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Nici L. Pulmonary Rehabilitation: Mechanisms of Functional Loss and Benefits of Exercise. Respir Care 2024; 69:640-650. [PMID: 38503465 PMCID: PMC11147626 DOI: 10.4187/respcare.11705] [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] [Indexed: 03/21/2024]
Abstract
Exercise limitation is a characteristic feature of chronic respiratory diseases such as COPD and is associated with poor outcomes including decreased functional status and health-related quality of life and increased mortality. The mechanisms responsible for exercise limitation are complex and include ventilatory limitation, cardiovascular impairment, and skeletal muscle dysfunction. In addition, comorbidities such as cardiovascular disease are common in this population and can further impact exercise capacity. Exercise training, a core component of pulmonary rehabilitation, improves exercise capacity by addressing many of these mechanisms that, in turn, can potentially slow the decline of lung function, reduce the frequency of exacerbations, and decrease mortality. This article will discuss the mechanisms of exercise limitation in individuals with chronic respiratory disease, primarily focusing on COPD, and provide an overview of exercise training and its benefits in this patient population.
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Affiliation(s)
- Linda Nici
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and Pulmonary and Critical Care Section, Providence Veterans Affairs Medical Center, Providence, Rhode Island.
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Kohlbrenner D, Kuhn M, Manettas A, Aregger C, Peterer M, Greco N, Sievi NA, Clarenbach C. Low-load blood flow restriction strength training in patients with COPD: a randomised single-blind pilot study. Thorax 2024; 79:340-348. [PMID: 38129116 PMCID: PMC10958309 DOI: 10.1136/thorax-2023-220546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/18/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE The objective of this study is to compare the effectiveness of lower limb low-load blood flow restriction training (LL-BFRT) with high-load strength training (HL-ST) as part of an outpatient pulmonary rehabilitation programme on leg strength in patients with chronic obstructive pulmonary disease (COPD). METHODS Participants were randomised to LL-BFRT or HL-ST (24 sessions). LL-BFRT was done at 30% 1-repetition maximum (1-RM) with 70% arterial occlusion pressure. HL-ST was done at 70% 1-RM. Primary outcome was isometric strength of knee extensors and flexors. Secondary outcomes were 1-RM, functional exercise capacity, physical activity, symptom burden and health-related quality of life. Perceptions of dyspnoea and leg fatigue were recorded after every exercise. We compared groups with t-tests. RESULTS We included 30 participants (13 women, 17 men, 64 (9) years, forced expiratory volume in 1 s 47 (18)% pred.), 24 completed the study. Isometric knee extensor strength improved to a clinically relevant degree in both legs in both groups (LL-BFRT: right leg 9 (20) Nm, left leg 10 (18) Nm; HL-ST: right leg 15 (26) Nm, left leg 16 (30) Nm, data are mean (SD)), without statistically significant or clinically relevant between-group differences (right leg mean difference= -6.4, 95% CI= -13.20 to 25.92 Nm, left leg mean difference= -5.6, 95% CI= -15.44 to 26.55 Nm). 1 min sit-to-stand test performance improved to a clinically relevant degree only in the LL-BFRT group (4 (4) vs 1 (5) repetitions). Interestingly, physical activity improved to a clinically relevant degree only in the LL-BFRT group (1506 (2441) vs -182 (1971) steps/day). LL-BFRT lowered perceived in-exercise dyspnoea and increased leg fatigue compared with HL-ST in the initial 12 trainings. CONCLUSION In patients with stable COPD undergoing outpatient pulmonary rehabilitation, LL-BFRT was not superior to HL-ST in improving leg strength. LL-BFRT led to similar strength gains as HL-ST while reducing perceptions of dyspnoea in the initial training phase. TRIAL REGISTRATION NUMBER NCT04151771.
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Affiliation(s)
- Dario Kohlbrenner
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Manuel Kuhn
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Anastasios Manettas
- Physiotherapy Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
- Biomechanics and Ergonomics, ErgoMech Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
| | - Céline Aregger
- Physiotherapy Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Matthias Peterer
- Physiotherapy Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Nicola Greco
- Physiotherapy Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Christian Clarenbach
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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Umehara T, Kaneguchi A, Watanabe K, Katayama N, Teramoto H, Kuwahara D, Kaneyashiki R, Mizuno T, Kito N, Kakehashi M. Improvement of muscle quality assessed using the phase angle is influenced by recovery of knee extension strength in patients with hip fractures. Clin Nutr 2024; 43:773-780. [PMID: 38335802 DOI: 10.1016/j.clnu.2024.02.003] [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: 06/20/2023] [Revised: 01/24/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND AND AIMS Studies reported that knee extension strength on the operated side in patients with hip fractures was not recovered to the level on the non-operated side 6 months after surgery or later. In a cross-sectional study, we revealed that a reduction in isometric knee extension muscle strength on the operated side in patients with hip fractures approximately 6 months after surgery was associated with not only a reduction in skeletal muscle mass but also a reduction in muscle quality, characterized by a reduction in the phase angle (PhA). Furthermore, the mechanisms of knee extension strength improvement can be clarified in more detail using the minimal significant change as the index of recovery. However, no longitudinal studies have examined the factors for knee extension strength improvement based on the minimal significant change in patients with hip fractures 6 months after surgery. This study aimed to longitudinally examine the factors influencing the recovery of knee extension strength based on the minimal significant change in patients with hip fractures between 2 weeks and approximately 6 months after surgery. METHODS In this study, the outcomes used were basic and medical information, PhA, skeletal muscle index (SMI), pain, one-leg standing time, movement control during one-leg standing, and walking speed. For PhA, SMI, pain, one-leg standing time, movement control during one-leg standing, and walking speed, the amount of change was calculated by subtracting the data at 2 weeks from the data at 6 months. Group classification was determined by dividing the patients into two groups using a previous study as a reference: recovery group if the knee extension strength value approximately 6 months after surgery minus that 2 weeks after surgery was ≥3.3 kgf and non-recovery group if the value was <3.3 kgf. Logistic regression analysis was performed to explore the association between the recovery and non-recovery groups. RESULTS The recovery group contained 55 patients, while the non-recovery group comprised 35 patients. The only significant factor associated with knee extension muscle strength in the recovery group was the amount of change in PhA. The odds ratio for the amount of change in PhA was 2.26. The discrimination rate of the model was 62.5%. CONCLUSIONS Our results suggest that recovery of knee extension strength in patients with hip fractures after surgery was mainly because of improvements in muscle quality, not improvements in muscle mass or pain.
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Affiliation(s)
- Takuya Umehara
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan.
| | - Akinori Kaneguchi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
| | - Keita Watanabe
- Department of Rehabilitation, Kure Kyosai Hospital, Nishichuo 2-3-28, Kure, Hiroshima, Japan
| | - Nobuhisa Katayama
- Department of Rehabilitation, Kure Kyosai Hospital, Nishichuo 2-3-28, Kure, Hiroshima, Japan
| | - Hidefumi Teramoto
- Department of Orthopedics Surgery, Kure Kyosai Hospital, Nishichuo 2-3-28, Kure, Hiroshima, Japan
| | - Daisuke Kuwahara
- Department of Rehabilitation, Saiseikai Kure Hospital, Sanjo 2-1-13, Kure, Hiroshima, Japan
| | - Ryo Kaneyashiki
- Department of Rehabilitation, Saiseikai Kure Hospital, Sanjo 2-1-13, Kure, Hiroshima, Japan
| | - Toshiyuki Mizuno
- Department of Orthopedics Surgery, Saiseikai Kure Hospital, Sanjo 2-1-13, Kure, Hiroshima, Japan
| | - Nobuhiro Kito
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
| | - Masayuki Kakehashi
- Department of Health Informatics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima, Hiroshima, Japan
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Casals C, Ávila-Cabeza-de-Vaca L, González-Mariscal A, Marín-Galindo A, Costilla M, Ponce-Gonzalez JG, Vázquez-Sánchez MÁ, Corral-Pérez J. Effects of an educational intervention on frailty status, physical function, physical activity, sleep patterns, and nutritional status of older adults with frailty or pre-frailty: the FRAGSALUD study. Front Public Health 2023; 11:1267666. [PMID: 38098822 PMCID: PMC10720710 DOI: 10.3389/fpubh.2023.1267666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/09/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction The prevalence of frailty is increasing worldwide, emphasizing the importance of prioritizing healthy ageing. To address this, cost-effective and minimally supervised interventions are being sought. This study aimed to assess the impact of an educational program on frailty status, physical function, physical activity, sleep patterns, and nutritional status in community-dwelling older adults with at least 1 Fried's frailty criteria. Methods A 6-month multicentre randomized controlled trial was conducted from March 2022 to February 2023 in 14 health centres located in Cadiz and Malaga, Spain. The educational intervention consisted of 4 group sessions and 6 follow-up phone calls spread over 6 months. The program focused on educating participants about frailty and its impact on health, providing guidelines for physical activity, healthy dietary habits, cognitive training, psychological well-being and social activities. A total of 163 participants, divided into control (n = 80) and educational groups (n = 83) were assessed before and after the intervention. Results The results showed a significant group-time interaction in the physical function evaluated with a large effect on Short Physical Performance Battery score (η2p = 0.179, -0.1 [-1.2-1.0] points for control group vs. 1.0 [0.0-3.0] points for educational group, p < 0.001), and an effect on the 4-meter gait test ((η2p = 0.122, 0.5 [0.1-0.0] s for control group vs. -0.4 [-0.5- -0.3] s for educational group, p < 0.001), and the 5-repetition sit-to-stand test (η2p = 0.136, 1.0 [0.0-1.2] s for control group vs. -4.3 [-7.0- -2.3] for educational group, p < 0.001). Additionally, the use of accelerometers to assess physical activity, inactivity, and sleep patterns revealed a significant small effect in the number of awakenings at night ((η2p = 0.040, 1.1 [-0.5-3.4] awakenings for control group vs. 0.0 [-2.2-0.0] awakenings for educational group, p = 0.009). The findings also highlighted a significant medium effect regarding malnutrition risk, which was assessed using the Mini-Nutritional Assessment score (η2p = 0.088, -0.7 [-2.3-1.5] points for control group vs. 1.5 [-0.5-3.0] points for educational group, p < 0.001). Discussion Thus, the 6-month educational program effectively improved physical function, sleep patterns, and nutritional status compared to usual healthcare attendance in community-dwelling older adults with frailty or pre-frailty. These findings underscore the potential of minimally supervised interventions in promoting a healthy lifestyle in this vulnerable population.
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Affiliation(s)
- Cristina Casals
- ExPhy Research Group, Department of Physical Education, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Universidad de Cádiz, Cádiz, Spain
| | - Laura Ávila-Cabeza-de-Vaca
- ExPhy Research Group, Department of Physical Education, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Universidad de Cádiz, Cádiz, Spain
| | - Andrea González-Mariscal
- ExPhy Research Group, Department of Physical Education, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Universidad de Cádiz, Cádiz, Spain
| | - Alberto Marín-Galindo
- ExPhy Research Group, Department of Physical Education, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Universidad de Cádiz, Cádiz, Spain
| | - Manuel Costilla
- ExPhy Research Group, Department of Physical Education, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Universidad de Cádiz, Cádiz, Spain
| | - Jesus G. Ponce-Gonzalez
- ExPhy Research Group, Department of Physical Education, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Universidad de Cádiz, Cádiz, Spain
| | - María Ángeles Vázquez-Sánchez
- Department of Nursing, PASOS Research Group, Faculty of Health Sciences, UMA REDIAS Network of Law and Artificial Intelligence Applied to Health and Biotechnology, University of Malaga, Málaga, Spain
| | - Juan Corral-Pérez
- ExPhy Research Group, Department of Physical Education, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Universidad de Cádiz, Cádiz, Spain
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Jenkins AR, Gaynor-Sodeifi K, Lewthwaite H, Triandafilou J, Belo LF, de Oliveira MF, Jensen D. Efficacy of interventions to alter measures of fat-free mass in people with COPD: a systematic review and meta-analysis. ERJ Open Res 2023; 9:00102-2023. [PMID: 37529637 PMCID: PMC10388177 DOI: 10.1183/23120541.00102-2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/08/2023] [Indexed: 08/03/2023] Open
Abstract
Introduction Low fat-free mass (FFM) is linked to poor health outcomes in COPD, including impaired exercise tolerance and premature death. The aim of this systematic review was to synthesise evidence on the effectiveness of interventions for increasing FFM in COPD. Methods Searches of electronic databases (MEDLINE, Cochrane Library, Embase, Web of Science, Scopus) and trial registers (ClinicalTrials.gov) were undertaken from inception to August 2022 for randomised studies of interventions assessing measures of FFM in COPD. The primary outcome was change in FFM (including derivatives). Secondary outcomes were adverse events, compliance and attrition. Results 99 studies (n=5138 people with COPD) of 11 intervention components, used alone or in combination, were included. Exercise training increased mid-thigh cross-sectional area (k=3, standardised mean difference (SMD) 1.04, 95% CI 0.02-2.06; p=0.04), but not FFM (k=4, SMD 0.03, 95% CI -0.18-0.24; p=0.75). Nutritional supplementation significantly increased FFM index (k=11, SMD 0.31, 95% CI 0.13-0.50; p<0.001), but not FFM (k=19, SMD 0.16, 95% CI -0.06-0.39; p=0.16). Combined exercise training and nutritional supplementation increased measures related to FFM in 67% of studies. Anabolic steroids increased FFM (k=4, SMD 0.98, 95% CI 0.24-1.72; p=0.009). Neuromuscular electrical stimulation increased measures related to FFM in 50% of studies. No interventions were more at risk of serious adverse events, low compliance or attrition. Discussion Exercise training and nutritional supplementation were not effective in isolation to increase FFM, but were for localised muscle and index measures, respectively. Combined, exercise and nutritional supplementation shows promise as a strategy to increase FFM in COPD. Anabolic steroids are efficacious for increasing FFM in COPD.
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Affiliation(s)
- Alex R. Jenkins
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada
| | - Kaveh Gaynor-Sodeifi
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada
| | - Hayley Lewthwaite
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada
- Centre of Research Excellence in Treatable Traits, College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
- Asthma and Breathing Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Jaycie Triandafilou
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada
| | - Letícia F. Belo
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada
- Laboratory of Research in Respiratory Physiotherapy, Physiotherapy Department, State University of Londrina, Londrina, Brazil
| | - Mayron Faria de Oliveira
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada
- Science Division, Exercise Science, Lyon College, Batesville, AR, USA
| | - Dennis Jensen
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada
- Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
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Troosters T, Janssens W, Demeyer H, Rabinovich RA. Pulmonary rehabilitation and physical interventions. Eur Respir Rev 2023; 32:32/168/220222. [PMID: 37286219 DOI: 10.1183/16000617.0222-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/23/2023] [Indexed: 06/09/2023] Open
Abstract
Pulmonary rehabilitation has established a status of evidence-based therapy for patients with symptomatic COPD in the stable phase and after acute exacerbations. Rehabilitation should have the possibility of including different disciplines and be offered in several formats and lines of healthcare. This review focusses on the cornerstone intervention, exercise training, and how training interventions can be adapted to the limitations of patients. These adaptations may lead to altered cardiovascular or muscular training effects and/or may improve movement efficiency. Optimising pharmacotherapy (not the focus of this review) and oxygen supplements, whole-body low- and high-intensity training or interval training, and resistance (or neuromuscular electrical stimulation) training are important training modalities for these patients in order to accommodate cardiovascular and ventilatory impairments. Inspiratory muscle training and whole-body vibration may also be worthwhile interventions in selected patients. Patients with stable but symptomatic COPD, those who have suffered exacerbations and patients waiting for or who have received lung volume reduction or lung transplantation are good candidates. The future surely holds promise to further personalise exercise training interventions and to tailor the format of rehabilitation to the individual patient's needs and preferences.
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Affiliation(s)
- Thierry Troosters
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
| | - Wim Janssens
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
- KU Leuven, Department of Chronic Disease and Metabolism, Leuven, Belgium
| | - Heleen Demeyer
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Roberto A Rabinovich
- University of Edinburgh, MRC Centre for Information Research, Edinburgh, UK
- Respiratory Department, Royal Infirmary of Edinburgh, Edinburgh, UK
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Wang H, Liu Q, Liu L, Cao J, Liang Q, Zhang X. High-intensity interval training improves the outcomes of patients with chronic obstructive pulmonary disease: A meta-analysis of randomized controlled trials. Respir Med 2023; 208:107128. [PMID: 36717003 DOI: 10.1016/j.rmed.2023.107128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/10/2023] [Accepted: 01/20/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Pulmonary exercise is an important part in the treatment of chronic obstructive pulmonary disease (COPD). We aimed to evaluate the effects and safety of high-intensity interval training (HIIT) in patients with COPD, to provide insights to the COPD treatment and care. METHODS Two investigators searched PubMed, Medline, Embase, web of Science, Cochrane library, China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu databases up to Sept 15, 2022 for randomized controlled trials (RCTs) on the effects and safety of HIIT for COPD patients. RevMan5.3 software was used for statistical analysis. RESULTS A total of 20 RCTs involving 962 COPD patients were finally included. 514 patients underwent HIIT interventions. Meta-analysis showed that HIIT increased the peak oxygen consumption (SMD = 0.30, 95%CI:0.14-0.46), peak minute ventilation (SMD = 0.26, 95%CI: 0.05-0.47), peak work rate (SMD = 0.34, 95%CI: 0.17-0.51), 6-min walking distance (SMD = 0.39, 95%CI: 0.23-0.55) in COPD patients (all P < 0.05). HIIT improved the quality of life (SMD = 0.30, 95%CI: 0.06-0.54) and reduced the dyspnea (SMD = -0.27, 95%CI: -0.51∼-0.03) in COPD patients (all P < 0.05). There were no significant differences in the forced expiratory volume in 1 s/forced vital capacity (SMD = 0.28, 95%CI: -0.01-0.56) and St. George's Respiratory Questionnaire score (SMD = -0.35, 95%CI: -0.73-0.03) between HIIT and control group (all P > 0.05). There was no publication bias analyzed by the Egger test and funnel plots (all P > 0.05). CONCLUSIONS HIIT may be beneficial to improve the pulmonary function, exercise capacity and quality of life of patients with COPD, which is worthy of clinical promotion for COPD treatment and care.
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Affiliation(s)
- Hongyan Wang
- School of Nursing, Sichuan Nursing Vocational College, China
| | - Qin Liu
- School of Nursing, Chengdu University of TCM, China
| | - Linfeng Liu
- School of Nursing, Sichuan Nursing Vocational College, China
| | - Jun Cao
- School of Nursing, Sichuan Nursing Vocational College, China
| | | | - Xiangeng Zhang
- School of Nursing, Sichuan Nursing Vocational College, China.
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Qumu S, Sun W, Guo J, Zhang Y, Cai L, Si C, Xu X, Yang L, Situ X, Yang T, He J, Shi M, Liu D, Ren X, Huang K, Niu H, Li H, Yu C, Chen Y, Yang T. Pulmonary rehabilitation restores limb muscle mitochondria and improves the intramuscular metabolic profile. Chin Med J (Engl) 2023; 136:461-472. [PMID: 36752784 PMCID: PMC10106246 DOI: 10.1097/cm9.0000000000002175] [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: 04/26/2021] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Exercise, as the cornerstone of pulmonary rehabilitation, is recommended to chronic obstructive pulmonary disease (COPD) patients. The underlying molecular basis and metabolic process were not fully elucidated. METHODS Sprague-Dawley rats were classified into five groups: non-COPD/rest ( n = 8), non-COPD/exercise ( n = 7), COPD/rest ( n = 7), COPD/medium exercise ( n = 10), and COPD/intensive exercise ( n = 10). COPD animals were exposed to cigarette smoke and lipopolysaccharide instillation for 90 days, while the non-COPD control animals were exposed to room air. Non-COPD/exercise and COPD/medium exercise animals were trained on a treadmill at a decline of 5° and a speed of 15 m/min while animals in the COPD/intensive exercise group were trained at a decline of 5° and a speed of 18 m/min. After eight weeks of exercise/rest, we used ultrasonography, immunohistochemistry, transmission electron microscopy, oxidative capacity of mitochondria, airflow-assisted desorption electrospray ionization-mass spectrometry imaging (AFADESI-MSI), and transcriptomics analyses to assess rectal femoris (RF). RESULTS At the end of 90 days, COPD rats' weight gain was smaller than control by 59.48 ± 15.33 g ( P = 0.0005). The oxidative muscle fibers proportion was lower ( P < 0.0001). At the end of additional eight weeks of exercise/rest, compared to COPD/rest, COPD/medium exercise group showed advantages in weight gain, femoral artery peak flow velocity (Δ58.22 mm/s, 95% CI: 13.85-102.60 mm/s, P = 0.0104), RF diameters (Δ0.16 mm, 95% CI: 0.04-0.28 mm, P = 0.0093), myofibrils diameter (Δ0.06 μm, 95% CI: 0.02-0.10 μm, P = 0.006), oxidative muscle fiber percentage (Δ4.84%, 95% CI: 0.15-9.53%, P = 0.0434), mitochondria oxidative phosphorylate capacity ( P < 0.0001). Biomolecules spatial distribution in situ and bioinformatic analyses of transcriptomics suggested COPD-related alteration in metabolites and gene expression, which can be impacted by exercise. CONCLUSION COPD rat model had multi-level structure and function impairment, which can be mitigated by exercise.
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Affiliation(s)
- Shiwei Qumu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China; Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing 100029, China
| | - Weiliang Sun
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing 100029, China
| | - Jing Guo
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yuting Zhang
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing 100029, China
| | - Lesi Cai
- National Anti-Drug Laboratory Beijing Regional Center, Beijing 100164, China
| | - Chaozeng Si
- Department of Information Management, China–Japan Friendship Hospital, Beijing 100029, China
| | - Xia Xu
- Department of Immunology, School of Basic Medical Sciences, Capital Medical University, Beijing 100005, China
| | - Lulu Yang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China; Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing 100029, China
- Capital Medical University, Beijing 100069, China
| | - Xuanming Situ
- Department of Rehabilitation, China–Japan Friendship Hospital, Beijing 100029, China
| | - Tianyi Yang
- Department of Rehabilitation, China–Japan Friendship Hospital, Beijing 100029, China
| | - Jiaze He
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China; Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing 100029, China
- Capital Medical University, Beijing 100069, China
| | - Minghui Shi
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China; Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing 100029, China
- Capital Medical University, Beijing 100069, China
| | - Dongyan Liu
- Tsinghua University School of Medicine, Beijing 100084, China
| | - Xiaoxia Ren
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China; Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing 100029, China
| | - Ke Huang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China; Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing 100029, China
| | - Hongtao Niu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China; Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing 100029, China
| | - Hong Li
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing 100029, China
| | - Chang’An Yu
- Department of Cardiology, China–Japan Friendship Hospital, Beijing 100029, China
| | - Yang Chen
- The State Key Laboratory of Medical Molecular Biology, Department of Biochemistry and Molecular Biology, Institute of Basic Medical Sciences, School of Basic Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100005, China
| | - Ting Yang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China; Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing 100029, China
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9
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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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10
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Gloeckl R, Zwick R, Fürlinger U, Jarosch I, Schneeberger T, Leitl D, Koczulla A, Vonbank K, Alexiou C, Vogiatzis I, Spruit M. Prescribing and adjusting exercise training in chronic respiratory diseases – Expert-based practical recommendations. Pulmonology 2022:S2531-0437(22)00215-X. [DOI: 10.1016/j.pulmoe.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/26/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022] Open
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11
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Huhn A, Flenker U, Diel P. Effects of Carbohydrate and Protein Administration by Food Items on Strength Response after Training in Stable COPD. Nutrients 2022; 14:nu14173565. [PMID: 36079823 PMCID: PMC9460301 DOI: 10.3390/nu14173565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/22/2022] [Accepted: 08/26/2022] [Indexed: 11/19/2022] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is one of the world’s most common diseases and reasons for death. Systemic consequences, especially reduced muscle strength, muscle mass and muscle function, are common and contribute to worsening prognosis and increasing morbidity and mortality. There is strong evidence that physical activity and strength training are effective in prolonging life and lead to better quality of life. Numerous studies have shown that ingestion of protein and carbohydrates after strength training can increase regeneration of strength in young athletes. Recently, we demonstrated that the same effect can be achieved with these macronutrients administered in a meal. Until now, it is not clear if patients with COPD, integrated in regular physical training, respond similarly. Methods: Prescribed strength training, consisting of two sets circular training with machines for big muscle groups was supplemented with a meal rich in protein and carbohydrates. Changes in maximum strength after 24 h were investigated to find out about the impact of this meal on physical capacity. A pilot study was conducted with pragmatic cross-over design. Results: With nutritive intervention, strength in both knee extensor and chest press were significantly higher than in control training. Conclusion: The study showed beneficial effects for the intake of protein and carbohydrates in changes in maximum strength. For now, the underlying mechanism remains unclear. Clinical relevance needs further research. The study design and study protocol can be used for further studies with only small adaptions.
