title: Effects of nutritional supplementation combined with low-intensity exercise in malnourished patients with COPD.
abstract: OBJECTIVE
  The first aim of this study was to investigate the effects of nutritional supplementation combined with low-intensity exercise on body components, exercise tolerance, and health-related quality of life (HRQOL) in malnourished patients with COPD. The second aim of this study was to examine the degree of systemic inflammation and the actual changes in levels of systemic CRP, TNFα, IL-6 and IL-8 actual changes after a combination of nutritional supplementation and low-intensity exercise in these patients.
  
  
  METHODS
  A prospective randomized trial.
  
  
  METHODS
  Thirty-two moderate to severe, clinically stable malnourished COPD patients.
  
  
  METHODS
  Patients were randomly divided into a nutritional supplementation with low-intensity exercise group and a control group. Lung function, maximum inspiratory and expiratory muscle force, the Chronic Respiratory Disease Questionnaire (CRQ), the 6-min walking distance (6MWD), and the Borg scale were measured at baseline and were re-assessed at 3 months after intervention. The degree of systemic inflammation and the changes in levels of systemic CRP, TNFα, IL-6 and IL-8 were assessed before and after a combination nutritional supplementation with low-intensity exercise.
  
  
  RESULTS
  Body weight and FFM increased significantly after 12 weeks of nutritional supplementation therapy in patients with COPD. The dietary intake energy increased and the REE:REEpred ratio decreased significantly in the nutrition with low-intensity exercise group. PI(max), Quadriceps muscle force and the 6-min walking distance (6MWD) increased significantly from baseline through week 12. Health status, as assessed by CRQ, improved in the domains of dyspnea and total sores significantly in the nutrition with low-intensity exercise group after intervention. In this group, hsCRP, IL-6, IL-8, and TNFα, decreased significantly after intervention compared with the control group.
  
  
  CONCLUSIONS
  The combination of nutritional supplementation with low-intensity exercise training was successful in increasing weight and energy intake as well as exercise capacity and health-related QOL in our patients. Moreover, REE and major inflammatory cytokines decreased significantly after nutritional supplementation with low-intensity exercise training. The present study results suggest a potential role for the combination of nutritional supplementation and low-intensity exercise in the management of malnourished patients with COPD.
authors.affiliation: Department of Rehabilitation, Akita City General Hospital, Hondo, Akita, Japan.
authors.forename: Keiyu
authors.initials: K
authors.lastname: Sugawara
authors.forename: Hitomi
authors.initials: H
authors.lastname: Takahashi
authors.forename: Chikage
authors.initials: C
authors.lastname: Kasai
authors.forename: Noritaka
authors.initials: N
authors.lastname: Kiyokawa
authors.forename: Tohru
authors.initials: T
authors.lastname: Watanabe
authors.forename: Sayaka
authors.initials: S
authors.lastname: Fujii
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kashiwagura
authors.forename: Mitsunobu
authors.initials: M
authors.lastname: Honma
authors.forename: Masahiro
authors.initials: M
authors.lastname: Satake
authors.forename: Takanobu
authors.initials: T
authors.lastname: Shioya
mesh_terms: D000368:Aged; D001835:Body Weight / Q000502:physiology; D019587:Dietary Supplements; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000378:metabolism*; D016209:Interleukin-8 / Q000378:metabolism*; D007564:Japan; D008297:Male; D044342:Malnutrition / Q000178:diet therapy* / Q000503:physiopathology; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D011788:Quality of Life; D012129:Respiratory Function Tests; D011795:Surveys and Questionnaires; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*
chemical_list: D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha