunted response of Oxphen genes to an acute bout of exercise could contribute to decreased Oxphen in COPD. For this, 28 patients with less advanced COPD (age 65±7 yrs, FEV1 59±16% predicted) and 15 age- and gender-matched healthy controls performed an incremental cycle ergometry test. The Oxphen response to exercise was determined by the measurement of gene expression levels of Oxphen markers in pre and 4h-post exercise quadriceps biopsies. Because exercise-induced hypoxia and oxidative stress may interfere with Oxphen response, oxygen saturation and oxidative stress markers were assessed as well. Regardless of oxygen desaturation and absolute exercise intensities, the Oxphen regulatory response to exercise was comparable between COPD patients and controls with no evidence of increased oxidative stress. In conclusion, the muscle Oxphen regulatory response to acute exercise is not blunted in less advanced COPD, regardless of exercise-induced hypoxia. Hence, this study provides further rationale for incorporation of exercise training as integrated part of disease management to prevent or slow down loss of muscle Oxphen and related functional impairment in COPD.
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Affiliation(s)
- Ilse G. M. Slot
- Department of Respiratory Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Bram van den Borst
- Department of Respiratory Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Valéry A. C. V. Hellwig
- Department of Respiratory Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Esther Barreiro
- Pulmonology Department-Muscle and Respiratory System Research Unit (URMAR), Research Institute of Hospital del Mar (IMIM), Department of Experimental and Health Sciences (CEXS), Pompeu Fabra University (UPF), Barcelona Biomedical Research Park (PRBB), Barcelona, Spain
- Network of Excellence in Respiratory Research (CIBERES), Institute of Health Carlos III (ISCIII), Bunyola, Majorca, Balearic Islands, Spain
| | - Annemie M. W. J. Schols
- Department of Respiratory Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Harry R. Gosker
- Department of Respiratory Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
- * E-mail:
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Abstract
COPD is an important global health problem. In addition to pulmonary impairment, systemic inflammation, musculoskeletal abnormalities, and cardiovascular comorbidity influence disease burden and mortality risk. Body weight and body composition are important discriminants in classifying disease heterogeneity. The rationale for and efficacy of caloric supplementation in preventing and treating involuntary weight loss is currently well established. For maintenance of muscle and bone tissue, appropriately timed, high-quality protein intake and addressing vitamin D deficiency must be considered. Specific nutrients (eg, n-3 polyunsaturated fatty acids and polyphenolic compounds) may have the pharmacologic potential to boost decreased muscle mitochondrial metabolism and enhance impaired physical performance, particularly when the metabolic stimulus of physical activity alone is limited. At this stage, evidence is insufficient to support an intake of high doses of single nutritional supplements to modulate respiratory pathology, but some small studies have identified micronutrient modulation via the diet as a promising intervention.
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Affiliation(s)
- Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands.
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31
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Abstract
Muscle dysfunction often occurs in patients with chronic obstructive pulmonary disease (COPD) and may involve both respiratory and locomotor (peripheral) muscles. The loss of strength and/or endurance in the former can lead to ventilatory insufficiency, whereas in the latter it limits exercise capacity and activities of daily life. Muscle dysfunction is the consequence of complex interactions between local and systemic factors, frequently coexisting in COPD patients. Pulmonary hyperinflation along with the increase in work of breathing that occur in COPD appear as the main contributing factors to respiratory muscle dysfunction. By contrast, deconditioning seems to play a key role in peripheral muscle dysfunction. However, additional systemic factors, including tobacco smoking, systemic inflammation, exercise, exacerbations, nutritional and gas exchange abnormalities, anabolic insufficiency, comorbidities and drugs, can also influence the function of both respiratory and peripheral muscles, by inducing modifications in their local microenvironment. Under all these circumstances, protein metabolism imbalance, oxidative stress, inflammatory events, as well as muscle injury may occur, determining the final structure and modulating the function of different muscle groups. Respiratory muscles show signs of injury as well as an increase in several elements involved in aerobic metabolism (proportion of type I fibers, capillary density, and aerobic enzyme activity) whereas limb muscles exhibit a loss of the same elements, injury, and a reduction in fiber size. In the present review we examine the current state of the art of the pathophysiology of muscle dysfunction in COPD.
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Affiliation(s)
- Joaquim Gea
- Servei de Pneumologia, Hospital del Mar-IMIM, Universitat Pompeu Fabra, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), ISCIII, Bunyola, Spain
| | - Alvar Agustí
- CIBER de Enfermedades Respiratorias (CIBERES), ISCIII, Bunyola, Spain
- Servei de Pneumologia, Institut del Tòrax. Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain; and
- Fundació Investigació Sanitària Illes Balears (FISIB), Mallorca, Spain
| | - Josep Roca
- CIBER de Enfermedades Respiratorias (CIBERES), ISCIII, Bunyola, Spain
- Servei de Pneumologia, Institut del Tòrax. Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain; and
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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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van de Bool C, Steiner MC, Schols AMWJ. Nutritional targets to enhance exercise performance in chronic obstructive pulmonary disease. Curr Opin Clin Nutr Metab Care 2012; 15:553-60. [PMID: 23075934 DOI: 10.1097/mco.0b013e328358bdeb] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review presents current knowledge regarding the rationale and efficacy of nutrition as an ergogenic aid to enhance the effects of exercise and training in chronic obstructive pulmonary disease (COPD). RECENT FINDINGS Altered body composition and skeletal muscle dysfunction in COPD suggest that exercise capacity can be targeted via several metabolic routes. Muscle metabolic alterations in COPD include a reduced oxidative metabolism and enhanced susceptibility for oxidative stress. Muscle wasting may be associated with deficiencies of vitamin D and low branched-chain amino acid levels. Exercise training is of established benefit in COPD but clear-cut clinical trial evidence to support the performance enhancing effect of nutritional intervention is lacking. One randomized controlled trial suggested that augmentation of training with polyunsaturated fatty acids may improve exercise capacity. Conflicting results are reported on dietary creatine supplementation in patients with COPD receiving pulmonary rehabilitation and results from acute intervention studies do not directly imply long-term effects of glutamate or glutamine supplementation as an ergogenic aid in COPD. Recent data indicate that not only muscle but also visceral fat may be an important additional target for combined nutrition and exercise intervention in COPD to improve physical performance and decrease cardiometabolic risk. SUMMARY There is a clear need for adequately powered and controlled intervention and maintenance trials to establish the role of nutritional supplementation in the enhancement of exercise performance and training and the wider management of the systemic features of the disease.
