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Ohbayashi H, Ariga M, Ohta K, Kudo S, Furuta O, Yamamoto A. Effects of Ninjin'yoeito on Patients with Chronic Obstructive Pulmonary Disease and Comorbid Frailty and Sarcopenia: A Preliminary Open-Label Randomized Controlled Trial. Int J Chron Obstruct Pulmon Dis 2024; 19:995-1010. [PMID: 38737191 PMCID: PMC11088385 DOI: 10.2147/copd.s441767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 04/19/2024] [Indexed: 05/14/2024] Open
Abstract
Purpose To present the preliminarily findings regarding the effects of a herbal medicine, Ninjin'yoeito, on comorbid frailty and sarcopenia in patients with chronic obstructive pulmonary disease (COPD). Patients and Methods Patients with COPD (GOLD II or higher) and fatigue were randomly assigned to Group A (n = 28; no medication for 12 weeks, followed by 12-week administration) or B (n= 25; 24-week continuous administration). Visual analog scale (VAS) symptoms of fatigue, the COPD assessment test (CAT), and the modified Medical Research Council (mMRC) Dyspnea Scale were examined. Physical indices such asknee extension leg strength and walking speed, skeletal muscle mass index (SMI), and respiratory function test were also measured. Results VAS fatigue scales in Group B significantly improved after 4, 8, and 12 weeks compared to those in Group A (each p<0.001, respectively). Right and left knee extension leg strength in Group B significantly improved after 12 weeks compared to that in Group A (p=0.042 and p=0.037, respectively). The 1-s walking speed for continued to increase significantly over 24 weeks in Group B (p=0.016, p<0.001, p<0.001, p=0.004, p<0.001, and p<0.001 after 4, 8, 12, 16, 20, and 24 weeks, respectively); it also significantly increased after the administration of Ninjin'yoeito in Group A. In Group B, the SMI significantly increased at 12 weeks in patients with sarcopenia (p=0.025). The CAT scores in Group B significantly improved after 12 weeks compared to those in Group A (p=0.006). The mMRC scores in Group B also significantly improved after 8 and 12 weeks compared to those in Group A (p= 0.045 and p <0.001, respectively). The changes in %FEV1.0 in Group B were significantly improved at 12 and 24 weeks (p=0.039 and p=0.036, respectively). Conclusion Overall, Ninjin'yoeito significantly improved patients' quality of life, physical activity, muscle mass, and possibly lung function, suggesting that Ninjin'yoeito may improve frailty and sarcopenia in patients with COPD.
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Affiliation(s)
- Hiroyuki Ohbayashi
- Medical Corporation, Syureikai, Tohno Chuo Clinic, Mizunami City, Gifu, Japan
| | - Mitsue Ariga
- Medical Corporation, Syureikai, Tohno Chuo Clinic, Mizunami City, Gifu, Japan
| | - Kunihiro Ohta
- Medical Corporation, Syureikai, Tohno Chuo Clinic, Mizunami City, Gifu, Japan
| | - Sahori Kudo
- Medical Corporation, Syureikai, Tohno Chuo Clinic, Mizunami City, Gifu, Japan
| | - Osamu Furuta
- Medical Corporation, Syureikai, Tohno Chuo Clinic, Mizunami City, Gifu, Japan
| | - Akinori Yamamoto
- Medical Corporation, Syureikai, Tohno Chuo Clinic, Mizunami City, Gifu, Japan
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Mitra S, Mitra M, Nandi P, Saha M, Nandi DK. Yogistic efficacy on cardiopulmonary capacities, endurance efficiencies and musculoskeletal potentialities in female college students. Work 2024; 78:1201-1212. [PMID: 38640183 DOI: 10.3233/wor-230200] [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: 04/21/2024] Open
Abstract
