Resistance training prevents deterioration in quadriceps muscle function during acute exacerbations of chronic obstructive pulmonary disease.
BACKGROUND
Exacerbations of chronic obstructive pulmonary disease (COPD) acutely reduce skeletal muscle strength and result in long-term loss of functional capacity.


OBJECTIVE
To investigate whether resistance training is feasible and safe and can prevent deteriorating muscle function during exacerbations of COPD.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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).
Troosters
Thierry
T
Respiratory Rehabilitation and Respiratory Division, UZ Gasthuisberg, Herestraat 49, Leuven, Belgium. thierry.troosters@med.kuleuven.be
Probst
Vanessa Suziane
VS
Crul
Tim
T
Pitta
Fabio
F
Gayan-Ramirez
Ghislaine
G
Decramer
Marc
M
Gosselink
Rik
R
D000368:Aged; D000704:Analysis of Variance; D001706:Biopsy; D002097:C-Reactive Protein / Q000378:metabolism; D018450:Disease Progression; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology; D008297:Male; D018908:Muscle Weakness / Q000209:etiology / Q000517:prevention & control* / Q000534:rehabilitation; D009133:Muscular Atrophy / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000503:physiopathology* / Q000534:rehabilitation*; D052097:Quadriceps Muscle / Q000473:pathology / Q000503:physiopathology*; D055070:Resistance Training / Q000379:methods*
D002097:C-Reactive Protein