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Affiliation(s)
- Andrea Huhn
- Zwanzig-Neun-Fünf Essen GmbH, 45127 Essen, Germany
- Department of Molecular and Cellular SportsMedicine, Institute for Cardiovascular Research and Sports Medicine, German Sports University, 50333 Cologne, Germany
| | - Ulrich Flenker
- Department of Molecular and Cellular SportsMedicine, Institute for Cardiovascular Research and Sports Medicine, German Sports University, 50333 Cologne, Germany
| | - Patrick Diel
- Department of Molecular and Cellular SportsMedicine, Institute for Cardiovascular Research and Sports Medicine, German Sports University, 50333 Cologne, Germany
- Correspondence: ; Tel.: +49-221-4982-5860
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12
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Nyberg A, Milad N, Martin M, Patoine D, Morissette MC, Saey D, Maltais F. Role of progression of training volume on intramuscular adaptations in patients with chronic obstructive pulmonary disease. Front Physiol 2022; 13:873465. [PMID: 36082219 PMCID: PMC9446145 DOI: 10.3389/fphys.2022.873465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/15/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction: Quadriceps dysfunction is a common systemic manifestation of chronic obstructive pulmonary disease (COPD), for which treatment using resistance training is highly recommended. Even though training volume is suggested to be a key explanatory factor for intramuscular adaptation to resistance training in healthy older adults, knowledge is scarce on the role of progression of training volume for intramuscular adaptations in COPD. Methods: This study was a sub-analysis of a parallel-group randomized controlled trial. Thirteen patients with severe to very severe COPD (median 66 yrs, forced expiratory volume in 1 s 44% predicted) performed 8 weeks of low-load resistance training. In a post hoc analysis, they were divided into two groups according to their training volume progression. Those in whom training volume continued to increase after the first 4 weeks of training outlined the continued progression group (n = 9), while those with limited increase (<5%) or even reduction in training volume after the initial 4 weeks composed the discontinued progression group (n = 4). Fiber-type distribution and oxidative muscle protein levels, i.e., citrate synthase (CS), hydroxyacyl-coenzyme A dehydrogenase (HADH), mitochondrial transcription factor A (TfAM) as well as quadriceps endurance measures (total work from elastic band and isokinetic knee extension tests), were assessed before and after the intervention period. Results: The continued progression group sustained their training volume progression during weeks 5–8 compared to weeks 1–4 (median +25%), while the discontinued progression group did not (median -2%) (p = 0.007 between groups). Compared with baseline values, significant between-group differences in fiber type distribution and TfAM muscle protein levels (range ± 17–62%, p < 0.05) and in individual responses to change in Type I and Type IIa fiber type proportion, CS, HADH, and TfAM muscle protein levels outcomes (median 89 vs. 50%, p = 0.001) were seen in favor of the continued progression group. Moreover, only the continued progression group had a significant increase in HADH muscle protein levels (+24%, p = 0.004), elastic band (+56%, p = 0.004) and isokinetic (+7%, p = 0.004) quadriceps endurance, but the between-group differences did not reach statistical significance (range 14–29%, p = 0.330–1.000). Discussion: The novel findings of the current study were that patients with COPD who had a continued progression of training volume across the 8-weeks intervention had an increased proportion of Type I fibers, and TfAM muscle protein levels and decreased proportion of Type II fibers compared to those that did not continue to progress their training volume after the initial weeks. Additionally, HADH muscle protein levels and quadriceps endurance measurements only improved in the continued progression group, although no significant between-group differences were seen. These findings highlight the importance of continued progression of training volume during resistive training to counteract quadriceps dysfunction within the COPD population. Still, considering the small sample size and the post hoc nature of our analyses, these results should be interpreted cautiously, and further research is necessary.
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Affiliation(s)
- Andre Nyberg
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
- Department of Community Medicine and Rehabilitation, section of Physiotherapy, Umeå University, Umeå, Sweden
- *Correspondence: Andre Nyberg,
| | - Nadia Milad
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Mickael Martin
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Dany Patoine
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Mathieu C Morissette
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Didier Saey
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - François Maltais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
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13
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Ma K, Huang F, Qiao R, Miao L. Pathogenesis of sarcopenia in chronic obstructive pulmonary disease. Front Physiol 2022; 13:850964. [PMID: 35928562 PMCID: PMC9343800 DOI: 10.3389/fphys.2022.850964] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 06/28/2022] [Indexed: 11/25/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a common pulmonary disease characterized by persistent respiratory symptoms and airflow obstruction. In addition to lung diseases, chronic obstructive pulmonary disease (COPD) is often associated with other organ diseases, and sarcopenia is one of the common diseases. In recent years, multiple factors have been proposed to influence muscle dysfunction in COPD patients, including systemic and local inflammation, oxidative stress, hypoxia, hypercapnia, protein synthesis, catabolic imbalance, nutritional changes, disuse, ageing, and the use of medications such as steroids. These factors alone or in combination can lead to a reduction in muscle mass and cross-sectional area, deterioration of muscle bioenergy metabolism, defects in muscle repair and regeneration mechanisms, apoptosis and other anatomical and/or functional pathological changes, resulting in a decrease in the muscle’s ability to work. This article reviews the research progress of possible pathogenesis of sarcopenia in COPD.
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14
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Minimal important difference of two methods for assessment of quadriceps femoris strength post exercise program in individuals with COPD. Heart Lung 2022; 54:56-60. [PMID: 35390575 DOI: 10.1016/j.hrtlng.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/10/2022] [Accepted: 03/12/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The assessment of quadriceps femoris (QF) strength is recommended by international guidelines as an outcome of exercise training (ET) programs in patients with chronic obstructive pulmonary disease (COPD). OBJECTIVES To identify the minimal important difference (MID) of two methods for the assessment of improvement of QF strength after a high-intensity ET program in individuals with COPD: 1-repetition maximum (1RM) and maximal voluntary contraction (MVC). METHODS Individuals with moderate to very-severe stable COPD were submitted to high-intensity ET (3 days/week, 36 sessions). Lung function (spirometry), exercise capacity (6-minute walk test [6MWT]) and QF strength (1RM test and MVC by using a strain-gauge) were assessed before and after the ET program. RESULTS Twenty-one individuals were studied (65±8 years, BMI 27±6; FEV1 51±16%predicted). At the end of the ET program, QF strength improved significantly (10±4 Nm for MVC and 8 ± 6 kg for 1RM) (P<0.05 for both). The MID for improvement of the QF strength calculated by distribution-based methods ranged from 9.4 to 16 Nm (between 7.4% and 12.6% increase from baseline) for the MVC and from 2.5 to 3 kg (between 12% and 15% increase from baseline) for the 1RM test. Anchor-based MIDs could not be calculated since there was no correlation between the improvement of QF strength and the improvement of the proposed anchor (6MWT). CONCLUSIONS The MID for improvement of QF strength after a high-intensity ET program in individuals with moderate-to-severe stable COPD ranges between 9.4 and 16 Nm for the MVC assessed with a strain gauge and between 2.5 and 3 kg for the 1RM test.
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15
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Multi-omics research in sarcopenia: Current progress and future prospects. Ageing Res Rev 2022; 76:101576. [PMID: 35104630 DOI: 10.1016/j.arr.2022.101576] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 12/13/2021] [Accepted: 01/26/2022] [Indexed: 12/17/2022]
Abstract
Sarcopenia is a systemic disease with progressive and generalized skeletal muscle dysfunction defined by age-related low muscle mass, high content of muscle slow fibers, and low muscle function. Muscle phenotypes and sarcopenia risk are heritable; however, the genetic architecture and molecular mechanisms underlying sarcopenia remain largely unclear. In recent years, significant progress has been made in determining susceptibility loci using genome-wide association studies. In addition, recent advances in omics techniques, including genomics, epigenomics, transcriptomics, proteomics, and metabolomics, offer new opportunities to identify novel targets to help us understand the pathophysiology of sarcopenia. However, each individual technology cannot capture the entire view of the biological complexity of this disorder, while integrative multi-omics analyses may be able to reveal new insights. Here, we review the latest findings of multi-omics studies for sarcopenia and provide an in-depth summary of our current understanding of sarcopenia pathogenesis. Leveraging multi-omics data could give us a holistic understanding of sarcopenia etiology that may lead to new clinical applications. This review offers guidance and recommendations for fundamental research, innovative perspectives, and preventative and therapeutic interventions for sarcopenia.
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16
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Alves IGN, da Silva E Silva CM, Martinez BP, de Queiroz RS, Gomes-Neto M. Effects of neuromuscular electrical stimulation on exercise capacity, muscle strength and quality of life in COPD patients: A Systematic Review with Meta-Analysis. Clin Rehabil 2022; 36:449-471. [PMID: 35014892 DOI: 10.1177/02692155211067983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the effects of neuromuscular electrical stimulation on disabilities and activity limitation of individuals affected by chronic obstructive pulmonary disease. DATA SOURCES MEDLINE, PEDro database, Cochrane Controlled Trials Register, and SciELO, were searched from inception until October 2021. REVIEW METHODS Inclusion criteria were patients with COPD, randomized controlled trials comparing neuromuscular electrical stimulation alone or combined conventional pulmonary rehabilitation and neuromuscular electrical stimulation versus control or sham or pulmonary rehabilitation in disabilities and activity limitation in COPD. There were no mandatory language or publication date restrictions. Two reviewers selected studies independently. Weighted mean differences and 95% confidence intervals were calculated. RESULTS 32 studies met the study criteria, including 1.269 participants. Neuromuscular electrical stimulation improved exercise capacity (MD 1.10, 95% CI: 0.33, 1.86, N = 147), and muscle strength (0.53, 95% CI: 0.20, 0.87, N = 147) compared to sham group. Combined neuromuscular electrical stimulation and conventional rehabilitation improved exercise capacity (MD 34.28 meters, 95% CI: 6.84, 61.73, N = 262) compared to conventional rehabilitation alone. No adverse events were reported. CONCLUSIONS Neuromuscular electrical stimulation resulted in small improvement in disabilities and activity limitation (below the MCID) in COPD. Thus, the inclusion of neuromuscular electrical stimulation in rehabilitation programs must consider the cost Because of inadequate methodological conduction and reporting of methods, some studies were of low quality.
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Affiliation(s)
| | | | - Bruno Prata Martinez
- Department of Physiotherapy, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Mansueto Gomes-Neto
- Department of Physiotherapy, Federal University of Bahia, Salvador, Bahia, Brazil
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17
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De Brandt J, Beijers RJHCG, Chiles J, Maddocks M, McDonald MLN, Schols AMWJ, Nyberg A. Update on the Etiology, Assessment, and Management of COPD Cachexia: Considerations for the Clinician. Int J Chron Obstruct Pulmon Dis 2022; 17:2957-2976. [PMID: 36425061 PMCID: PMC9680681 DOI: 10.2147/copd.s334228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open
Abstract
Cachexia is a commonly observed but frequently neglected extra-pulmonary manifestation in patients with chronic obstructive pulmonary disease (COPD). Cachexia is a multifactorial syndrome characterized by severe loss of body weight, muscle, and fat, as well as increased protein catabolism. COPD cachexia places a high burden on patients (eg, increased mortality risk and disease burden, reduced exercise capacity and quality of life) and the healthcare system (eg, increased number, length, and cost of hospitalizations). The etiology of COPD cachexia involves a complex interplay of non-modifiable and modifiable factors (eg, smoking, hypoxemia, hypercapnia, physical inactivity, energy imbalance, and exacerbations). Addressing these modifiable factors is needed to prevent and treat COPD cachexia. Oral nutritional supplementation combined with exercise training should be the primary multimodal treatment approach. Adding a pharmacological agent might be considered in some, but not all, patients with COPD cachexia. Clinicians and researchers should use longitudinal measures (eg, weight loss, muscle mass loss) instead of cross-sectional measures (eg, low body mass index or fat-free mass index) where possible to evaluate patients with COPD cachexia. Lastly, in future research, more detailed phenotyping of cachectic patients to enable a better comparison of included patients between studies, prospective longitudinal studies, and more focus on the impact of exacerbations and the role of biomarkers in COPD cachexia, are highly recommended.
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Affiliation(s)
- Jana De Brandt
- Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Rosanne J H C G Beijers
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Joe Chiles
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Merry-Lynn N McDonald
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - André Nyberg
- Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
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18
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Stoffels AA, Meys R, van Hees HW, Franssen FM, van den Borst B, van ’t Hul AJ, Klijn PH, Vaes AW, De Brandt J, Burtin C, Spruit MA. Isokinetic testing of quadriceps function in COPD: feasibility, responsiveness, and minimal important differences in patients undergoing pulmonary rehabilitation. Braz J Phys Ther 2022; 26:100451. [PMID: 36288671 PMCID: PMC9593178 DOI: 10.1016/j.bjpt.2022.100451] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 09/09/2022] [Accepted: 10/03/2022] [Indexed: 11/26/2022] Open
Abstract
Evaluation of isokinetic quadriceps testing in COPD is needed to assess its efficacy. Isokinetic testing was performed incorrectly in a quarter of patients with COPD. Quadriceps peak torque and total work improved following pulmonary rehabilitation. Minimal important differences for peak torque and total work were determined.