BACKGROUND Physical exercise participation among female students is significantly compromised throughout the academic periods of college or university due to scholastic demands and also by less parental and community encouragements. Thus, physical inactivity in female college students leads to less musculoskeletal efficiency and work performance. OBJECTIVE Customized yogic module may be considered to enhance both aerobic and anaerobic power, pulmonary capacity and musculoskeletal efficiency for the improvement of systemic body functions among female college students. METHODS A randomized, controlled parallel study design (n = 60; age = 20.16±2.05 years), on sedentary female college students practicing customized yogic module (n = 30) for 5 days / week for 3 months (60 min daily in the morning) to observe anthropometric, physiological, cardiopulmonary and muscular endurance indices. RESULTS After yogic practice, a significant reduction in body fat (p < 0.05) (%), heart rate (p < 0.001), systolic blood pressure (p < 0.001), double product (p‹0.01) and rate pressure product (p < 0.05) were estimated. Significant improvement (p < 0.001) in vital capacity, forced expiratory volume in 1 sec was also observed. Evaluation of hand grip strength, maximal oxygen consumption and physical work capacity showed significant increase (p < 0.01) after yogic intervention. CONCLUSIONS A three-month customized yogic training improved resting physiological activities, cardiopulmonary functions, musculoskeletal strength and endurance fitness due to focused breathing, mindfulness meditation and by stretching-strengthening patterns for achieving recreational physical activity among female college students.
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Affiliation(s)
- Sudeep Mitra
- Department of Human Physiology & Department of BMLT, Laboratory of Human Performance, Raja Narendra Lal Khan Women's College (Autonomous), Midnapore, India
| | - Mousumi Mitra
- Department of Human Physiology & Department of BMLT, Laboratory of Human Performance, Raja Narendra Lal Khan Women's College (Autonomous), Midnapore, India
| | - Purna Nandi
- Department of Human Physiology & Department of BMLT, Laboratory of Human Performance, Raja Narendra Lal Khan Women's College (Autonomous), Midnapore, India
| | - Mantu Saha
- Work Physiology & Yoga Laboratory, Defence Institute of Physiology and Allied Sciences (DIPAS), Defence Research and Development Organisation (DRDO), Delhi, India
| | - Dilip Kumar Nandi
- Department of Human Physiology & Department of BMLT, Laboratory of Human Performance, Raja Narendra Lal Khan Women's College (Autonomous), Midnapore, India
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Mañas-García L, Denhard C, Mateu J, Duran X, Gea J, Barreiro E. Beneficial Effects of Resveratrol in Mouse Gastrocnemius: A Hint to Muscle Phenotype and Proteolysis. Cells 2021; 10:cells10092436. [PMID: 34572085 PMCID: PMC8469306 DOI: 10.3390/cells10092436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/08/2021] [Accepted: 09/13/2021] [Indexed: 12/16/2022] Open
Abstract
We hypothesized that the phenolic compound resveratrol mitigates muscle protein degradation and loss and improves muscle fiber cross-sectional area (CSA) in gastrocnemius of mice exposed to unloading (7dI). In gastrocnemius of mice (female C57BL/6J, 10 weeks) exposed to a seven-day period of hindlimb immobilization with/without resveratrol treatment, markers of muscle proteolysis (tyrosine release, systemic troponin-I), atrophy signaling pathways, and muscle phenotypic features and function were analyzed. In gastrocnemius of unloaded mice treated with resveratrol, body and muscle weight and function were attenuated, whereas muscle proteolysis (tyrosine release), proteolytic and apoptotic markers, atrophy signaling pathways, and myofiber CSA significantly improved. Resveratrol treatment of mice exposed to a seven-day period of unloading prevented body and muscle weight and limb strength loss, while an improvement in muscle proteolysis, proteolytic markers, atrophy signaling pathways, apoptosis, and muscle fiber CSA was observed in the gastrocnemius muscle. These findings may have potential therapeutic implications in the management of disuse muscle atrophy in clinical settings.
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Affiliation(s)
- Laura Mañas-García
- Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Pulmonology Department, IMIM—Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (L.M.-G.); (C.D.); (J.G.)
- Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Barcelona Biomedical Research Park (PRBB), 08003 Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 08003 Barcelona, Spain
| | - Charlotte Denhard
- Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Pulmonology Department, IMIM—Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (L.M.-G.); (C.D.); (J.G.)
- Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Barcelona Biomedical Research Park (PRBB), 08003 Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 08003 Barcelona, Spain
| | - Javier Mateu
- Department of Pharmacy, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain;
| | - Xavier Duran
- Scientific and Technical Department, Hospital del Mar-IMIM, 08003 Barcelona, Spain;
| | - Joaquim Gea
- Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Pulmonology Department, IMIM—Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (L.M.-G.); (C.D.); (J.G.)
- Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Barcelona Biomedical Research Park (PRBB), 08003 Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 08003 Barcelona, Spain
| | - Esther Barreiro
- Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Pulmonology Department, IMIM—Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain; (L.M.-G.); (C.D.); (J.G.)
- Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Barcelona Biomedical Research Park (PRBB), 08003 Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), 08003 Barcelona, Spain
- Correspondence: ; Tel.: +34-93-316-0385; Fax: +34-93-316-0410
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Muscle Phenotype, Proteolysis, and Atrophy Signaling During Reloading in Mice: Effects of Curcumin on the Gastrocnemius. Nutrients 2020; 12:nu12020388. [PMID: 32024036 PMCID: PMC7071295 DOI: 10.3390/nu12020388] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/24/2019] [Accepted: 01/24/2020] [Indexed: 12/31/2022] Open
Abstract
We hypothesized that curcumin may mitigate muscle protein degradation and loss through attenuation of proteolytic activity in limb muscles of mice exposed to reloading (7dR) following immobilization (7dI). In gastrocnemius of mice (female C57BL/6J, 10 weeks) exposed to recovery following a seven-day period of hindlimb immobilization with/without curcumin treatment, markers of muscle proteolysis (systemic troponin-I), atrophy signaling pathways and histone deacetylases, protein synthesis, and muscle phenotypic characteristics and function were analyzed. In gastrocnemius of reloading mice compared to unloaded, muscle function, structure, sirtuin-1, and protein synthesis improved, while proteolytic and signaling markers (FoxO1/3) declined. In gastrocnemius of unloaded and reloaded mice treated with curcumin, proteolytic and signaling markers (NF-kB p50) decreased and sirtuin-1 activity and hybrid fibers size increased (reloaded muscle), while no significant improvement was seen in muscle function. Treatment with curcumin elicited a rise in sirtuin-1 activity, while attenuating proteolysis in gastrocnemius of mice during reloading following a period of unloading. Curcumin attenuated muscle proteolysis probably via activation of histone deacetylase sirtuin-1, which also led to decreased levels of atrophy signaling pathways. These findings offer an avenue of research in the design of therapeutic strategies in clinical settings of patients exposed to periods of disuse muscle atrophy.
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Xavier VB, Avanzi O, de Carvalho BDMC, Alves VLDS. Combined aerobic and resistance training improves respiratory and exercise outcomes more than aerobic training in adolescents with idiopathic scoliosis: a randomised trial. J Physiother 2020; 66:33-38. [PMID: 31859153 DOI: 10.1016/j.jphys.2019.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 11/25/2019] [Indexed: 11/17/2022] Open
Abstract
QUESTION In adolescents with idiopathic scoliosis, does combined aerobic and resistance training improve respiratory function, perceived exertion and functional exercise capacity more than aerobic training only? DESIGN Randomised controlled trial with concealed allocation, blinded assessors and intention-to-treat analysis. PARTICIPANTS Forty adolescents with idiopathic scoliosis and formal indication for surgical correction (spinal curvature ≥ 45 deg). INTERVENTION Both groups undertook three 60-minute training sessions per week for 12 weeks. The experimental group performed combined aerobic and resistance training and the control group performed only aerobic training. OUTCOME MEASURES At baseline and upon completion of treatment, participants completed: a 6-minute walk test with Borg scale (0 to 10) rating of exertion, spirometry, maximal respiratory pressures and peak expiratory flow measurement. RESULTS After 12 weeks of training, the experimental group improved more than the control group on the 6-minute walk test (MD 22 m, 95% CI 4 to 40), with lower perceived exertion at the end of the test (MD -1.2, 95% CI -1.9 to -0.4). The experimental group also improved more than the control group on several respiratory measures, including: FEV1 (MD 270 ml, 95% CI 30 to 510), maximal inspiratory pressure (MD 4 cmH2O, 95% CI 1 to 8) and peak expiratory flow (MD 33 l/minute, 95% CI 7 to 58). CONCLUSION In adolescents with idiopathic scoliosis, combined aerobic and resistance training improves functional exercise capacity and several respiratory outcomes more than a similar training regimen with aerobic training only. It is unclear whether the magnitude of the benefits is large enough to be worthwhile. TRIAL REGISTRATION NCT02413788.
