Nutritional targets to enhance exercise performance in chronic obstructive pulmonary disease.
OBJECTIVE
This review presents current knowledge regarding the rationale and efficacy of nutrition as an ergogenic aid to enhance the effects of exercise and training in chronic obstructive pulmonary disease (COPD).


RESULTS
Altered body composition and skeletal muscle dysfunction in COPD suggest that exercise capacity can be targeted via several metabolic routes. Muscle metabolic alterations in COPD include a reduced oxidative metabolism and enhanced susceptibility for oxidative stress. Muscle wasting may be associated with deficiencies of vitamin D and low branched-chain amino acid levels. Exercise training is of established benefit in COPD but clear-cut clinical trial evidence to support the performance enhancing effect of nutritional intervention is lacking. One randomized controlled trial suggested that augmentation of training with polyunsaturated fatty acids may improve exercise capacity. Conflicting results are reported on dietary creatine supplementation in patients with COPD receiving pulmonary rehabilitation and results from acute intervention studies do not directly imply long-term effects of glutamate or glutamine supplementation as an ergogenic aid in COPD. Recent data indicate that not only muscle but also visceral fat may be an important additional target for combined nutrition and exercise intervention in COPD to improve physical performance and decrease cardiometabolic risk.


CONCLUSIONS
There is a clear need for adequately powered and controlled intervention and maintenance trials to establish the role of nutritional supplementation in the enhancement of exercise performance and training and the wider management of the systemic features of the disease.
Department of Respiratory Medicine, NUTRIM School for Nutrition, Toxicology, and Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands.
Coby
C
van de Bool
Michael C
MC
Steiner
Annemie M W J
AM
Schols
D000597:Amino Acids, Branched-Chain / Q000008:administration & dosage; D000975:Antioxidants / Q000008:administration & dosage; D001823:Body Composition; D002908:Chronic Disease; D003401:Creatine / Q000008:administration & dosage; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage; D019587:Dietary Supplements; D015444:Exercise / Q000502:physiology*; D005231:Fatty Acids, Unsaturated / Q000008:administration & dosage; D006801:Humans; D018482:Muscle, Skeletal / Q000187:drug effects / Q000378:metabolism; D009135:Muscular Diseases / Q000178:diet therapy; D009752:Nutritional Status; D029424:Pulmonary Disease, Chronic Obstructive / Q000178:diet therapy / Q000534:rehabilitation*; D014807:Vitamin D / Q000008:administration & dosage
D000597:Amino Acids, Branched-Chain; D000975:Antioxidants; D004040:Dietary Carbohydrates; D004044:Dietary Proteins; D005231:Fatty Acids, Unsaturated; D014807:Vitamin D; D003401:Creatine