Background Isokinetic testing of peripheral muscle function is valid and reliable in patients with chronic obstructive pulmonary disease (COPD). Objective To evaluate whether and to what extent isokinetic testing of quadriceps function meets pre-defined test criteria in patients with COPD; to determine the response to pulmonary rehabilitation (PR), and to calculate minimal important differences (MIDs) of isokinetic quadriceps function. Methods Retrospective analysis of 2033 patients with COPD (age: 65±9 years, body mass index: 26±6 kg/m2, FEV1: 49±22% predicted) who followed a comprehensive PR program. Pre and post PR isokinetic quadriceps function was assessed with 30 maximal extension-flexion contractions at an angular speed of 90°/s on a computerized dynamometer. The chosen anchors were 6-min walk test and COPD assessment test. Results Pre PR, 27% of the patients performed the isokinetic test incorrectly. In male and female patients with a correct pre and post PR isokinetic test, peak torque (Δ=10±13 Nm or 9% and Δ=7±9 Nm or 10%, respectively) and total work (Δ=263±270 J or 14% and Δ=198±190 J or 15%, respectively) improved significantly. There was no change in work fatigue index following PR. Using distribution-based calculations, MID estimates for peak torque and total work ranged between 6–7 Nm and 97–135 J in males and between 4–5 Nm and 62–99 J in females. Conclusions Based on the current test criteria, three in four patients with COPD performed the isokinetic quadriceps test correctly during baseline PR assessment. Furthermore, peak torque and total work, but not work fatigue index, were responsive to PR and sex-specific MIDs were established.
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Affiliation(s)
- Anouk A.F. Stoffels
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, the Netherlands,Department of Research and Development, Ciro, Horn, the Netherlands,Nutrim School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands,Corresponding author at: Department of Pulmonary Diseases, Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands
| | - Roy Meys
- Department of Research and Development, Ciro, Horn, the Netherlands,Nutrim School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | | | - Frits M.E. Franssen
- Department of Research and Development, Ciro, Horn, the Netherlands,Nutrim School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Bram van den Borst
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alex J. van ’t Hul
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Peter H. Klijn
- Department of Pulmonology, Merem Pulmonary Rehabilitation Centre, Hilversum, the Netherlands,Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Anouk W. Vaes
- Department of Research and Development, Ciro, Horn, the Netherlands
| | - Jana De Brandt
- REVAL–Rehabilitation Research Center, BIOMED–Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Chris Burtin
- REVAL–Rehabilitation Research Center, BIOMED–Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Martijn A. Spruit
- Department of Research and Development, Ciro, Horn, the Netherlands,Nutrim School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
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19
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Li P, Li J, Wang Y, Xia J, Liu X. Effects of Exercise Intervention on Peripheral Skeletal Muscle in Stable Patients With COPD: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:766841. [PMID: 34869477 PMCID: PMC8636927 DOI: 10.3389/fmed.2021.766841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/18/2021] [Indexed: 12/05/2022] Open
Abstract
Objectives: Peripheral skeletal muscle dysfunction is an important extrapulmonary manifestation of chronic obstructive pulmonary disease (COPD) that can be counteracted by exercise training. This study aimed to review the effect of three major exercise training modalities, which are used in pulmonary rehabilitation to improve on skeletal muscle mass, function, and exercise capacity in COPD. Methods: PubMed, Embase, EBSCO, Web of Science, and the PEDro database were searched on April 25, 2020. Only randomized controlled studies published in English evaluating the effects of exercise interventions on peripheral skeletal muscle mass, strength, and exercise capacity in stable COPD patients were included. The quality of included studies was evaluated using the PEDro scale. The mean difference (MD) or the standardized mean difference (SMD) with 95% CI was calculated to summarize the results. Subgroup meta-analysis was used to investigate the effects of different exercise training modalities and different outcome measures. The Grading of Recommendations Assessment, Development, and Evaluation guidelines were used to rate evidence quality. Results: A total of 30 randomized controlled trials involving 1,317 participants were included. Data from trials investigating endurance exercise (EE), resistance exercise (RE), and combined aerobic and resistance exercise (CE) were pooled into a meta-analysis, and the differences compared with the non-exercising COPD control were improvement in the muscle strength and exercise capacity in stable COPD patients. Subgroup meta-analysis for different exercise training modalities showed that RE significantly improved muscle strength (SMD = 0.6, 95% CI 0.35–0.84, I2 = 61%), EE and CE significantly increased VO2peak (EE: MD = 3.5, 95% CI 1.1–5.91, I2 = 92%; CE: MD = 1.66, 95% CI 0.22–3.1, I2 = 1%). Subgroup meta-analysis for different outcome measures showed that only isotonic strength was improved after exercise interventions (SMD = 0.89, 95% CI 0.51–1.26, I2 = 71%). Conclusion: Moderate evidence supports that exercise training in stable COPD patients has meaningful and beneficial effects on peripheral skeletal muscle strength and exercise capacity. Peripheral skeletal muscle shows a higher response to RE, and the isotonic test is relatively sensitive in reflecting muscle strength changes. The proportion of aerobic and resistance exercise components in a combined exercise program still needs exploration. Systematic Review Registration: The review was registered with the PROSPERO: (The website is https://www.crd.york.ac.uk/PROSPERO/, and the ID is CRD42020164868).
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Affiliation(s)
- Peijun Li
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Jian Li
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yingqi Wang
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Jun Xia
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xiaodan Liu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Institute of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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20
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Mason SE, Moreta-Martinez R, Labaki WW, Strand MJ, Regan EA, Bon J, San Jose Estepar R, Casaburi R, McDonald ML, Rossiter HB, Make B, Dransfield MT, Han MK, Young K, Curtis JL, Stringer K, Kinney G, Hokanson JE, San Jose Estepar R, Washko GR. Longitudinal association between muscle loss and mortality in ever-smokers. Chest 2021; 161:960-970. [PMID: 34785234 DOI: 10.1016/j.chest.2021.10.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/25/2021] [Accepted: 10/23/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Body composition measures, specifically low weight or reduced muscle mass, are associated with mortality in chronic obstructive pulmonary disease (COPD), but the effect of longitudinal body composition changes is undefined. RESEARCH QUESTION Is the longitudinal loss of fat-free mass (FFM) associated with increased mortality including in those with initially normal or elevated body composition metrics? STUDY DESIGN AND METHODS Participants with complete data for at least one visit in the COPDGene (n=9,268) and ECLIPSE studies (1,760) were included and followed for 12 and 8 years, respectively. Pectoralis muscle area (PMA) was derived from thoracic CT scans and used as a proxy for FFM. A longitudinal mixed sub-model for PMA and a Cox proportional hazards sub-model for survival were fitted on a joint distribution using a shared random intercept parameter and Markov chain Monte Carlo parameter estimation. RESULTS Both cohorts demonstrated a left shifted distribution of baseline FFM, not reflected in BMI, and an increase in all-cause mortality risk associated with longitudinal loss of PMA. For each one cm2 PMA loss, mortality increased 3.1% (95% CI 2.4, 3.7, p<0.001) in COPDGene, and 2.4% (95% CI 0.9, 4.0, p<0.001) in ECLIPSE. Increased mortality risk was independent of enrollment values for BMI and disease severity (BODE index quartiles) and was significant even in participants with initially greater than average PMA. INTERPRETATION Longitudinal loss of PMA is associated with increased all-cause mortality, regardless of BMI or initial muscle mass. Consideration of novel screening tests and further research into mechanisms contributing to muscle decline may improve risk stratification and identify novel therapeutic targets in ever-smokers.
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Affiliation(s)
- Stefanie E Mason
- Department of Medicine, Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston MA.
| | | | - Wassim W Labaki
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor MI
| | - Matthew J Strand
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver CO
| | - Elizabeth A Regan
- Department of Medicine, Division of Rheumatology, National Jewish Health, Denver CO
| | - Jessica Bon
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Pittsburgh PA; VA Pittsburgh Healthcare System, Pittsburgh, PA
| | | | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Division of Pulmonary and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance CA
| | - Merry-Lynn McDonald
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, University of Alabama at Birmingham, Birmingham AL
| | - Harry B Rossiter
- Rehabilitation Clinical Trials Center, Division of Pulmonary and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance CA
| | - Barry Make
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver CO
| | - Mark T Dransfield
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, University of Alabama at Birmingham, Birmingham AL
| | - MeiLan K Han
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor MI
| | - Kendra Young
- Department of Epidemiology, Colorado School of Public Health, Aurora CO
| | - Jeffrey L Curtis
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor MI; Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Kathleen Stringer
- Department of Clinical Sciences, University of Michigan College of Pharmacy, Ann Arbor, MI
| | - Greg Kinney
- Department of Epidemiology, Colorado School of Public Health, Aurora CO
| | - John E Hokanson
- Department of Epidemiology, Colorado School of Public Health, Aurora CO
| | | | - George R Washko
- Department of Medicine, Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston MA
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21
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Sadeghi H, Jehu DA, Daneshjoo A, Shakoor E, Razeghi M, Amani A, Hakim MN, Yusof A. Effects of 8 Weeks of Balance Training, Virtual Reality Training, and Combined Exercise on Lower Limb Muscle Strength, Balance, and Functional Mobility Among Older Men: A Randomized Controlled Trial. Sports Health 2021; 13:606-612. [PMID: 33583253 PMCID: PMC8558995 DOI: 10.1177/1941738120986803] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Poor muscle strength, balance, and functional mobility have predicted falls in older adults. Fall prevention guidelines recommend highly challenging balance training modes to decrease falls; however, it is unclear whether certain modes are more effective. The purpose of this study was to determine whether traditional balance training (BT), virtual reality balance training (VR), or combined exercise (MIX) relative to a waitlist control group (CON) would provoke greater improvements in strength, balance, and functional mobility as falls risk factor proxies for falls in older men. HYPOTHESIS We hypothesized that 8 weeks of MIX will provoke the greatest improvements in falls risk factors, followed by similar improvements after BT and VR, relative to the CON. STUDY DESIGN Single-blinded randomized controlled trial NCT02778841 (ClinicalTrials.gov identifier). LEVEL OF EVIDENCE Level 2. METHODS In total, 64 community-dwelling older men (age 71.8 ± 6.09 years) were randomly assigned into BT, VR, MIX, and CON groups and tested at baseline and at the 8-week follow-up. The training groups exercised for 40 minutes, 3 times per week, for 8 weeks. Isokinetic quadriceps and hamstrings strength on the dominant and nondominant legs were primary outcomes measured by the Biodex Isokinetic Dynamometer. Secondary outcomes included 1-legged stance on firm and foam surfaces, tandem stance, the timed-up-and-go, and gait speed. Separate one-way analyses of covariance between groups were conducted for each outcome using baseline scores as covariates. RESULTS (1) MIX elicited greater improvements in strength, balance, and functional mobility relative to BT, VR, and CON; (2) VR exhibited better balance and functional mobility relative to BT and CON; and (3) BT demonstrated better balance and functional mobility relative to CON. CONCLUSION The moderate to large effect sizes in strength and large effect sizes for balance and functional mobility underline that MIX is an effective method to improve falls risk among older adults. CLINICAL RELEVANCE This study forms the basis for a larger trial powered for falls.
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Affiliation(s)
- Hassan Sadeghi
- Department of Biomechanics and Sports
Injuries, Faculty of Physical Education and Sports Sciences, Kharazmi University,
Tehran, Iran
- Department of Sports Studies, Faculty of
Educational Studies, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Deborah A. Jehu
- Aging, Mobility and Cognitive
Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine,
University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility,
Vancouver Coastal Health Research Institute, Vancouver, British Columbia,
Canada
- Djavad Mowafaghian Centre for Brain
Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia,
Canada
| | - Abdolhamid Daneshjoo
- Department of Sports Injuries and
Corrective Exercises, Faculty of Sports Sciences, Shahid Bahonar University of
Kerman, Kerman, Iran
| | - Elham Shakoor
- Department of Physical Education and
Sport Sciences, School of Education and Psychology, Shiraz University, Shiraz,
Iran
- Shiraz Geriatric Research Center,
Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Razeghi
- School of Rehabilitation Sciences,
Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Amani
- Faculty of Sports Science, Shomal
University, Amol, Iran
| | - Muhammad Nazrul Hakim
- Department of Biomedical Sciences,
Faculty of Medicine and Health Sciences, Universiti Putra, Serdang, Selangor,
Malaysia
| | - Ashril Yusof
- Centre for Sports and Exercise
Sciences, University of Malaya, Kuala Lumpur, Malaysia
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22
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A Home-Based Multimedia Pulmonary Rehabilitation Program Improves Clinical Symptoms and Physical Performance of Patients with Chronic Obstructive Pulmonary Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111479. [PMID: 34769994 PMCID: PMC8582790 DOI: 10.3390/ijerph182111479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 11/23/2022]
Abstract
Home-based pulmonary rehabilitation can decrease symptoms in chronic obstructive pulmonary disease (COPD) patients. The purpose of this study was to compare the effects of a home-based pulmonary rehabilitation by instructive multimedia in the form of videos and flip charts on clinical symptoms and exercise performance in COPD patients. An eight-week home-based pulmonary rehabilitation program was performed with twenty COPD patients older than 60 years of age with moderate to severe stages. They were separated into two groups: a multimedia group (n = 10) and a control group, which was only provided with telephone monitoring (n = 10). Clinical symptoms were measured by using the clinical COPD questionnaire (CCQ), and exercise performance was measured using a six-minute walk test (6MWT) and an upper-lower limb muscle strengthening test. After 8 weeks, the results showed that both groups showed a statistically significant decrease in the CCQ (p < 0.05). The multimedia group showed a statistically significant increase in the lower-limb muscle strengthening (p < 0.05), while the control group was not found to show a statistically significant increase in the lower-limb muscle strengthening. Therefore, a pulmonary rehabilitation program using multimedia at home can lessen symptoms and improve exercise performance in COPD patients.