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Affiliation(s)
| | - Osmar Avanzi
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | | | - Vera Lúcia Dos Santos Alves
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil; Universidade de Mogi das Cruzes, Mogi das Cruzes, São Paulo, Brazil.
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Magnetic Resonance Imaging-Based Morphological Change of Paraspinal Muscles in Girls With Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976) 2019; 44:1356-1363. [PMID: 31022152 DOI: 10.1097/brs.0000000000003078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional study. OBJECTIVE To investigate and compare any morphological differences in paraspinal muscles (PSM) between adolescent idiopathic scoliosis (AIS) patients (with severe or non-severe curves) and healthy controls. SUMMARY OF BACKGROUND DATA Several studies have reported abnormalities in biochemical, electromyographic activity, and histological changes of PSM in AIS. However, these studies only had qualitative data and without comparison with controls. Changes of muscle mass and mean density at the lumbar region have been described for scoliotic spines. All these findings suggested that imbalance of PSM in AIS could be a contributing factor to the development of severe scoliotic curve. METHODS T2-weighted MR images with multi-planar reconstruction were acquired in 41 Chinese AIS girls with a primary right-sided thoracic curve and 23 age-matched controls. In AIS, measurements of PSM were taken on both concavity and convexity of scoliosis starting from two vertebrae above and two below the apex. Morphological assessments of the multifidus (MF) and erector spinae (ES) muscles on both sides were made including signal intensity (SI) and fat deposition using manual tracing and thresholding technique, respectively. Same parameters were measured in controls at matched vertebrae. One-way analysis of variance (ANOVA) and Pearson correlation tests were used for statistical analysis. RESULTS Abnormalities were found at concavity of muscles between AIS and controls. Significantly higher SI and fatty components was observed in AIS at MF muscles on concavity than controls (P-value <0.001). Additionally, SI at MF muscles was significantly correlated with Cobb angle. CONCLUSION Increased SI and fatty components are asymmetrically present in PSM at apex in AIS. Our results showed higher intensity in PSM at concavity in AIS when compared with controls. There was a significant linear correlation between abnormal muscle signal and scoliotic curve. Above features are suggestive of altered muscle composition in concave PSM, possibly due to prolonged compression and reduced muscle activity of PSM caused by the spinal deformity. LEVEL OF EVIDENCE 4.
