title: Should we treat obesity in COPD? The effects of diet and resistance exercise training.
abstract: Obesity is an established risk factor for poor health outcomes, but paradoxically in chronic obstructive pulmonary disease (COPD), it is associated with improved survival and lung function. A major evidence gap exisits to inform treatment recommendations for patients with COPD who are obese. We aimed to determine the effect of weight reduction involving a low-energy diet utilizing a partial meal replacement plan, coupled with resistance exercise training in obese COPD patients.
  
  
  
  In a proof of concept before-after clinical trial, obese (body mass index ≥30 kg/m(2) ) COPD patients received a 12 week weight reduction programme involving meal replacements, dietary counselling by a dietitian and resistance exercise training prescribed and supervised by a physiotherapist. Patients were reviewed face to face by the dietitian and physiotherapist every 2 weeks for counselling.
  
  
  
  Twenty-eight participants completed the intervention. Mean (standard deviation) body mass index was 36.3 kg/m(2) (4.6) at baseline and reduced by 2.4 kg/m(2) ((1.1) P < 0.0001) after the intervention. Importantly, skeletal muscle mass was maintained. Clinical outcomes improved with weight loss including exercise capacity, health status, dyspnea, strength and functional outcomes. There was also a significant reduction in the body mass index, obstruction, dyspnea and exercise score (BODE). Systemic inflammation measured by C-reactive protein however did not change.
  
  
  
  In obese COPD patients, dietary energy restriction coupled with resistance exercise training results in clinically significant improvements in body mass index, exercise tolerance and health status, whilst preserving skeletal muscle mass. This novel study provides a framework for development of guidelines for the management of obese COPD patients and in guiding future research.
authors.affiliation: School of Nursing and Midwifery, The University of Newcastle, Callaghan, New South Wales, Australia.|School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.|Priority Research Centre for Healthy Lungs, Callaghan, New South Wales, Australia.|Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton, New South Wales, Australia.
authors.forename: Vanessa M
authors.initials: VM
authors.lastname: McDonald
authors.affiliation: School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.|Priority Research Centre for Healthy Lungs, Callaghan, New South Wales, Australia.|Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton, New South Wales, Australia.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Gibson
authors.affiliation: School of Biomedical Science and Pharmacy, The University of Newcastle, Callaghan, New South Wales, Australia.|Priority Research Centre for Healthy Lungs, Callaghan, New South Wales, Australia.
authors.forename: Hayley A
authors.initials: HA
authors.lastname: Scott
authors.affiliation: School of Nursing and Midwifery, The University of Newcastle, Callaghan, New South Wales, Australia.|Priority Research Centre for Healthy Lungs, Callaghan, New South Wales, Australia.
authors.forename: Penelope J
authors.initials: PJ
authors.lastname: Baines
authors.affiliation: School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.|Priority Research Centre for Healthy Lungs, Callaghan, New South Wales, Australia.|Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton, New South Wales, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hensley
authors.affiliation: Priority Research Centre for Healthy Lungs, Callaghan, New South Wales, Australia.|Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton, New South Wales, Australia.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Pretto
authors.affiliation: School of Biomedical Science and Pharmacy, The University of Newcastle, Callaghan, New South Wales, Australia.|Priority Research Centre for Healthy Lungs, Callaghan, New South Wales, Australia.
authors.forename: Lisa G
authors.initials: LG
authors.lastname: Wood
mesh_terms: D000368:Aged; D015992:Body Mass Index; D004032:Diet / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000503:physiopathology / Q000628:therapy*; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000628:therapy*; D055070:Resistance Training / Q000379:methods*; D012129:Respiratory Function Tests
keywords: COPD; muscle mass; obesity; weight loss