Task-related oxygen uptake during domestic activities of daily life in patients with COPD and healthy elderly subjects.

BACKGROUND: Patients with COPD generally have a poor peak aerobic capacity and, therefore, may experience more inconvenience during domestic activities of daily life (ADLs). Yet, task-related oxygen uptake and symptom perception during ADLs have been studied rarely in COPD. Therefore, it remains unknown whether and to what extent differences may exist in task-related oxygen uptake and symptom perception during ADLs in patients with COPD after stratification for sex; GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage; Medical Research Council (MRC) dyspnea grade; or score on the BMI, obstruction, dyspnea, exercise capacity (BODE) index. METHODS: Ninety-seven patients with COPD and 20 healthy elderly subjects performed the following five self-paced domestic ADLs with 4-min rest intervals: putting on socks, shoes, and vest; folding eight towels; putting away groceries; washing four dishes, cups, and saucers; and sweeping the floor for 4 min. Task-related oxygen uptake was assessed using an Oxycon Mobile device, whereas Borg scores were used to assess task-related dyspnea and fatigue. RESULTS: Patients with COPD used a significantly higher proportion of their peak aerobic capacity and ventilation to perform ADLs than did the healthy subjects, accompanied by higher task-related Borg dyspnea scores. Patients with GOLD stage IV, MRC dyspnea grade 5, or BODE score ≥ 6 points had the highest task-related oxygen uptake and dyspnea perception during the performance of domestic ADLs. Results showed no sex-related differences. CONCLUSION: Patients with COPD experience a relatively high metabolic load and symptom perception during the performance of ADLs that is not the same as seen in their healthy peers, particularly in patients with GOLD stage IV, MRC dyspnea grade 5, or BODE score ≥ 6 points.

Highly elevated C-reactive protein levels in obese patients with COPD: a fat chance?

BACKGROUND & AIMS: Chronic obstructive pulmonary disease (COPD) has been recognized as a multi component disease. Currently, limited data are available about determining factors of systemic inflammation in COPD, in particular C-reactive protein (CRP). The aim was to determine whether and to what extent COPD patients with a low, high or obese body mass index (BMI) are more likely to have elevated CRP levels compared to normal-weight COPD patients. Furthermore, we aimed to explore the effects of clinically relevant covariates on the likelihood of having elevated CRP levels. METHODS: In 628 elderly patients with moderate to severe COPD (61% male), lung function and BMI were assessed before entering pulmonary rehabilitation. In addition, blood was collected in the fasted state. High-sensitive C-reactive protein (CRP) was classified into: normal, < or =3; elevated, >3-5 and highly elevated, >5mg/l. RESULTS: Obese COPD patients (BMI> or =30 kg/m(2)) were 3.3 times more likely (95% CI, 1.5-7.0, p=0.002) to have highly elevated CRP levels compared to normal weight (BMI 21-24.9 kg/m(2)) COPD patients after taking clinically relevant confounders into account. In contrast, COPD patients with a low BMI (<21 kg/m(2)) were 2 times less likely (OR, 0.5; 95% CI, 0.3-0.9, p=0.022) to have highly elevated CRP levels compared to normal-weight peers. CONCLUSION: Obese BMI is associated with highly elevated CRP levels in patients with COPD. These findings are suggestive for an adipocyte-induced systemic inflammation in COPD.

Effects of neuromuscular electrical stimulation of muscles of ambulation in patients with chronic heart failure or COPD: a systematic review of the English-language literature.

INTRODUCTION: Despite optimal drug treatment, many patients with congestive heart failure (CHF) or COPD still experience disabling dyspnea, fatigue, and exercise intolerance. They also exhibit significant changes in body composition. Attempts to rehabilitate these patients are often futile because conventional exercise-training modalities are limited by the severity of exertional dyspnea. Therefore, there is substantial interest in new training modalities that do not evoke dyspnea, such as transcutaneous neuromuscular electrical stimulation (NMES). MATERIALS AND METHODS: In this article, we systematically review the literature that addresses the effects of NMES applied to the muscles of ambulation. We focused on the effects of NMES on strength, exercise capacity, and disease-specific health status in patients with CHF or COPD. We also address the methodological quality of the reported studies as well as the safety of NMES. Manuscripts published prior to December 2007 were identified by searching the Medline/PubMed, Embase, Cochrane Controlled Trials Register, CINAHL, and Physiotherapy Evidence Database (PEDro) databases. RESULTS: Fourteen trials were identified (nine trials that examined NMES in CHF patients, and five in COPD patients). PEDro scores for methodological quality of the trials were generally moderate to good. Many of the studies reported significant improvements in muscle strength, exercise capacity, and/or health status. DISCUSSION: Nonetheless, the limited number of studies, the disparity in patient populations, and the variability in NMES methodology prohibit the use of metaanalysis. Yet, from the viewpoint of a systematic review, NMES looks promising as a means of rehabilitating patients with CHF and COPD. There is at least sufficient evidence to warrant more large prospective, randomized, controlled trials.

