Six-Minute Walking-Induced Systemic Inflammation and Oxidative Stress in Muscle-Wasted COPD Patients

Helvoort, H.A.C. van; Heijdra, Yvonne F.; Boer, Roline C.C. de; Swinkels, Astrid; Thijs, Hub M.H.; Dekhuijzen, P.N.R.

doi:10.1378/chest.06-1655

Cited by 54 publications

(34 citation statements)

References 31 publications

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“…There is some debate in the literature as to whether the 6MWT in patients with COPD reflects maximal [17,18] or submaximal [19,20] sustainable exercise. Troosters et al [19] compared the physiological responses of 20 patients with COPD during an encouraged 6MWT and maximal-cycle ergometer exercise testing.…”

Section: Discussionmentioning

confidence: 99%

“…Turner et al [22] observed similar peak exercise responses achieved in the 6MWT and CPET in 20 patients with moderate to severe COPD. Controversially, van Helvoort et al [20] found that VO 2 and HR were lower after the 6MWT than at peak cycling. According to the ATS criteria [4] for the determination of test intensity, 81.9% of our patients reached at least one limitation; this being a substantial number, the 6MWT could be considered as maximal sustainable exercise.…”

Section: Discussionmentioning

confidence: 99%

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Cardiopulmonary and Gas-Exchange Responses during the Six-Minute Walk Test in Patients with Chronic Obstructive Pulmonary Disease

Gestel

Baty²,

Rausch-Osthof³

et al. 2014

Respiration

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Background: The 6-min walk test (6MWT) is representative of daily life activities and reflects the functional capacity of patients with chronic obstructive pulmonary disease (COPD). Information on the cardiopulmonary and gas exchange responses to the 6MWT is limited. Objectives: We aimed to analyze the breath-by-breath cardiopulmonary and gas exchange responses of patients with COPD during the 6MWT. We also investigated the extent to which parameters reflecting cardiopulmonary and gas exchange function are associated with exercise capacity. Methods: The oxygen uptake (VO₂) kinetics of patients were obtained using mobile telemetric cardiopulmonary monitoring during a 6MWT. A new mean response time (MRT) index was developed to quantify VO₂ on-kinetics by correcting MRT for work rate (wMRT). Multiple linear regression analysis was performed to assess the association between variables reflecting cardiopulmonary and gas exchange function and exercise capacity [6-min walking distance (6MWD) and VO₂ at steady state (VO_2SS)]. Results: In 72 COPD patients (29 females) with a mean (SD) age of 65 (10) years, FEV₁ 44 (14) % predicted exercise capacity as assessed by VO_2SS (p = 0.003) was significantly reduced across the stages of COPD. The criteria for maximal effort during the 6MWT were fulfilled by 82% of the patients. After adjustment for covariates, wMRT was independently associated with 6MWD (p = 9.7 × 10^-5) and VO_2SS (p = 5.5 × 10^-10). Conclusions: As wMRT mostly depends on the rate of increase of pulmonary blood flow, our results underline the fact that cardiocirculatory function may play a significant role in exercise tolerance in patients with COPD. Our findings imply that modification of cardiocirculatory function may be beneficial in the treatment of COPD patients and improve their outcome more than anticipated previously.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary and Gas-Exchange Responses during the Six-Minute Walk Test in Patients with Chronic Obstructive Pulmonary Disease

Gestel

Baty²,

Rausch-Osthof³

et al. 2014

Respiration

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“…Nonetheless, the response of patients with COPD to submaximal exercise is less clear. While one study showed normal differences in the leukocytosis response between maximal and submaximal exercise in COPD patients [76], another was unable to find any differences [72]. The latter results might indicate an intensified response to submaximal exercise in COPD patients and thus frequent exposure to bursts of inflammation in response to submaximal activities in daily life.…”