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23
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Pancera S, Lopomo NF, Bianchi LNC, Pedersini P, Villafañe JH. Isolated Resistance Training Programs to Improve Peripheral Muscle Function in Outpatients with Chronic Obstructive Pulmonary Diseases: A Systematic Review. Healthcare (Basel) 2021; 9:1397. [PMID: 34683077 PMCID: PMC8535539 DOI: 10.3390/healthcare9101397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/14/2021] [Accepted: 10/16/2021] [Indexed: 01/01/2023] Open
Abstract
This systematic review aims to establish which isolated resistance training (RT) programs have been used in outpatients with chronic obstructive pulmonary disease (COPD) and their impact on all aspects of peripheral skeletal muscle function. Electronic databases were systematically searched up to June 2021. The eligibility criteria were: (1) randomized controlled trials investigating the effects of supervised and isolated RT programs in outpatients with COPD and (2) RT programs lasting 8-12 weeks, (3) including at least one outcome measure related to trainable muscle characteristics. Initially, 6576 studies were identified, whereas 15 trials met the inclusion criteria. All the included trials reported that isolated RT improved both upper and lower limbs' maximal strength. Muscle endurance and power also increased after RT but received less attention in the analysis. Furthermore, few studies assessed the effect of RT on muscle mass and cross-sectional area, reporting only limited improvement. Isolated RT programs carried out 2-3 days a week for 8-12 weeks improved skeletal muscle function in individuals with COPD. The RT program should be specifically focused to the trainable muscle characteristic to be improved. For this reason, we further encourage the introduction of a detailed assessment of muscle function and structure during the pulmonary rehabilitation practice.
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Affiliation(s)
- Simone Pancera
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy; (L.N.C.B.); (P.P.); (J.H.V.)
| | - Nicola F. Lopomo
- Department of Information Engineering, University of Brescia, Via Branze 38, 25123 Brescia, Italy;
| | - Luca N. C. Bianchi
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy; (L.N.C.B.); (P.P.); (J.H.V.)
| | - Paolo Pedersini
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy; (L.N.C.B.); (P.P.); (J.H.V.)
| | - Jorge H. Villafañe
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy; (L.N.C.B.); (P.P.); (J.H.V.)
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24
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Higashimoto Y, Shiraishi M, Sugiya R, Mizusawa H, Nishiyama O, Ryo Y, Iwanaga T, Chiba Y, Tohda Y, Fukuda K. Effect of Pulmonary Rehabilitation on Erector Spinae Muscles in Individuals With COPD. Respir Care 2021; 66:1458-1468. [PMID: 34230214 PMCID: PMC9993866 DOI: 10.4187/respcare.08678] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND A recent paper reported that low muscle mass in the erector spinae muscles (ESM) was strongly associated with poor prognosis and declining muscle mass over time in subjects with COPD. However, effects of pulmonary rehabilitation (PR), if any, on ESM mass have not been reported. We hypothesized that PR reduces the annual decline in ESM mass. METHODS This was a retrospective cohort study. Thirty-nine subjects with COPD who received PR and underwent chest computed tomography before and after PR were evaluated (rehabilitation group). We also evaluated 39 age-matched subjects with COPD who did not receive PR (nonrehabilitation group). Data were collected from August 2010 until March 2020 in both groups. The ESM cross-sectional area (ESMCSA) was measured using axial computed tomography images, and annual changes were calculated. The 6-min walk distance (6MWD) was measured before and after PR; the minimum clinically important difference was defined as 30 m. RESULTS ESMCSA declined in the nonrehabilitation group over time (-116.0 ± 141.2 mm2/y) but increased in the PR group (51.0 ± 95.3 mm2/y; P < .001). The annual increase in ESMCSA was significantly higher among subjects with an increase in 6MWD that exceeded the minimum clinically important difference compared with nonresponders in the rehabilitation group. The annual change in ESMCSA was negatively correlated with comorbidity index, and triple therapy (long-acting β2-agonist/long-acting muscarinic antagonist/inhaled corticosteroid) had a favorable effect on annual change in ESMCSA. Multiple regression analysis revealed that only PR was an independent factor for annual change in ESMCSA. CONCLUSIONS ESM mass was shown to decline yearly in subjects with COPD. The annual decline in muscle mass was reduced by PR.
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Affiliation(s)
- Yuji Higashimoto
- Department of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan.
| | - Masashi Shiraishi
- Department of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Ryuji Sugiya
- Department of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Hiroki Mizusawa
- Department of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
| | - Osamu Nishiyama
- Department of Respiratory Medicine and Allergology, Kindai University School of Medicine, Osaka, Japan
| | - Yamazaki Ryo
- Department of Respiratory Medicine and Allergology, Kindai University School of Medicine, Osaka, Japan
| | - Takashi Iwanaga
- Department of Respiratory Medicine and Allergology, Kindai University School of Medicine, Osaka, Japan
| | - Yasutaka Chiba
- Division of Biostatistics, Clinical Research Center, Kindai University School of Medicine, Osaka, Japan
| | | | - Kanji Fukuda
- Department of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan
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25
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Frykholm E, Gephine S, Saey D, Lemson A, Klijn P, Bij de Vaate E, Maltais F, van Hees H, Nyberg A. Isotonic quadriceps endurance is better associated with daily physical activity than quadriceps strength and power in COPD: an international multicentre cross-sectional trial. Sci Rep 2021; 11:11557. [PMID: 34078960 PMCID: PMC8172909 DOI: 10.1038/s41598-021-90758-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/12/2021] [Indexed: 11/24/2022] Open
Abstract
Knowledge about modifiable determinants of daily physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD) is crucial to design effective PA interventions. The present study aimed to determine the contribution of quadriceps strength, power and endurance to daily PA in COPD. Additionally, for quadriceps endurance, we also aimed to determine to what extent the association varies according to the mode of movement (isotonic, isometric, or isokinetic). Using a multicentre cross-sectional trial design we determined the contribution of quadriceps function to daily PA (steps, sedentary time and time spent doing moderate-to-very-vigorous physical activity [MVPA]) using bivariate and partial Pearson correlation analysis (r) and multiple linear regression models (ΔR2). Pre-determined controlling factors were sex, age, body mass index (BMI), COPD-assessment test, forced expiratory volume in one second in percent of the predicted value (FEV1pred), and distance walked on the 6-minute walk test. Eighty-one patients with COPD (mean ± SD: age 67 ± 8 years, FEV1pred 57 ± 19%, daily steps 4968 ± 3319, daily sedentary time 1016 ± 305 min, and MVPA time 83 ± 45 min) were included. Small to moderate bivariate correlations (r = .225 to .452, p < .05) were found between quadriceps function and measures of PA. The best multiple linear regression models explained 38–49% of the variance in the data. Isotonic endurance was the only muscle contributor that improved all PA models; daily steps (ΔR2 = .04 [relative improvement 13%] p = .026), daily sedentary time (ΔR2 = .07 [23%], p = .005) and MVPA-minutes (ΔR2 = .08 [20%], p = .001). Isotonic endurance was also independently associated with most PA variables, even when controlling for strength, power or isometric-isokinetic endurance properties of the muscle (r = .246 to .384, p < .05). In contrast, neither strength, power, isometric-or isokinetic endurance properties of the muscle was independently associated with PA measures when controlling for isotonic endurance (r = .037 to .219, p > .05). To conclude, strength, power, and endurance properties of the quadriceps were low to moderately associated with PA in patients with COPD. Isotonic quadriceps endurance was the only quadriceps property that was independently associated with the different measures of PA after controlling for a basic set of known determinants of PA, quadriceps strength or power, or isometric or isokinetic quadriceps endurance. Future longitudinal studies should investigate its potential as a modifiable determinant of PA.
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Affiliation(s)
- Erik Frykholm
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University , Umeå, Sweden.
| | - Sarah Gephine
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec, Canada.,Univ. Lille, Univ. Artois, Univ. Littoral Côte D'opale, ULR 7369-Urepsss, Lille, France
| | - Didier Saey
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec, Canada
| | - Arthur Lemson
- Department of Pulmonary Diseases, Radboud UMC, Nijmegen, The Netherlands
| | - Peter Klijn
- Department of Pulmonary Rehabilitation, Merem Medical Rehabilitation, Hilversum, The Netherlands.,Department of Pulmonary Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Eline Bij de Vaate
- Department of Pulmonary Rehabilitation, Merem Medical Rehabilitation, Hilversum, The Netherlands
| | - François Maltais
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec, Canada
| | | | - André Nyberg
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University , Umeå, Sweden
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26
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Kohlbrenner D, Aregger C, Osswald M, Sievi NA, Clarenbach CF. Blood-Flow-Restricted Strength Training Combined With High-Load Strength and Endurance Training in Pulmonary Rehabilitation for COPD: A Case Report. Phys Ther 2021; 101:6134603. [PMID: 33580965 DOI: 10.1093/ptj/pzab063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/03/2020] [Accepted: 12/31/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The purpose of this report is to describe the case of a patient with chronic obstructive pulmonary disease (COPD) who was load compromised and being referred for outpatient pulmonary rehabilitation. Low-load blood flow restriction strength training (LL-BFRT) was applied to prepare for and increase tolerability of subsequently applied high-load strength training. METHODS (CASE DESCRIPTION) A 62-year-old woman with COPD GOLD 2 B presented with severe breathlessness. Lower limb strength was severely reduced while functional exercise capacity was preserved. The patient was severely load compromised and had high risk to be intolerant of the high training loads required to trigger the desired adaptations. LL-BFRT was applied during the first 12 training sessions and high-load strength training in the subsequent 12 training sessions of the rehabilitation program. Endurance training on a cycle ergometer was performed throughout the program. RESULTS Symptom burden in the COPD assessment test was reduced by 6 points (40%). Lower limb strength improved by 95.3 Nm (521%) and 88.4 Nm (433%) for the knee extensors and by 33.8 Nm (95%) and 56 Nm (184%) for the knee flexors, respectively. Functional exercise capacity improved by 44 m (11%) in the 6-minute walk test and 14 repetitions (108%) in the 1-minute sit-to stand test. The patient did not experience any adverse events related to the exercise training. CONCLUSION Clinically relevant changes were observed in both strength-related functional and self-reported outcomes. The achievements translated well into daily living and enabled functioning according to the patients' desires. LL-BFRT was reported to be well tolerated and implementable into an outpatient pulmonary rehabilitation program. IMPACT The description of this case encourages the systematic investigation of LL-BFRT in COPD. LL-BFRT has the potential to increase benefits as well as tolerability of strength training in pulmonary rehabilitation. Consideration of the physiological changes achieved through LL-BFRT highlights potential in targeting peripheral muscle dysfunction in COPD.
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Affiliation(s)
- Dario Kohlbrenner
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Céline Aregger
- Department of Physiotherapy and Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Martin Osswald
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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27
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Iwakura M, Wakasa M, Okura K, Kawagoshi A, Sugawara K, Takahashi H, Shioya T. Functionally Relevant Threshold of Quadriceps Muscle Strength in Patients with Chronic Obstructive Pulmonary Disease. Prog Rehabil Med 2021; 6:20210008. [PMID: 33564729 PMCID: PMC7862007 DOI: 10.2490/prm.20210008] [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: 09/10/2020] [Accepted: 01/20/2021] [Indexed: 01/29/2023] Open
Abstract
Objectives We aimed to identify the quadriceps muscle strength (QMS) thresholds below which exercise capacity is compromised in men with chronic obstructive pulmonary disease (COPD). Methods We measured the quadriceps isometric maximum voluntary contraction (QMVC) and calculated the QMVC values normalized to weight (QMVC-BW), height squared (QMVC-H2), and body mass index (QMVC-BMI) in 113 patients with COPD. The functional exercise capacity was evaluated using the 6-minute walk distance (6MWD), and 6MWD <350 m was defined as functional exercise intolerance. Thresholds were determined for QMVC and its normalized values to achieve high specificity (>0.90) with maximal sensitivity. P-values <0.01 were considered statistically significant. Results Data from 99 male patients (age, 74 ± 6 years; percentages of predicted forced expiratory volume in 1-s, 56.9 ± 26.4%) were analyzed; 3 women and 11 participants with the missing data were excluded. Multivariate logistic regression models identified significant associations of QMVC and QMVC-H2 with 6MWD, after adjustment for age and dyspnea. C-statistics showed that the area under the curves of all QMVC parameters were comparable. The thresholds of QMVC and QMVC-H2 for predicting compromised exercise capacity were 26.2 kg and 9.6 kg/m2, respectively. Conclusions QMS thresholds in men with COPD could help clinicians evaluate whether QMS is insufficient to achieve 6MWD ≥350 m and thereby identify patients who should be specifically targeted for muscle strengthening training during their pulmonary rehabilitation program.