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Affiliation(s)
- Coby van de Bool
- Department of Respiratory Medicine, NUTRIM School for Nutrition, Toxicology, and Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Ramires BR, de Oliveira EP, Pimentel GD, McLellan KCP, Nakato DM, Faganello MM, Galhardo ML, Venâncio LDS. Resting energy expenditure and carbohydrate oxidation are higher in elderly patients with COPD: a case control study. Nutr J 2012; 11:37. [PMID: 22672689 PMCID: PMC3502439 DOI: 10.1186/1475-2891-11-37] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 05/31/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elderly patients with chronic obstructive pulmonary disease (COPD) usually have a compromised nutritional status which is an independent predictor of morbidity and mortality. To know the Resting Energy Expenditure (REE) and the substrate oxidation measurement is essential to prevent these complications. This study aimed to compare the REE, respiratory quotient (RQ) and body composition between patients with and without COPD. METHODS This case-control study assessed 20 patients with chronic obstructive pulmonary disease attending a pulmonary rehabilitation program. The group of subjects without COPD (control group) consisted of 20 elderly patients attending a university gym, patients of a private service and a public healthy care. Consumption of oxygen (O₂) and carbon dioxide (CO₂) was determined by indirect calorimetry and used for calculating the resting energy expenditure and respiratory quotient. Body mass index (BMI) and waist circumference (WC) were also measured. Percentage of body fat (%BF), lean mass (kg) and muscle mass (kg) were determined by bioimpedance. The fat free mass index (FFMI) and muscle mass index (MMI) were then calculated. RESULTS The COPD group had lower BMI than control (p = 0.02). However, WC, % BF, FFMI and MM-I did not differ between the groups. The COPD group had greater RQ (p = 0.01), REE (p = 0.009) and carbohydrate oxidation (p = 0.002). CONCLUSIONS Elderly patients with COPD had higher REE, RQ and carbohydrate oxidation than controls.
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Layec G, Haseler LJ, Richardson RS. The effect of higher ATP cost of contraction on the metabolic response to graded exercise in patients with chronic obstructive pulmonary disease. J Appl Physiol (1985) 2011; 112:1041-8. [PMID: 22174392 DOI: 10.1152/japplphysiol.00986.2011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
To better understand the metabolic implications of a higher ATP cost of contraction in chronic obstructive pulmonary disease (COPD), we used (31)P-magnetic resonance spectroscopy ((31)P-MRS) to examine muscle energetics and pH in response to graded exercise. Specifically, in six patients and six well-matched healthy controls, we determined the intracellular threshold for pH (T(pH)) and inorganic phosphate-to-phosphocreatine ratio (T(Pi/PCr)) during progressive dynamic plantar flexion exercise with work rate expressed as both absolute and relative intensity. Patients with COPD displayed a lower peak power output (WRmax) compared with controls (controls 25 ± 4 W, COPD 15 ± 5 W, P = 0.01) while end-exercise pH (controls 6.79 ± 0.15, COPD 6.76 ± 0.21, P = 0.87) and PCr consumption (controls 82 ± 10%, COPD 70 ± 18%, P = 0.26) were similar between groups. Both T(pH) and T(Pi/PCr) occurred at a significantly lower absolute work rate in patients with COPD compared with controls (controls: 14.7 ± 2.4 W for T(pH) and 15.3 ± 2.4 W for T(Pi/PCr); COPD: 9.7 ± 4.5 W for T(pH) and 10.0 ± 4.6 W for T(Pi/PCr), P < 0.05), but these thresholds occurred at the same percentage of WRmax (controls: 63 ± 11% WRmax for T(pH) and 67 ± 18% WRmax for T(Pi/PCr); COPD: 59 ± 9% WRmax for T(pH) and 61 ± 12% WRmax for T(Pi/PCr), P > 0.05). Indexes of mitochondrial function, the PCr recovery time constant (controls 42 ± 7 s, COPD 45 ± 11 s, P = 0.66) and the PCr resynthesis rate (controls 105 ± 21%/min, COPD 91 ± 31%/min, P = 0.43) were similar between groups. In combination, these results reveal that when energy demand is normalized to WRmax, as a consequence of higher ATP cost of contraction, patients with COPD display the same metabolic pattern as healthy subjects, suggesting that skeletal muscle energy production is well preserved in these patients.
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Affiliation(s)
- Gwenael Layec
- Department of Medicine, Division of Geriatrics, University of Utah, Salt Lake City, Utah, USA.
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