Section: Inflammation and Exercisementioning

confidence: 99%

“…The oxidative response to exercise might provide additional information about the inflammatory response, since these responses seem to be closely related [72,76]. Since inflammatory mediators seem to increase the level of ROS and reduce the amount of antioxidants, exercise might be accompanied by increased oxidative stress.…”

Section: Inflammation and Exercisementioning

confidence: 99%

The Potential Anti-Inflammatory Effect of Exercise in Chronic Obstructive Pulmonary Disease

Vlist¹,

Janssen²

2009

Respiration

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People with chronic obstructive pulmonary disease (COPD) suffer from muscle dysfunction which seems to be partly caused by systemic inflammation. Muscle protein breakdown as well as synthesis might be affected by this systemic inflammation. Additionally, it seems to induce excessive oxidative stress and reduce the level of growth-stimulating factors. As exercise training can have an anti-inflammatory effect in healthy people, the main question in this review is whether exercise (training) can also induce such effects in patients with COPD. However, because of the known inflammatory response after an acute bout of exercise, some researchers are afraid that exercise might actually worsen the inflammation in COPD. Recent evidence suggests, however, that the response might actually be anti-inflammatory and thus beneficial. Unfortunately, the evidence about the response of the inflammatory cytokines tumor necrosis factor-α and interleukin-6 to exercise in patients with COPD is inconsistent, making it impossible to conclude whether a single exercise bout is harmful or beneficial in patients with COPD. Long-term exercise training in healthy people as well as in patients with chronic heart failure, another chronic inflammatory disease, seems to have beneficial effects on the inflammatory response. In patients with COPD, however, no training-induced changes in cytokine levels have been found and it must be concluded that physical exercise training does not seem to have an anti-inflammatory effect in COPD. On the other hand, it does not have a proinflammatory effect, and since patients with COPD benefit from exercise training with regard to other health parameters it is still recommended that they exercise regularly.

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“…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) .…”

Section: Acute Exercise and Exercise Training In Copdmentioning

confidence: 86%

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

Oh‐ishi

Nemoto

Saito

2015

JPFSM

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Chronic obstructive pulmonary disease (COPD) is an increasingly important global health problem, including Japan. COPD is associated with an enhanced inflammatory response to irritants in the airways and lungs, in particular cigarette smoke. Cigarette smoke contains gaseous and particulate oxidants, and is considered to be the major etiological factor in the development of COPD. The oxidants in cigarette smoke induce inflammation, and chronic inflammation causes narrowing of the small airways and destruction of the lung parenchyma. Inflammation and oxidative stress are intricately related and seem to play a critical role in the development and/or progression of COPD. There is growing evidence that systemic inflammation exists in patients with stable COPD, leading to extra-pulmonary manifestations including skeletal muscle dysfunction and other comorbidities. Oxidative stress is also observed in skeletal muscle of COPD patients. Therefore, both systemic inflammation and oxidative stress may be associated with skeletal muscle dysfunction in COPD patients, resulting in reduced limb muscle strength and exercise endurance and poor health status and quality of life. Pulmonary rehabilitation is important to improve exercise capacity and health-related quality of life for COPD patients. However, physical exercise, the main component of pulmonary rehabilitation, may increase oxidative stress in the skeletal muscle of such patients. Therefore, rehabilitation programs that not only improve exercise capacity and quality of life, but also reduce exerciseinduced oxidative stress should be established in the future.

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Six-Minute Walking-Induced Systemic Inflammation and Oxidative Stress in Muscle-Wasted COPD Patients

Cited by 54 publications

References 31 publications

Cardiopulmonary and Gas-Exchange Responses during the Six-Minute Walk Test in Patients with Chronic Obstructive Pulmonary Disease

Cardiopulmonary and Gas-Exchange Responses during the Six-Minute Walk Test in Patients with Chronic Obstructive Pulmonary Disease

The Potential Anti-Inflammatory Effect of Exercise in Chronic Obstructive Pulmonary Disease

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

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