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Mendoza L, Gogali A, Shrikrishna D, Cavada G, Kemp SV, Natanek SA, Jackson AS, Polkey MI, Wells AU, Hopkinson NS. Quadriceps strength and endurance in fibrotic idiopathic interstitial pneumonia. Respirology 2013; 19:138-43. [DOI: 10.1111/resp.12181] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 07/04/2013] [Accepted: 08/03/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Laura Mendoza
- Hospital Clínico; Universidad de Chile; Santiago Chile
- National Institute for Health Research Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | - Athena Gogali
- National Institute for Health Research Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | - Dinesh Shrikrishna
- National Institute for Health Research Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | - Gabriel Cavada
- Escuela de Salud Pública; Universidad de Chile; Santiago Chile
| | - Samuel V. Kemp
- National Institute for Health Research Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | - Samantha A. Natanek
- National Institute for Health Research Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | - Abigail S. Jackson
- National Institute for Health Research Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | - Michael I. Polkey
- National Institute for Health Research Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | - Athol U. Wells
- National Institute for Health Research Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | - Nicholas S. Hopkinson
- National Institute for Health Research Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
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Gea J, Casadevall C, Pascual S, Orozco-Levi M, Barreiro E. Respiratory diseases and muscle dysfunction. Expert Rev Respir Med 2012; 6:75-90. [PMID: 22283581 DOI: 10.1586/ers.11.81] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Many respiratory diseases lead to impaired function of skeletal muscles, influencing quality of life and patient survival. Dysfunction of both respiratory and limb muscles in chronic obstructive pulmonary disease has been studied in depth, and seems to be caused by the complex interaction of general (inflammation, impaired gas exchange, malnutrition, comorbidity, drugs) and local factors (changes in respiratory mechanics and muscle activity, and molecular events). Some of these factors are also present in cystic fibrosis and asthma. In obstructive sleep apnea syndrome, repeated exposure to hypoxia and the absence of reparative rest are believed to be the main causes of muscle dysfunction. Deconditioning appears to be crucial for the functional impairment observed in scoliosis. Finally, cachexia seems to be the main mechanism of muscle dysfunction in advanced lung cancer. A multidimensional therapeutic approach is recommended, including pulmonary rehabilitation, an adequate level of physical activity, ventilatory support and nutritional interventions.
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Affiliation(s)
- Joaquim Gea
- Servei de Pneumologia, Hospital del Mar-IMIM, Departament de Ciències Experimentals i de la Salut (CEXS), Universitat Pompeu Fabra, CIBER de Enfermedades Respiratorias ISC III, Barcelona, Catalunya, Spain.
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Riddoch-Contreras J, George T, Natanek SA, Marsh GS, Hopkinson NS, Tal-Singer R, Kemp P, Polkey MI. p38 Mitogen-activated Protein Kinase is Not Activated in the Quadriceps of Patients with Stable Chronic Obstructive Pulmonary Disease. COPD 2012; 9:142-50. [DOI: 10.3109/15412555.2011.644359] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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de Theije C, Costes F, Langen RC, Pison C, Gosker HR. Hypoxia and muscle maintenance regulation: implications for chronic respiratory disease. Curr Opin Clin Nutr Metab Care 2011; 14:548-53. [PMID: 21934612 DOI: 10.1097/mco.0b013e32834b6e79] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW Muscle wasting and impaired muscle oxidative metabolism are common extrapulmonary features of chronic respiratory failure (CRF) that significantly increase disease burden. This review aims to address the question whether hypoxia, an obvious consequence of this disease, actually plays a causal role in these muscle impairments. RECENT FINDINGS In experimental models, a causal role for hypoxia in muscle atrophy and metabolic impairments has clearly been shown. Although the hypoxia-inducible factors and nuclear factor kappa B are putative mediators of these hypoxia-induced alterations, their true involvement remains to be proven. Molecular signatures of disrupted regulation of muscle mass and oxidative metabolism observed in these experimental models also have been shown in muscles of patients suffering from CRF, suggestive of but not conclusive for a causal role of hypoxia. Therapies, including but not restricted to those aimed at alleviating hypoxia, have been shown to partially but not completely restore muscle mass and oxidative capacity in CRF patients, which may imply an additive effect of nutritional modulation of substrate metabolism. SUMMARY Although hypoxia clearly affects skeletal muscle maintenance, it remains to be confirmed whether and by which underlying molecular mechanisms hypoxia is causally involved in CRF-related muscle atrophy and impaired oxidative capacity.