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Affiliation(s)
| | - Masahiko Wakasa
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Kazuki Okura
- Department of Rehabilitation, Akita University Hospital, Akita, Japan
| | | | - Keiyu Sugawara
- Department of Rehabilitation, Akita City Hospital, Akita, Japan
| | - Hitomi Takahashi
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, Ohtawara, Japan
| | - Takanobu Shioya
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
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28
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Mason SE, Moreta-Martinez R, Labaki WW, Strand M, Baraghoshi D, Regan EA, Bon J, San Jose Estepar R, Casaburi R, McDonald MLN, Rossiter H, Make BJ, Dransfield MT, Han MK, Young KA, Kinney G, Hokanson JE, San Jose Estepar R, Washko GR. Respiratory exacerbations are associated with muscle loss in current and former smokers. Thorax 2021; 76:554-560. [PMID: 33574123 DOI: 10.1136/thoraxjnl-2020-215999] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/30/2020] [Accepted: 12/21/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Muscle wasting is a recognised extra-pulmonary complication in chronic obstructive pulmonary disease and has been associated with increased risk of death. Acute respiratory exacerbations are associated with reduction of muscle function, but there is a paucity of data on their long-term effect. This study explores the relationship between acute respiratory exacerbations and long-term muscle loss using serial measurements of CT derived pectoralis muscle area (PMA). DESIGN AND SETTING Participants were included from two prospective, longitudinal, observational, multicentre cohorts of ever-smokers with at least 10 pack-year history. PARTICIPANTS The primary analysis included 1332 (of 2501) participants from Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) and 4384 (of 10 198) participants from Genetic Epidemiology of COPD (COPDGene) who had complete data from their baseline and follow-up visits. INTERVENTIONS PMA was measured on chest CT scans at two timepoints. Self-reported exacerbation data were collected from participants in both studies through the use of periodic longitudinal surveys. MAIN OUTCOME MEASURES Age-related and excess muscle loss over time. RESULTS Age, sex, race and body mass index were associated with baseline PMA. Participants experienced age-related decline at the upper end of reported normal ranges. In ECLIPSE, the exacerbation rate over time was associated with an excess muscle area loss of 1.3% (95% CI 0.6 to 1.9, p<0.001) over 3 years and in COPDGene with an excess muscle area loss of 2.1% (95% CI 1.2 to 2.8, p<0.001) over 5 years. Excess muscle area decline was absent in 273 individuals who participated in pulmonary rehabilitation. CONCLUSIONS Exacerbations are associated with accelerated skeletal muscle loss. Each annual exacerbation was associated with the equivalent of 6 months of age-expected decline in muscle mass. Ameliorating exacerbation-associated muscle loss represents an important therapeutic target.
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Affiliation(s)
- Stefanie Elizabeth Mason
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew Strand
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado, USA
| | - David Baraghoshi
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado, USA
| | - Elizabeth A Regan
- Division of Rheumatology, National Jewish Health, Denver, Colorado, USA
| | - Jessica Bon
- Division of Pulmonary, Allergy and Critical Care, UPMC, Pittsburgh, Pennsylvania, USA
| | | | - Richard Casaburi
- Division of Respiratory and Critical Care Physiology and Medicine, Los Angeles Biomedical Research Institute, Torrance, California, USA
| | - Merry-Lynn N McDonald
- Division of Pulmonary, Allergy, and Critical Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Harry Rossiter
- Division of Respiratory and Critical Care Physiology and Medicine, Los Angeles Biomedical Research Institute, Torrance, California, USA
| | - Barry J Make
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, Colorado, USA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy, and Critical Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kendra A Young
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Greg Kinney
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - John E Hokanson
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | | | - George R Washko
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Oliveira A, Rebelo P, Paixão C, Jácome C, Cruz J, Martins V, Simão P, Brooks D, Marques A. Minimal Clinically Important Difference for Quadriceps Muscle Strength in People with COPD following Pulmonary Rehabilitation. COPD 2021; 18:35-44. [PMID: 33533285 DOI: 10.1080/15412555.2021.1874897] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Quadriceps strength training is a key component of pulmonary rehabilitation (PR). Clinical interpretability of changes in muscle strength following PR is however limited due to the lack of cut-off values to define clinical improvement. This study estimated the minimal clinically important difference (MCID) for the isotonic and isometric quadriceps muscle strength assessed with the one-repetition maximum (1RM) and hand-held dynamometry (HHD) in people with chronic obstructive pulmonary disease (COPD) following PR.A secondary analysis of a real life non-randomised controlled study was conducted in people with COPD enrolled in a 12-week community-based PR programme. Anchor and distribution-based methods were used to compute the MCIDs. The anchors explored were the St. George's respiratory questionnaire (SGRQ) and the six-minute walk test (6MWT) using Pearson's correlations. Pooled MCIDs were computed using the arithmetic weighted mean (2/3 anchor, 1/3 distribution-based methods) and reported as absolute and/or percentage of change values.Eighty-nine people with COPD (84% male, 69.9 ± 7.9 years, FEV1 49.9 ± 18.9% predicted) were included. No correlations were found between changes in 1RM and the SGRQ neither between changes in HHD and the SGRQ and 6MWT (p > 0.05). Thus, anchor-based methods were used only in the MCID of the 1RM with the 6MWT as the anchor. The pooled MCIDs were 5.7Kg and 26.9% of change for the isotonic quadriceps muscle strength with 1RM and 5.2KgF for isometric quadriceps muscle strength assessed with HHD.The MCIDs found are estimates to improve interpretability of community-based PR effects on quadriceps muscle strength and may contribute to guide interventions.
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Affiliation(s)
- Ana Oliveira
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.,Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada.,Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
| | - Patrícia Rebelo
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal.,iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Cátia Paixão
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal.,iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Cristina Jácome
- CINTESIS -Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Joana Cruz
- School of Health Sciences, Polytechnic Institute of Leiria, Leiria, Portugal; Centre for Innovative Care and Health Technology (ciTechCare), School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal
| | - Vitória Martins
- Pulmonology Department, Hospital Distrital da Figueira da Foz, Figueira da Foz, Portugal
| | - Paula Simão
- Pulmonology Department, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Dina Brooks
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.,Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada
| | - Alda Marques
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal.,iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
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30
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Iwakura M, Okura K, Kubota M, Sugawara K, Kawagoshi A, Takahashi H, Shioya T. Estimation of minimal clinically important difference for quadriceps and inspiratory muscle strength in older outpatients with chronic obstructive pulmonary disease: a prospective cohort study. Phys Ther Res 2020; 24:35-42. [PMID: 33981526 DOI: 10.1298/ptr.e10049] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/17/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To estimate the minimal clinically important difference (MCID) of quadriceps and inspiratory muscle strength after a home-based pulmonary rehabilitation program (PRP) in chronic obstructive pulmonary disease (COPD). METHOD Eighty-five COPD patients were included. Quadriceps maximal voluntary contraction (QMVC) was measured. We measured maximal inspiratory mouth pressure (PImax), the 6-minute walk distance (6MWD), the chronic respiratory questionnaire (CRQ) and the modified Medical Research Council dyspnoea score (mMRC). All measurements were conducted at baseline and at the end of the PRP. The MCID was calculated using anchor-based (using 6MWD, CRQ, and mMRC as possible anchor variables) and distribution-based (half standard deviation and 1.96 standard error of measurement) approaches. Changes in the five variables were compared in patients with and without changes in QMVC or PImax >MCID for each variable. RESULTS Sixty-nine COPD patients (age 75±6 years) were analysed. QMVC improved by 2.4 (95%CI 1.1-3.7) kgf, PImax by 5.8 (2.7-8.8) cmH2O, 6MWD by 21 (11-32) meters and CRQ by 3.9 (1.6-6.3) points. The MCID of QMVC and PImax was 3.3-7.5 kgf and 17.2-17.6 cmH2O, respectively. The MCID of QMVC (3.3 kgf) could differentiate individuals with significant improvement in 6MWD and PImax from those without. CONCLUSION The MCID of QMVC (3.3 kgf) can identify a meaningful change in quadriceps muscle strength after a PRP. The MCID of PImax (17.2 cmH2O) should be used with careful consideration, because the value is estimated using distributionbased method.
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Affiliation(s)
| | - Kazuki Okura
- Department of Rehabilitation, Akita University Hospital, Japan
| | - Mika Kubota
- Department of Rehabilitation, Akita City Hospital, Japan
| | - Keiyu Sugawara
- Department of Rehabilitation, Akita City Hospital, Japan
| | | | - Hitomi Takahashi
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, Japan
| | - Takanobu Shioya
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Japan
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31
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Li N, Li P, Lu Y, Wang Z, Li J, Liu X, Wu W. Effects of resistance training on exercise capacity in elderly patients with chronic obstructive pulmonary disease: a meta-analysis and systematic review. Aging Clin Exp Res 2020; 32:1911-1922. [PMID: 31494915 DOI: 10.1007/s40520-019-01339-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/27/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The objective of this study was to summarize and determine the effectiveness of resistance training on exercise capacity in patients with chronic obstructive pulmonary disease (COPD). METHODS We searched PubMed, EMBASE, Cochrane Library, and two Chinese databases (China National Knowledge Infrastructure and Wanfang Data) to identify articles written in English or Chinese and published from January 2000 to January 2019. Randomized controlled trials were included if they evaluated the effects of resistance training on exercise capacity in COPD patients. We assessed the quality of the trials using the Physiotherapy Evidence Database Scale. Data from these studies were pooled to calculate weighted mean difference (WMD) or standardized mean difference (SMD) with 95% confidence intervals (CI). RESULTS Eleven studies with a total of 405 participants met the inclusion criteria. Compared with the non-exercise control group, resistance training significantly improved 6-min walking distance (WMD, 54.52; 95% CI 25.47-83.56; I2 = 43%; P = 0.14), transfer numbers for the 6-min pegboard and ring test (WMD, 25.17; 95% CI 10.17-40.16; I2 = 0%; P = 0.55), and tolerance time for the unsupported upper-limb exercise test (SMD, 0.41; 95% CI 0.03-0.79; I2 = 0%; P = 0.83). There were no significant differences in constant work rate endurance test results or in peak oxygen uptake between the two groups. CONCLUSIONS Resistance training was an effective approach to improve functional exercise capacity, endurance exercise capacity, and peak exercise capacity in COPD patients.
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Affiliation(s)
- Ning Li
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, 200438, China
| | - Peijun Li
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, 200438, China
| | - Yufan Lu
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, 200438, China
| | - Zhengrong Wang
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, 200438, China
| | - Jian Li
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, 200438, China
| | - Xiaodan Liu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
- Institute of Rehabilitation Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, 201203, China.
| | - Weibing Wu
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, 200438, China.
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32
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Meys R, Stoffels AAF, de Brandt J, van Hees HWH, Franssen FME, Sillen MJH, Wouters EFM, Burtin C, Klijn P, Bij de Vaate E, van den Borst B, Otker JM, Donkers J, Schleich FN, Hayot M, Pomiès P, Everaert I, Derave W, Spruit MA. Beta-alanine supplementation in patients with COPD receiving non-linear periodised exercise training or neuromuscular electrical stimulation: protocol of two randomised, double-blind, placebo-controlled trials. BMJ Open 2020; 10:e038836. [PMID: 32928863 PMCID: PMC7488791 DOI: 10.1136/bmjopen-2020-038836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Exercise intolerance is common in patients with chronic obstructive pulmonary disease (COPD) and, although multifactorial, it is largely caused by lower-limb muscle dysfunction. Research has shown that patients with severe to very severe COPD have significantly lower levels of muscle carnosine, which acts as a pH buffer and antioxidant. Beta-alanine (BA) supplementation has been shown to consistently elevate muscle carnosine in a variety of populations and may therefore improve exercise tolerance and lower-limb muscle function. The primary objective of the current studies is to assess the beneficial effects of BA supplementation in enhancing exercise tolerance on top of two types of exercise training (non-linear periodised exercise (NLPE) training or neuromuscular electrical stimulation (NMES)) in patients with COPD. METHODS AND ANALYSIS Two randomised, double-blind, placebo-controlled trials have been designed. Patients will routinely receive either NLPE (BASE-TRAIN trial) or NMES (BASE-ELECTRIC trial) as part of standard exercise-based care during their 8-to-10 week pulmonary rehabilitation (PR) programme. A total of 222 patients with COPD (2×77 = 154 patients in the BASE-TRAIN trial and 2×34 = 68 patients in the BASE-ELECTRIC trial) will be recruited from two specialised PR centres in The Netherlands. For study purposes, patients will receive 3.2 g of oral BA supplementation or placebo per day. Exercise tolerance is the primary outcome, which will be assessed using the endurance shuttle walk test (BASE-TRAIN) or the constant work rate cycle test (BASE-ELECTRIC). Furthermore, quadriceps muscle strength and endurance, cognitive function, carnosine levels (in muscle), BA levels (in blood and muscle), markers of oxidative stress and inflammation (in blood, muscles and lungs), physical activity and quality of life will be measured. ETHICS AND DISSEMINATION Both trials were approved by CMO Regio Arnhem-Nijmegen, The Netherlands (NL70781.091.19. and NL68757.091.19). TRIAL REGISTRATION NUMBER NTR8427 (BASE-TRAIN) and NTR8419 (BASE-ELECTRIC).
