Rehabilitation Decreases Exercise-induced Oxidative Stress in Chronic Obstructive Pulmonary Disease

Abstract

The effect of exercise at different intensities as well as the effect of intensive supervised pulmonary rehabilitation on oxidative stress were studied for chronic obstructive pulmonary disease (COPD). Eleven patients with COPD and 11 healthy age-matched control subjects performed a maximal and submaximal exercise cycle ergometry test at 60% of peak workload. Patients with COPD performed these tests before and after 8 wk of pulmonary rehabilitation. Measurements were done before, immediately after, and 4 h after both exercise tests. At rest, increased oxidative stress was observed in patients compared with control subjects, as measured by urinary malondialdehyde (MDA; p < 0.05) and hydrogen peroxide (H2O2) in breath condensate (p < 0.05). In healthy control subjects, a significant increase in urinary MDA was observed 4 h after both exercise tests (p = 0.05), whereas H2O2 significantly increased immediately after maximal exercise (p < 0.05). In patients with COPD, before rehabilitation, reactive oxygen species-induced DNA damage in peripheral blood mononuclear cells, urinary MDA, and plasma uric acid were significantly increased after both exercise tests (p < 0.05), whereas no significant increase was observed in plasma MDA. In contrast, exhaled H2O2 was only significantly increased after maximal exercise (p < 0.02). Although after rehabilitation peak workload was increased by 24%, a similar oxidative stress response was found. Remarkably, a decrease in reactive oxygen species-induced DNA damage was detected after exercise at submaximal intensity despite increased exercise duration of 73%. In summary, patients with COPD had increased pulmonary and systemic oxidative stress both at rest and induced by exercise. In addition, pulmonary rehabilitation increased exercise capacity and was associated with reduced exercise-induced oxidative stress.

Nonpharmacological treatment and relief of symptoms in COPD: Table 1—

“…Training the peripheral muscles counteracts the increased exercise-induced oxidative stress [20] and improves exercise capacity and dyspnoea [21]. In severe COPD, there is a close association between changes in a systemic and multidimensional index of performance and functional status (body mass index, airflow obstruction, dyspnoea and exercise capacity index) induced by PR and patient outcomes [22].…”

Skeletal muscle dysfunction and oxidative stress in patients with chronic obstructive lung disease

“…Moreover, because even light exercise increases oxidative stress in COPD patients, they are likely to develop oxidative stress while performing the regular activities of daily life. In addition to the above studies, many other studies have shown increased oxidative stress in both acute maximal [64][65][66][67] and submaximal aerobic 64,66) exercise. Although conflicting data exist about antioxidant levels in COPD patients, the levels of antioxidants, such as GSH and vitamin E, have been shown to be lower in COPD patients, particularly muscle-wasted patients, than that in control subjects 64,65) .…”

“…Exercise training has also been reported to improve skeletal muscle oxidative capacity in patients with moderate to severe COPD 77) . In addition, pulmonary rehabilitation has been shown to not only increase exercise capacity but also to decrease exercise-induced oxidative stress in COPD patients 78) , based on exhaled H2O2 and urinary MDA as markers for pulmonary and systemic oxidative stress, respectively. Therefore, exercise training in COPD patients would be expected to upregulate antioxidant capacity and oxidative capacity in active tissues.…”

The Effect of a Short Duration, High Intensity Exercise Intervention on Gait Biomechanics in Patients With COPD: Findings From a Pilot Study

“…29,31 Unfortunately, increases in physical activity are less reliablyobserved. [32][33][34][35][36][37][38][39][40][41] Pulmonaryrehabilitationprograms mainlyutilizeafocusoneducation,nutritionandexercise 42 andarenotnecessarilyfocusedonimprovingfunctional limitations.Aprogramthatfocusedonhigh-intensity cardio-respiratoryandstrengthtrainingmaydemonstrate astrongerimpactonfunctionallimitations,specificallygait.…”