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Affiliation(s)
- Chiel de Theije
- Nutrim School for Nutrition, Toxicology and Metabolism, Department of Anatomy and Embryology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Polkey MI, Moxham J. Attacking the disease spiral in chronic obstructive pulmonary disease: an update. Clin Med (Lond) 2011; 11:461-4. [PMID: 22034706 PMCID: PMC4954240 DOI: 10.7861/clinmedicine.11-5-461] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In chronic obstructive pulmonary disease (COPD) a pathophysiological cycle occurs such that locomotor muscle weakness and fatiguabilty exist, which in turn limit exercise performance both because of leg discomfort and also because anaerobic metabolism leads to lactic acid production. Since the lactic acid is buffered by bicarbonate there is consequent carbon dioxide (CO2) production. Patients with advanced COPD are flow limited and cannot excrete the CO2 by raising ventilation and thus these patients experience breathlessness which discourages exercise and, in turn, prompts further deconditioning. Structured exercise, termed pulmonary rehabilitation is at the core of reversing the cycle but novel strategies should be employed for patients with advanced disease and alternative therapeutic opportunities may soon be available to improve pulmonary mechanics.
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Affiliation(s)
- Michael I Polkey
- National Heart and Lung Institute, Respiratory Biomedical Research Unit, Royal Brompton Hospital and Imperial College, London.
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Seymour JM, Spruit MA, Hopkinson NS, Natanek SA, Man WDC, Jackson A, Gosker HR, Schols AMWJ, Moxham J, Polkey MI, Wouters EFM. The prevalence of quadriceps weakness in COPD and the relationship with disease severity. Eur Respir J 2010; 36:81-8. [PMID: 19897554 PMCID: PMC3039205 DOI: 10.1183/09031936.00104909] [Citation(s) in RCA: 323] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Quadriceps strength relates to exercise capacity and prognosis in chronic obstructive pulmonary disease (COPD). We wanted to quantify the prevalence of quadriceps weakness in COPD and hypothesised that it would not be restricted to patients with severe airflow obstruction or dyspnoea. Predicted quadriceps strength was calculated using a regression equation (incorporating age, sex, height and fat-free mass), based on measurements from 212 healthy subjects. The prevalence of weakness (defined as observed values 1.645 standardised residuals below predicted) was related to Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage and Medical Research Council (MRC) dyspnoea score in two cohorts of stable COPD outpatients recruited from the UK (n = 240) and the Netherlands (n = 351). 32% and 33% of UK and Dutch COPD patients had quadriceps weakness. A significant proportion of patients in GOLD stages 1 and 2, or with an MRC dyspnoea score of 1 or 2, had quadriceps weakness (28 and 26%, respectively). These values rose to 38% in GOLD stage 4, and 43% in patients with an MRC Score of 4 or 5. Quadriceps weakness was demonstrable in one-third of COPD patients attending hospital respiratory outpatient services. Quadriceps weakness exists in the absence of severe airflow obstruction or breathlessness.
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Affiliation(s)
- J M Seymour
- Dept of Respiratory Medicine, King's College Hospital, London SE5 9RJ, UK.
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Abstract
COPD (chronic obstructive pulmonary disease) is the most common pulmonary disease and is the only common cause of death in which mortality is presently rising. It is caused by the inhalation of smoke, which leads to oxidative stress and inflammation both in the lungs and systemically. Reduced physical activity is a well-recognized consequence of the condition, but we argue here that inactivity is itself an early cause of lung function decline and symptoms. This hypothesis is supported by data from population studies that link activity levels to decline in spirometric indices, both in smokers and non-smokers. In addition, smokers with low physical activity levels are more likely to be diagnosed subsequently with COPD. Physical exercise reduces oxidative stress, has an anti-inflammatory effect and reduces the frequency of upper respiratory tract infections, providing a number of mechanisms by which it could attenuate the harmful effects of smoking. There is sufficient evidence to justify population trials of lifestyle interventions aimed at improving physical activity levels and reducing lung function decline in people diagnosed with early COPD through spirometry screening.
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