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Affiliation(s)
- Roy Meys
- Department of Research and Development, CIRO, Horn, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Anouk A F Stoffels
- Department of Research and Development, CIRO, Horn, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Department of Pulmonary Diseases, Radboud UMC Dekkerswald, Nijmegen, The Netherlands
| | - Jana de Brandt
- Reval Rehabilitation Research, Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, DIepenbeek, Belgium
| | | | - Frits M E Franssen
- Department of Research and Development, CIRO, Horn, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | | | - Emiel F M Wouters
- Department of Research and Development, CIRO, Horn, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Chris Burtin
- Reval Rehabilitation Research, Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, DIepenbeek, Belgium
| | - Peter Klijn
- Department of Pulmonology, Merem Pulmonary Rehabilitation Centre, Hilversum, The Netherlands
- Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Eline Bij de Vaate
- Department of Pulmonology, Merem Pulmonary Rehabilitation Centre, Hilversum, The Netherlands
| | - Bram van den Borst
- Department of Pulmonary Diseases, Radboud UMC Dekkerswald, Nijmegen, The Netherlands
| | - Jacqueline M Otker
- Patient Advisory Council, Lung Foundation Netherlands, Amersfoort, The Netherlands
- Client Council, CIRO, Horn, The Netherlands
| | | | - Florence N Schleich
- Department of Respiratory Medicine, CHU Sart-Tilman Liege, GIGA I3, Liege, Belgium
| | - Maurice Hayot
- PhyMedExp, INSERM - CNRS, University of Montpellier - Montpellier CHU, Montpellier, France
| | - Pascal Pomiès
- PhyMedExp, INSERM - CNRS, University of Montpellier - Montpellier CHU, Montpellier, France
| | - Inge Everaert
- Department of Movement and Sport Sciences, University Ghent, Ghent, Belgium
| | - Wim Derave
- Department of Movement and Sport Sciences, University Ghent, Ghent, Belgium
| | - Martijn A Spruit
- Department of Research and Development, CIRO, Horn, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Reval Rehabilitation Research, Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, DIepenbeek, Belgium
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Frykholm E, Géphine S, Saey D, van Hees H, Lemson A, Klijn P, Maltais F, Nyberg A. Inter-day test-retest reliability and feasibility of isokinetic, isometric, and isotonic measurements to assess quadriceps endurance in people with chronic obstructive pulmonary disease: A multicenter study. Chron Respir Dis 2020; 16:1479973118816497. [PMID: 30789016 PMCID: PMC6302975 DOI: 10.1177/1479973118816497] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aims were to determine reliability and feasibility of measurements to assess quadriceps endurance in people with chronic obstructive pulmonary disease. Sixty participants (forced expiratory volume in one second (mean ± standard deviation) 55 ± 18% of predicted, age 67 ± 8 years) were tested in an inter-day, test-retest design. Isokinetic, isometric, and isotonic protocols were performed using a computerized dynamometer. Test-retest relative and absolute reliability was determined via intraclass correlation coefficient (ICC), coefficient of variation (CV%), and limits of agreement (LoA%). Isokinetic total work demonstrated very high relative reliability (ICC: [95% confidence interval] = 0.98 [0.94-0.99]) and the best absolute reliability (CV% (LoA%) = 6.5% (18.0%)). Isokinetic fatigue index, isometric, and isotonic measures demonstrated low-to-high relative reliability (ICC = 0.64 [0.46-0.77], 0.88 [0.76-0.94], 0.91 [0.85-0.94]), and measures of absolute reliability (CV% (LoA%)) were 20.3% (56.4%), 14.9% (40.8%), and 15.8% (43.1%). For isokinetic total work and isometric measurements, participants performed better on retest (4.8% and 10.0%, respectively). The feasibility was similar across protocols with an average time consumption of less than 7.5 minutes. In conclusion, isokinetic, isometric, and isotonic measurements of quadriceps endurance were feasible to a similar extent and presented low-to-very high relative reliability. Absolute reliability seems to favor isokinetic total work measurements.
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Affiliation(s)
- Erik Frykholm
- Department of Community Medicine and Rehabilitation, Unit of
Physiotherapy, Umeå University, Umeå, Sweden
- Erik Frykholm, Department of Community
Medicine and Rehabilitation, Unit of Physiotherapy, Umeå University, Umeå 901
87, Sweden.
| | - Sarah Géphine
- Quebec Heart and Lung Institute Research Centre, Faculty of
medicine, Laval University, Quebec city, Canada
| | - Didier Saey
- Quebec Heart and Lung Institute Research Centre, Faculty of
medicine, Laval University, Quebec city, Canada
| | - Hieronymus van Hees
- Department of Pulmonary Diseases, Radboud University Medical Center,
Nijmegen, the Netherlands
| | - Arthur Lemson
- Department of Pulmonary Diseases, Radboud University Medical Center,
Nijmegen, the Netherlands
| | - Peter Klijn
- Department of Pulmonology, Pulmonary Rehabilitation Centre Merem,
Hilversum, the Netherlands
- Department of Pulmonary Medicine, Amsterdam University Medical
Center, Amsterdam, the Netherlands
| | - François Maltais
- Quebec Heart and Lung Institute Research Centre, Faculty of
medicine, Laval University, Quebec city, Canada
| | - André Nyberg
- Department of Community Medicine and Rehabilitation, Unit of
Physiotherapy, Umeå University, Umeå, Sweden
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Ramachandran P, Devaraj U, Patrick B, Saxena D, Venkatnarayan K, Louis V, Krishnaswamy UM, D'souza GA. Ultrasonographic assessment of skeletal muscle mass and diaphragm function in patients with chronic obstructive pulmonary disease: A case-control study. Lung India 2020; 37:220-226. [PMID: 32367843 PMCID: PMC7353944 DOI: 10.4103/lungindia.lungindia_103_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Although muscle dysfunction is a major contributor to morbidity in chronic obstructive pulmonary disease (COPD), assessment of skeletal muscle, and diaphragm function is not routinely performed in COPD patients. OBJECTIVES (1) The aim is to assess muscle dysfunction in COPD by measuring the zone of apposition of diaphragm, diaphragm excursion, thickness of diaphragm, and rectus femoris cross-sectional area (RFCSA) with ultrasonography.(2) To correlate the above assessments with spirometric parameters; notably forced expiratory volume in 1 s (FEV1). METHODS Twenty-four consecutive stable COPD patients and 18 controls were included after obtaining written informed consent. Demographic and clinical data, spirometric values, 6-min walk distance, and sonographic parameters mentioned above were compiled for the analysis. RESULTS All included participants were male with a mean age of 62.5 ± 8.4 years. The mean FEV1in cases was 1.12 ± 0.4 L versus 2.41 ± 0.5 L in controls. The diaphragm thickness (1.8 ± 0.5 mm vs. 2.2 ± 0.6 mm;P = 0.005) and RFCSA was significantly lower in COPD patients (4.8 ± 1.3 cm[2] vs. 6.12 ± 1.2 cm[2];P = 0.02). However, diaphragm excursion (5.35 ± 2.8 cm vs. 7 ± 2.6 cm) although lower in COPD patients, was not significantly different between the groups. Correlation between FEV1and ultrasound diaphragm measurements and RFCSA by Spearman's Rho correlation was poor (ρ= 0.2). CONCLUSION Ultrasonographic assessment of the diaphragm and rectus femoris can be used as markers to assess skeletal muscle dysfunction in COPD as diaphragmatic function and RFCSA were lower in COPD patients.
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Affiliation(s)
- Priya Ramachandran
- Department of Pulmonary and Sleep Medicine, St. John's Medical College, Bengaluru, Karnataka, India
| | - Uma Devaraj
- Department of Pulmonary and Sleep Medicine, St. John's Medical College, Bengaluru, Karnataka, India
| | - Bhavna Patrick
- Department of Pulmonary and Sleep Medicine, St. John's Medical College, Bengaluru, Karnataka, India
| | - Deepali Saxena
- Department of Radiology, St. John's Medical College, Bengaluru, Karnataka, India
| | - Kavitha Venkatnarayan
- Department of Pulmonary Medicine, St. John's Medical College, Bengaluru, Karnataka, India
| | - Varghese Louis
- Department of Pulmonary Medicine, St. John's Medical College, Bengaluru, Karnataka, India
| | | | - George A D'souza
- Department of Pulmonary and Sleep Medicine, St. John's Medical College, Bengaluru, Karnataka, India
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Boutou AK, Daniil Z, Pitsiou G, Papakosta D, Kioumis I, Stanopoulos I. Cardiopulmonary exercise testing in patients with asthma: What is its clinical value? Respir Med 2020; 167:105953. [PMID: 32280032 DOI: 10.1016/j.rmed.2020.105953] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/29/2020] [Accepted: 03/31/2020] [Indexed: 01/28/2023]
Abstract
Asthma is one of the most common respiratory disorders, characterized by fully or largely reversible airflow limitation. Asthma symptoms can be triggered or magnified during exertion, while physical activity limitation is often present among asthmatic patients. Cardiopulmonary exercise testing (CPET) is a dynamic, non-invasive technique which provides a thorough assessment of exercise physiology, involving the integrative assessment of cardiopulmonary, neuromuscular and metabolic responses during exercise. This review summarizes current evidence regarding the utility of CPET in the diagnostic work-up, functional evaluation and therapeutic intervention among patients with asthma, highlighting its potential role for thorough patient assessment and physician clinical desicion-making.
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Affiliation(s)
- Afroditi K Boutou
- Department of Respiratory Medicine, "G. Papanikolaou" Hospital, Thessaloniki, Greece.
| | - Zoi Daniil
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Georgia Pitsiou
- Department of Respiratory Failure, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Despoina Papakosta
- Department of Respiratory Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kioumis
- Department of Respiratory Failure, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Stanopoulos
- Department of Respiratory Failure, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Marillier M, Bernard AC, Vergès S, Neder JA. Locomotor Muscles in COPD: The Rationale for Rehabilitative Exercise Training. Front Physiol 2020; 10:1590. [PMID: 31992992 PMCID: PMC6971045 DOI: 10.3389/fphys.2019.01590] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/19/2019] [Indexed: 12/28/2022] Open
Abstract
Exercise training as part of pulmonary rehabilitation is arguably the most effective intervention to improve tolerance to physical exertion in patients with chronic obstructive pulmonary disease (COPD). Owing to the fact that exercise training has modest effects on exertional ventilation, operating lung volumes and respiratory muscle performance, improving locomotor muscle structure and function are key targets for pulmonary rehabilitation in COPD. In the current concise review, we initially discuss whether patients’ muscles are exposed to deleterious factors. After presenting corroboratory evidence on this regard (e.g., oxidative stress, inflammation, hypoxemia, inactivity, and medications), we outline their effects on muscle macro- and micro-structure and related functional properties. We then finalize by addressing the potential beneficial consequences of different training strategies on these muscle-centered outcomes. This review provides, therefore, an up-to-date outline of the rationale for rehabilitative exercise training approaches focusing on the locomotor muscles in this patient population.
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Affiliation(s)
- Mathieu Marillier
- Laboratory of Clinical Exercise Physiology, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Anne-Catherine Bernard
- Laboratory of Clinical Exercise Physiology, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Samuel Vergès
- HP2 Laboratory, INSERM, CHU Grenoble Alpes, Grenoble Alpes University, Grenoble, France
| | - J Alberto Neder
- Laboratory of Clinical Exercise Physiology, Kingston General Hospital, Queen's University, Kingston, ON, Canada
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Nunes MF, Hervé BB, Lukrafka JL, Monteiro MB. Handgrip strength and its relation to isokinetic dynamometry in COPD. FISIOTERAPIA EM MOVIMENTO 2020. [DOI: 10.1590/1980-5918.033.ao56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Muscle dysfunction is one of the major changes found in chronic obstructive pulmonary disease (COPD) and associated with loss of functionality, morbidity and mortality. Objective: correlate two strength assessment methods: manual dynamometry for handgrip strength and isokinetic dynamometry for quadriceps strength in patients with COPD, and assess the body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE), quality of life and muscle strength. Method: twenty-five patients with moderate to very severe COPD were evaluated by pulmonary function parameters, anthropometric variables, functional capacity, via the six-minute walk test, dyspnea, applying the modified Medical Research Council (mMRC) scale, BODE, quality of life, using the Saint George's Respiratory Questionnaire (SGRQ), handgrip strength with manual dynamometer and quadriceps force using an isokinetic dynamometer. Muscle strength was assessed with a manual portable dynamometer and isokinetic dynamometer. For statistical analysis, ANOVA with Bonferroni’s post-test, the chi-squared test and Pearson's correlation coefficient were used. Results: There was a strong correlation between the strength measurements and the two instruments (torque and quadriceps extension power with right handgrip strength: r = 0.74; p <0.001). The patients classified as very severe exhibited worse performance in the strength tests when compared to the moderate group, albeit with no statistically significant difference. Conclusion: In muscle strength measurements, a strong correlation was detected between the isokinetic dynamometer for quadriceps and the manual dynamometer for handgrip strength. These findings indicate that, in clinical practice, the manual dynamometer for handgrip strength could be used to assess peripheral muscle strength in patients with COPD.
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38
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Balnis J, Korponay TC, Vincent CE, Singer DV, Adam AP, Lacomis D, Lee CG, Elias JA, Singer HA, Jaitovich A. IL-13-driven pulmonary emphysema leads to skeletal muscle dysfunction attenuated by endurance exercise. J Appl Physiol (1985) 2020; 128:134-148. [PMID: 31774358 PMCID: PMC7054638 DOI: 10.1152/japplphysiol.00627.2019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/13/2019] [Accepted: 11/24/2019] [Indexed: 02/07/2023] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) usually develop skeletal muscle dysfunction, which represents a major comorbidity in these patients and is strongly associated with mortality and other poor outcomes. Although clinical data indicates that accelerated protein degradation and metabolic disruption are common associations of muscle dysfunction in COPD, there is very limited data on the mechanisms regulating the process, in part, due to the lack of research performed on a validated animal model of pulmonary emphysema. This model deficiency complicates the translational value of data generated with highly reductionist settings. Here, we use an established transgenic animal model of COPD based on inducible IL-13-driven pulmonary emphysema (IL-13TG) to interrogate the mechanisms of skeletal muscle dysfunction. Skeletal muscles from these emphysematous mice develop most features present in COPD patients, including atrophy, decreased oxygen consumption, and reduced force-generation capacity. Analysis of muscle proteome indicates downregulation of succinate dehydrogenase C (SDH-C), which correlates with reduced enzymatic activity, also consistent with previous clinical observations. Ontology terms identified with human data, such as ATP binding/bioenergetics are also downregulated in this animal's skeletal muscles. Moreover, chronic exercise can partially restore muscle mass, metabolic and force-generation capacity, and SDH activity in COPD mice. We conclude that this animal model of COPD/emphysema is an adequate platform to further investigate mechanisms of muscle dysfunction in this setting and demonstrates multiple approaches that can be used to address specific mechanisms regulating this process.NEW & NOTEWORTHY Skeletal muscle dysfunction is a relevant comorbidity in patients with chronic obstructive pulmonary disease (COPD). Mechanistic research in the area has so far been accomplished with models based on specific exposures to otherwise healthy animals, and no investigation using an established and validated animal model of COPD has been accomplished. We present an animal model of COPD that was previously shown to recapitulate pulmonary functional and histologic features present in patients with COPD, and demonstrates most of the features present in patients with pulmonary emphysema-associated muscle dysfunction, which we proposed as an adequate tool to develop mechanistic research in the area.
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Affiliation(s)
- Joseph Balnis
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, New York
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, New York
| | - Tanner C Korponay
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, New York
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, New York
| | | | - Diane V Singer
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, New York
| | - Alejandro P Adam
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, New York
- Department of Ophthalmology, Albany Medical College, Albany, New York
| | - David Lacomis
- Departments of Neurology and Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Chun Geun Lee
- Department of Molecular Microbiology and Immunology, Brown University, Providence, Rhode Island
| | - Jack A Elias
- Department of Molecular Microbiology and Immunology, Brown University, Providence, Rhode Island
| | - Harold A Singer
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, New York
| | - Ariel Jaitovich
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, New York
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, New York
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Thalacker-Mercer A, Riddle E, Barre L. Protein and amino acids for skeletal muscle health in aging. ADVANCES IN FOOD AND NUTRITION RESEARCH 2019; 91:29-64. [PMID: 32035599 DOI: 10.1016/bs.afnr.2019.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Proteins and its building blocks, amino acids, have many physiological roles in the body. While some amino acids can be synthesized endogenously, exogenous protein and amino acids are necessary to maintain homeostasis. Because skeletal muscle contains a large portion of endogenous protein and plays important roles in movement, regulation, and metabolism, imbalanced protein and amino acid availability may result in clinical conditions including skeletal muscle atrophy, impaired muscle growth or regrowth, and functional decline. Aging is associated with changes in protein metabolism and multiple physiological and functional alterations in the skeletal muscle that are accentuated by decreased dietary protein intake and impaired anabolic responses to stimuli. Inactivity and chronically elevated inflammation of the skeletal muscle can initiate and/or augment pathological remodeling of the tissue (i.e., increase of fat and fibrotic tissues and atrophy of the muscle). Defining an adequate amount of dietary protein that is appropriate to maintain the availability of amino acids for biological needs is necessary but is still widely debated for older adults. This chapter will provide (i) an overview of dietary protein and amino acids and their role in skeletal muscle health; (ii) an overview of skeletal muscle structure and function and the deterioration of muscle that occurs with advancing age; (iii) a discussion of the relationship between protein/amino acid metabolism and skeletal muscle decline with aging; and (iv) a brief discussion of optimal protein intakes for older adults to maintain skeletal muscle health in aging.
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Affiliation(s)
| | | | - Laura Barre
- Cornell University, Ithaca, NY, United States
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Marklund S, Bui KL, Nyberg A. Measuring and monitoring skeletal muscle function in COPD: current perspectives. Int J Chron Obstruct Pulmon Dis 2019; 14:1825-1838. [PMID: 31695351 PMCID: PMC6707440 DOI: 10.2147/copd.s178948] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/25/2019] [Indexed: 11/23/2022] Open
Abstract
Skeletal muscle dysfunction is an important systemic consequence of chronic obstructive pulmonary disease (COPD) that worsens the natural cause of the disease. Up to a third of all people with COPD express some form of impairment which encompasses reductions in strength and endurance, as well as an increased fatigability. Considering this complexity, no single test could be used to measure and monitor all aspects of the impaired skeletal muscle function within the COPD population, resulting in a wide range of available tests and measurement techniques. The aim of the current review is to highlight current and new perspectives relevant to skeletal muscle function measurements within the COPD population in order to provide guidance for researchers as well as for clinicians. First of all, standardized and clinically feasible measurement protocols, as well as normative values and predictive equations across the spectrum of impaired function in COPD, are needed before assessment of skeletal muscle function can become a reality in clinical praxis. This should minimally target the quadriceps muscle; however, depending on the objective of measurements, eg, to determine upper limb muscle function or walking capacity, other muscles could also be tested. Furthermore, even though muscle strength measurements are important, current evidence suggests that other aspects, such as the endurance and power capacity of the muscle, should also be considered. Moreover, although static (isometric) measurements have been favored, dynamic measurements of skeletal muscle function should not be neglected as they, in a larger extent than static measurements, are related to tasks of daily living. Lastly, the often modest relationships between functional tests and skeletal muscle function measurements indicate that they evaluate different constructs and thus cannot replace one another. Therefore, for accurate measurements of skeletal muscle function in people with COPD, specific and formal measurements should still be prioritized.
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Affiliation(s)
- Sarah Marklund
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Kim-Ly Bui
- Rehabilitation Department, Faculty of Medicine Laval University and Centre de recherche, Laval University Quebec Heart and Lung Institute (CRIUCPQ), Québec, QC, Canada
| | - Andre Nyberg
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
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Neder JA, Marillier M, Bernard AC, James MD, Milne KM, O’Donnell DE. The Integrative Physiology of Exercise Training in Patients with COPD. COPD 2019; 16:182-195. [DOI: 10.1080/15412555.2019.1606189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- J. Alberto Neder
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Division of Respirology, Department of Medicine, Kingston Health Science Center and Queen’s University, Kingston, Ontario, Canada
| | - Mathieu Marillier
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Division of Respirology, Department of Medicine, Kingston Health Science Center and Queen’s University, Kingston, Ontario, Canada
| | - Anne-Catherine Bernard
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Division of Respirology, Department of Medicine, Kingston Health Science Center and Queen’s University, Kingston, Ontario, Canada
| | - Matthew D. James
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Division of Respirology, Department of Medicine, Kingston Health Science Center and Queen’s University, Kingston, Ontario, Canada
| | - Kathryn M. Milne
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Division of Respirology, Department of Medicine, Kingston Health Science Center and Queen’s University, Kingston, Ontario, Canada
- Clinician Investigator Program, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Denis E. O’Donnell
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Division of Respirology, Department of Medicine, Kingston Health Science Center and Queen’s University, Kingston, Ontario, Canada
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Effects of Pulmonary Rehabilitation on Gait Characteristics in Patients with COPD. J Clin Med 2019; 8:jcm8040459. [PMID: 30959769 PMCID: PMC6518247 DOI: 10.3390/jcm8040459] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 03/27/2019] [Accepted: 04/03/2019] [Indexed: 01/23/2023] Open
Abstract
Pulmonary rehabilitation (PR) improves lower-limb muscle function in patients with chronic obstructive pulmonary disease (COPD). However, it remains unclear whether patients improve gait characteristics, in particular stride-to-stride fluctuations that are associated with fall risks. This study aims to identify whether, and to what extent, PR affects positively gait characteristics in COPD. In this prospective observational study, 44 COPD patients (aged: 62 ± 7 years; Forced expiratory volume in 1 s 56 ± 20% predicted) performed self-paced, treadmill 6-min-walk tests (Gait Real-time Analysis Interactive Lab) before and after PR, while spatiotemporal parameters and center of mass position were recorded (100 Hz, Vicon Nexus). Standard deviation, coefficient of variation, predictability (sample entropy), and consistency in organization (local divergence exponent) were calculated. Sub-analysis was performed to identify gait differences between good and poor responders (<30 m change in a 6-min-walk distance). Patients demonstrated shorter stride times (p = 0.001) and improved lower-limb muscle function (p < 0.001) following PR. The good responders had a greater increase in stride length (p < 0.001) and a greater decrease in stride time (p < 0.001) compared to the poor responders. Current PR improved stride time in patients, while movement patterns within stride-to-stride fluctuations did not change. Training programs specifically targeting balance issues and gait function may be beneficial in improving gait characteristics in COPD.
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Lakhdar R, Rabinovich RA. Can muscle protein metabolism be specifically targeted by nutritional support and exercise training in chronic obstructive pulmonary disease? J Thorac Dis 2018; 10:S1377-S1389. [PMID: 29928520 PMCID: PMC5989103 DOI: 10.21037/jtd.2018.05.81] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/08/2018] [Indexed: 12/18/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) associates with several extra-pulmonary effects. Muscle dysfunction and wasting is one of the most prominent extra-pulmonary effects and contributes to exercise limitation and health related quality of life (HRQoL), morbidity as well as mortality. The loss of muscle mass is characterised by an impaired balance between protein synthesis (anabolism) and protein breakdown (catabolism) which relates to nutritional disturbances, muscle disuse and the presence of a systemic inflammation, among other factors. Current approaches to reverse skeletal muscle dysfunction and wasting attain only modest improvements. The development of new therapeutic strategies aiming at improving skeletal muscle dysfunction and wasting are needed. This requires a better understanding of the underlying molecular pathways responsible for these abnormalities. In this review we update recent research on protein metabolism, nutritional depletion as well as physical (in)activity in relation to muscle wasting and dysfunction in patients with COPD. We also discuss the role of nutritional supplementation and exercise training as strategies to re-establish the disrupted balance of protein metabolism in the muscle of patients with COPD. Future areas of research and clinical practice directions are also addressed.
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Affiliation(s)
- Ramzi Lakhdar
- ELEGI Colt Laboratory, MRC Centre for Inflammation Research, The Queen’s Medical Research Institute, University of Edinburgh, Scotland, UK
| | - Roberto A. Rabinovich
- ELEGI Colt Laboratory, MRC Centre for Inflammation Research, The Queen’s Medical Research Institute, University of Edinburgh, Scotland, UK
- Respiratory Medicine Department, Royal Infirmary of Edinburgh, Scotland, UK
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