The metabolic response during resistance training and neuromuscular electrical stimulation (NMES) in patients with COPD, a pilot study.

Resistance training and transcutaneous neuromuscular electrical stimulation (NMES) are new modalities in rehabilitation of severely disabled patients with chronic obstructive pulmonary disease (COPD). The purpose of this study was to compare the metabolic response during resistance training and during NMES of the quadriceps femoris muscles in patients with COPD entering pulmonary rehabilitation. Pulmonary function, body composition, peak aerobic capacity, the Medical Research Council dyspnoea grade, the one-repetition maximum strength assessment were evaluated in 13 COPD patients. Additionally, peak oxygen uptake, peak minute ventilation and Borg symptom scores were assessed during a resistance training session and a NMES session. The median peak oxygen uptake and median peak minute ventilation during the resistance training session were significantly higher compared to the NMES session. Additionally, these higher metabolic responses were accompanied by higher symptom Borg scores for dyspnoea and leg fatigue. To conclude, the metabolic response was significantly lower during a NMES session compared to a resistance exercise training session in patients with COPD. Nevertheless, both modalities seem to result in an acceptable metabolic response accompanied by a clinically acceptable sensation of dyspnoea and leg fatigue.

Extra-pulmonary features in COPD patients entering rehabilitation after stratification for MRC dyspnea grade.

Experts have stated that referral for rehabilitation of patients with chronic obstructive pulmonary disease (COPD) becomes appropriate when these patients become aware of their disability (e.g. usually grade 3 to 5 on the Medical Research Council (MRC) dyspnea scale). However, patients with MRC dyspnea grade 1/2 may also suffer from extra-pulmonary features, such as abnormal body composition, exercise intolerance and reduced disease-specific health status. In the present study, we have studied whether and to what extent chronic obstructive pulmonary disease (COPD) patients with MRC dyspnea grade 1/2 have extra-pulmonary features compared to patients with grade 3, 4 or 5? Pulmonary function, body composition, 6-min walking distance, peak exercise capacity, anxiety, depression and disease-specific health status have been assessed in 333 outpatients who had been referred for pulmonary rehabilitation. On average, patients with MRC dyspnea grade 1/2 had a better exercise tolerance and disease-specific health status compared to patients with grade 4 or 5. Nevertheless, grade 1/2 patients had a higher prevalence of muscle mass depletion. In addition, these patients did still have aberrant values in one or more of the aforementioned outcomes. On average, patients with MRC dyspnea grade 1/2 may clearly suffer from extra-pulmonary features, indicating the necessity to refer these patients for rehabilitation. Therefore, MRC dyspnea scale alone does not appear to be a suitable measure to identify most patients with COPD who have to be referred for rehabilitation.

The functional, metabolic, and anabolic responses to exercise training in renal transplant and hemodialysis patients.

BACKGROUND: Exercise intolerance is common in hemodialysis (HD) and renal transplant (RTx) patients and is related to muscle weakness. Its pathogenesis may vary between these groups leading to a different response to exercise. The aim of the study was to compare intrinsic muscular parameters between HD and RTx patients and controls, and to assess the response to exercise training on exercise capacity and muscular structure and function in these groups. METHODS: Quadriceps function (isokinetic dynamometry), body composition (dual-energy x-ray absorptiometry), and vastus lateralis muscle biopsies were analyzed before and after a 12-week lasting training-program in 35 RTx patients, 16 HD patients, and 21 healthy controls. RESULTS: At baseline, myosin heavy chain (MyHC) isoform composition and enzyme activities were not different between the groups. VO2peak and muscle strength improved significantly and comparably over the training-period in RTx, HD patients and controls (p(time)<0.05). The proportion of MyHC type I isoforms decreased (p(time)<0.001) and type IIa MyHC isoforms increased (p(time)<0.05). The 3-hydroxyacyl-CoA-dehydrogenase activity increased (p(time)=0.052). Intrinsic muscular changes were not significantly different between groups. In the HD group, changes in lean body mass were significantly related to changes in muscle insulin-like growth factor (IGF)-II and IGF binding protein-3. CONCLUSIONS: Abnormalities in metabolic enzyme activities or muscle fiber redistribution do not appear to be involved in muscle dysfunction in RTx and HD patients. Exercise training has comparable beneficial effects on functional and intrinsic muscular parameters in RTx patients, HD patients, and controls. In HD patients, the anabolic response to exercise training is related to changes in the muscle IGF system.

Exercise capacity before and after an 8-week multidisciplinary inpatient rehabilitation program in lung cancer patients: a pilot study.

