Resistance Training Prevents Deterioration in Quadriceps Muscle Function During Acute Exacerbations of Chronic Obstructive Pulmonary Disease

• Published in: American journal of respiratory and critical care medicine Vol. 181; no. 10; pp. 1072 - 1077
• Main Authors: Troosters, Thierry, Probst, Vanessa Suziane, Crul, Tim, Pitta, Fabio, Gayan-Ramirez, Ghislaine, Decramer, Marc, Gosselink, Rik
• Format: Journal Article
• Language: English
• Published: New York, NY American Thoracic Society 15.05.2010
• Subjects: Aged; Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Biopsy; C-Reactive Protein - metabolism; Chronic obstructive pulmonary disease; Chronic obstructive pulmonary disease, asthma; Disease Progression; Dyspnea; Female; Force; Forced Expiratory Volume; Growth factors; Humans; Inflammation; Inflammation - blood; Inflammation - etiology; Intensive care medicine; Male; Medical sciences; Muscle function; Muscle Weakness - etiology; Muscle Weakness - prevention & control; Muscle Weakness - rehabilitation; Muscular Atrophy - etiology; Muscular Atrophy - pathology; Muscular Atrophy - prevention & control; Musculoskeletal system; Pneumology; Proteins; Pulmonary Disease, Chronic Obstructive - blood; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Disease, Chronic Obstructive - rehabilitation; Quadriceps Muscle - pathology; Quadriceps Muscle - physiopathology; Resistance Training - methods; Steroids; Strength training; Lung disease; Intensive care; resistance training; Respiratory disease; Deterioration; exacerbations; Bronchus disease; Chronic obstructive pulmonary disease; Striated muscle; skeletal muscle; Resuscitation
• ISSN: 1073-449X; 1535-4970; 1535-4970
• DOI: 10.1164/rccm.200908-1203OC

Exacerbations of chronic obstructive pulmonary disease (COPD) acutely reduce skeletal muscle strength and result in long-term loss of functional capacity. To investigate whether resistance training is feasible and safe and can prevent deteriorating muscle function during exacerbations of COPD. Forty patients (FEV(1) 49 +/- 17% predicted) hospitalized with a severe COPD exacerbation were randomized to receive usual care or an additional resistance training program during the hospital admission. Patients were followed up for 1 month after discharge. Primary outcomes were quadriceps force and systemic inflammation. A muscle biopsy was taken in a subgroup of patients to assess anabolic and catabolic pathways. Resistance training did not yield higher systemic inflammation as indicated by C-reactive protein levels and could be completed uneventfully. Enhanced quadriceps force was seen at discharge (+9.7 +/- 16% in the training group; -1 +/- 13% in control subjects; P = 0.05) and at 1 month follow-up in the patients who trained. The 6-minute walking distance improved after discharge only in the group who received resistance training (median 34; interquartile range, 14-61 m; P = 0.002). In a subgroup of patients a muscle biopsy showed a more anabolic status of skeletal muscle in patients who followed training. Myostatin was lower (P = 0.03) and the myogenin/MyoD ratio tended to be higher (P = 0.08) in the training group compared with control subjects. Resistance training is safe, successfully counteracts skeletal muscle dysfunction during acute exacerbations of COPD, and may up-regulate the anabolic milieu in the skeletal muscle. Clinical trial registered with www.clinicaltrials.gov (NCT00877084).