A randomized clinical trial investigating the efficacy of targeted nutrition as adjunct to exercise training in COPD

Abstract

BackgroundEvidence regarding the efficacy of nutritional supplementation to enhance exercise training responses in COPD patients with low muscle mass is limited.The objective was to study if nutritional supplementation targeting muscle derangements enhances outcome of exercise training in COPD patients with low muscle mass.MethodsEighty‐one COPD patients with low muscle mass, admitted to out‐patient pulmonary rehabilitation, randomly received oral nutritional supplementation, enriched with leucine, vitamin D, and omega‐3 fatty acids (NUTRITION) or PLACEBO as adjunct to 4 months supervised high intensity exercise training.ResultsThe study population (51% males, aged 43–80) showed moderate airflow limitation, low diffusion capacity, normal protein intake, low plasma vitamin D, and docosahexaenoic acid. Intention‐to‐treat analysis revealed significant differences after 4 months favouring NUTRITION for body mass (mean difference ± SEM) (+15 ± 06 kg, P = 001), plasma vitamin D (+24%, P = 0004), eicosapentaenoic acid (+91%,P < 0001), docosahexaenoic acid (+31%, P < 0001), and steps/day (+24%, P = 0048). After 4 months, both groups improved skeletal muscle mass (+04 ± 01 kg, P < 0001), quadriceps muscle strength (+123 ± 23 Nm,P < 0001), and cycle endurance time (+1914 ± 343 s, P < 0001). Inspiratory muscle strength only improved in NUTRITION (+05 ± 01 kPa, P = 0001) and steps/day declined in PLACEBO (−18%,P = 0005).ConclusionsHigh intensity exercise training is effective in improving lower limb muscle strength and exercise performance in COPD patients with low muscle mass and moderate airflow obstruction. Specific nutritional supplementation had additional effects on nutritional status, inspiratory muscle strength, and physical activity compared with placebo.

Targeted medical nutrition for cachexia in chronic obstructive pulmonary disease: a randomized, controlled trial

“…Although an increase in LBM would have been preferable, this might have been achieved had an exercise programme been specified, as was recently demonstrated in an RCT of a nutritional intervention combined with high-intensity exercise in patients with COPD and low muscle mass. 37 Moreover, any weight gain in this patient group could be beneficial in terms of survival. 36 The impact of TMN on lipid profiles was generally favourable, as expected based on studies of high-dose omega-3 PUFAs in healthy adults.…”

Pulmonary rehabilitation, physical activity, respiratory failure and palliative respiratory care

“…Calder and colleagues47 investigated 3 months of multimodal nutritional intervention including high-quality protein, vitamin D and n−3 fatty acids versus an isocaloric control, and showed positive effects on blood pressure, blood lipids and on exercise-induced fatigue. A Dutch trial48 investigated the efficacy of a similar multimodal nutritional intervention as adjunct to 4 months of high-intensity exercise training. Muscle mass and physical performance improved in both groups, but the intervention group showed additional effects on nutritional status and PA compared with placebo.…”

Frailty, Comorbidity, and COPD

“…Alvin L. Barach (67) and Thomas Petty (68) were the first to suggest that exercise was a key component of pulmonary rehabilitation. It has been shown that exercise together with protein supplementation is the most efficacious management for COPD (69)(70)(71)(72). An exercise intervention prescribed in 58 frail older patients after hospital admission for acute COPD exacerbation in improved muscle strength, balance, and exacerbation (73,74).…”