Locomotor Muscles in COPD: The Rationale for Rehabilitative Exercise Training

Abstract

Exercise training as part of pulmonary rehabilitation is arguably the most effective intervention to improve tolerance to physical exertion in patients with chronic obstructive pulmonary disease (COPD). Owing to the fact that exercise training has modest effects on exertional ventilation, operating lung volumes and respiratory muscle performance, improving locomotor muscle structure and function are key targets for pulmonary rehabilitation in COPD. In the current concise review, we initially discuss whether patients' muscles are exposed to deleterious factors. After presenting corroboratory evidence on this regard (e.g., oxidative stress, inflammation, hypoxemia, inactivity, and medications), we outline their effects on muscle macro-and micro-structure and related functional properties. We then finalize by addressing the potential beneficial consequences of different training strategies on these muscle-centered outcomes. This review provides, therefore, an up-to-date outline of the rationale for rehabilitative exercise training approaches focusing on the locomotor muscles in this patient population.

Towards Personalized Management of Sarcopenia in COPD

“…7 General principles of exercise training are no different in COPD patients from healthy controls or even athletes, although the physiological response might be altered in COPD patients. 5,122 Aerobic exercise or endurance training in COPD patients specifically improves exercise tolerance, breathlessness, exercise induced hyperinflation and stimulates a muscle fiber shift back to more oxidative type I fibers, improving mitochondrial capacity and thus efficiency. [123][124][125] Interval training is a variation to continuous endurance training, with short periods of highintensity exercise alternated with periods of lower intensity or rest.…”

“…123,127 Resistance training consistently increased muscle mass, and was more effective in counteracting muscle atrophy than endurance training in COPD. 122 Therefore, a combination of both endurance or interval training and resistance training, as commonly applied in PR, might be optimal to improve muscle mass, strength and endurance in sarcopenic COPD patients. Theoretically, oxygen supplementation during exercise would enable a higher training intensity and thus would yield better improvements in muscle mass and strength.…”

“…Both in young healthy adults, as in sarcopenic patients, testosterone or anabolic steroid treatment proved to increase muscle mass and reduce fat mass. 124 Testosterone administration in COPD patients, alone or in conjunction with exercise, was associated with reduced hospitalization, increased FFM and muscle strength, but did not enhance exercise capacity, 122,149,150 Similarly, intramuscular anabolic steroid injection in the form of nandrolone decanoate (ND) increased FFM without further improvement of exercise capacity compared to control when provided during PR, although exercise capacity was reported to increase by ND in the subgroup of patients on glucocorticoid medication. 151 Although testosterone induced an increase in FFM, whether or not effects can be sustained after cessation of supplementation remains to be determined.…”

Practical Recommendations Relevant to the Use of Resistance Training for COVID-19 Survivors

“…Previous studies showed that, in people with pulmonary diseases, low muscle strength is associated with physical inactivity ( Osthoff et al, 2013 ) and is an independent predictor of morbidity and mortality independent of the degree of respiratory limitation ( Swallow et al, 2007 ). Consequently, the key target in rehabilitation for pulmonary diseases should be improving locomotor muscle structure and function, as exercise results in reduced benefits on exertional ventilation, operating lung volumes, and respiratory muscle performance ( Marillier et al, 2020 ). Moreover, the performance of physical exercise is advised as adjuvant non-pharmacological treatment during pulmonary fibrosis rehabilitation ( Spruit et al, 2009 ).…”

Prevalencia y repercusión del síndrome locomotor en el perfil clínico de la enfermedad pulmonar obstructiva crónica

“…Los resultados de nuestro estudio han mostrado un deterioro funcional y de calidad de vida significativamente mayor en los pacientes EPOC con SL. Por ello, en esta población las actividades relacionadas con la salud publica deben ir enfocadas a la instauración de intervenciones educativas que promuevan cambios de comportamiento y estilo de vida a largo plazo, como rehabilitación física y pulmonar 42 .…”