Although lung cancer is a highly prevalent type of cancer, the effects of an inpatient multidisciplinary rehabilitation program on pulmonary function and exercise capacity have never been studied in these patients. Pulmonary function, 6-min walking distance and peak exercise capacity of 10 patients with a severely impaired pulmonary function following treatment of lung cancer were assessed in this pilot study before and after an 8-week inpatient multidisciplinary rehabilitation program. At baseline, patients had a restrictive pulmonary function and an apparent exercise intolerance (median 6-min walking distance: 63.6% predicted; median peak cycling load: 58.5% predicted). Despite the lack of change in median pulmonary function [FEV1: -0.01L, p = 0.5469], functional exercise capacity [145 m; 43.2% of the initial values, p=0.0020] and peak exercise capacity [26 W; 34.4% of the initial values, p = 0.0078] improved significantly compared to baseline. Future trials have to corroborate the present findings. Nevertheless, patients with lung cancer have a clear indication to start a comprehensive rehabilitation program following intensive treatment of their disease. In fact, based on the results of the present pilot study it appears that these patients are good candidates for pulmonary rehabilitation programs.

Similarities in skeletal muscle strength and exercise capacity between renal transplant and hemodialysis patients.

Exercise intolerance is common in hemodialysis (HD) and renal transplant (RTx) patients. Aim of the study was to assess to what extent exercise capacity and skeletal muscle strength of RTx patients differ from HD patients and healthy controls and to elucidate potential determinants of exercise capacity in RTx patients. Exercise capacity, muscle strength, lean body mass (LBM) and physical activity level (PAL) were measured by cycle-ergometry, isokinetic dynamometry, DEXA and Baecke Questionnaire, respectively, in 35 RTx, 16 HD and 21 controls. VO2peak and muscle strength of the RTx patients were significantly lower compared to controls (p<0.01), but not different compared to HD patients. In RTx patients, strength (p<0.001), PAL (p=0.001) and age (p=0.045) were significant predictors of VO2peak. Muscle strength was related to LBM (p=0.001) and age (p=0.001), whereas gender (p<0.001) and renal function (p=0.01) turned out to be significant predictors of LBM. No effects of corticosteroids were observed. Exercise capacity and muscle strength seem equally reduced in RTx and HD patients compared to controls. In RTx patients, muscle strength and PAL are highly related to exercise capacity. Renal function appears to be a significant predictor of LBM, and through the LBM, of muscle strength and exercise capacity.

Limb muscle dysfunction in COPD: effects of muscle wasting and exercise training.

PURPOSE: Lower-limb muscle weakness has often been reported in COPD, and contributes to exercise intolerance. Controversial information is available regarding upper-limb muscle adaptations and the influence of muscle wasting on muscle weakness. We investigated leg and arm muscle function in 59 stable COPD patients (GOLD stage III) with preserved fat-free mass (FFM) and in 28 patients with reduced FFM relative to age- and sex-matched healthy control subjects and studied the effects of 8 wk of whole-body exercise training. METHODS: FFM was measured with bioelectrical impedance analysis. Isokinetic quadriceps (F-leg) and biceps strength (F-arm), as well as quadriceps (E-leg) and biceps endurance (E-arm) were determined with a Biodex dynamometer. Exercise training consisted of cycle ergometry, treadmill walking, weight training, and gymnastics during 5 d.wk. RESULTS: F-leg (76.2 +/- 3.6 vs 118.2 +/- 6.3 N.m, P < 0.001) and F-arm (25.6 +/- 1.3 vs 38.1 +/- 2.1 N.m, P < 0.001) were significantly and similarly reduced in the COPD patient group compared with controls. Also, E-leg (-2.13 +/- 0.12 vs -1.61 +/- 0.11, P < 0.01), but not E-arm (-2.72 +/- 0.11 and -2.47 +/- 0.13 NS), was decreased in patients. F-leg (62.4 +/- 4.3 vs 82.8 +/- 4.7 N.m, P < 0.01), but not F-arm or muscle endurance, was reduced in FFM-depleted compared with non-FFM-depleted patients. Whereas after training F-leg and E-leg significantly increased by 20% in the whole COPD group, biceps muscle function remained unchanged. CONCLUSION: Lower- and upper-limb muscle dysfunction was observed in COPD patients, irrespective of the presence of FFM depletion. Generalized muscle weakness suggests systemic muscular involvement, although the preserved arm endurance and the poor response of arm performance to exercise training is indicative for intrinsic differences in muscular adaptations between leg and arm muscles.

Effects of whole-body exercise training on body composition and functional capacity in normal-weight patients with COPD.

BACKGROUND: Skeletal muscle wasting is related to muscle dysfunction, exercise intolerance, and increased mortality risk in patients with COPD. STUDY OBJECTIVES: The aims of this study were to investigate the effects of whole-body exercise training on body composition in normal-weight patients with COPD, and to study the relationship between changes in body composition and functional capacity. SETTING AND PARTICIPANTS: Fifty patients with COPD (FEV(1), 39% of predicted [SD, 16]) admitted to the pulmonary rehabilitation center at Hornerheide, and 36 healthy age-matched control subjects (for baseline comparison) were included. INTERVENTIONS: Patients participated in a standardized inpatient exercise training program consisting of daily submaximal cycle ergometry, treadmill walking, weight training, and gymnastics during 8 weeks. MEASUREMENTS: Fat-free mass (FFM) was measured by bioelectrical impedance analysis. None of the patients met the criteria for nutritional supplementation (body mass index