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Exercise Capacity, Muscle Strength, and Fatigue in Sarcoidosis: A Follow-Up Study

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Abstract

Purpose

The purpose of this study was to examine changes in the prevalence of exercise intolerance, reduced muscle strength, and fatigue and the changes in these parameters in individual patients during a 2-year follow-up study.

Methods

Ninety sarcoidosis patients (62 males and 28 females; mean age: 46.0 ± 10.2 years) participated in a 2-year follow-up study. At the baseline and follow-up measurements, patients performed a 6-min walk test and elbow flexor muscle strength, quadriceps peak torque, and hamstrings peak torque tests. Maximal inspiratory pressure was recorded. All patients completed the Fatigue Assessment Scale.

Results

Both at baseline and follow-up, a substantial proportion of the patients showed a reduced 6-minute walk test (41.6 and 34.8 %, respectively), elbow flexor muscle strength (6.7 and 14.6 %), quadriceps peak torque (21.3 and 18 %), hamstrings peak torque (13.5 and 12.4 %), and maximal inspiratory pressure (45.9 and 48.6 %). The majority of the patients reported fatigue (86 and 77 %). These physical impairments remained stable during the follow-up period. The prevalence of these physical impairments in patients diagnosed with sarcoidosis <2 years before inclusion in this study was similar to that in patients with a longer history of the disease.

Conclusions

Exercise intolerance, muscle weakness, and fatigue are frequent problems in symptomatic sarcoidosis patients with a stable and persistent character. This study highlights that beyond medical treatment a rehabilitation program should be considered as adjunct therapy in the multidisciplinary management of sarcoidosis patients even though the achieved benefit needs future studies.

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References

  1. Statement on sarcoidosis (1999) Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med 160(2):736–755

    Google Scholar 

  2. Iannuzzi MC, Fontana JR (2011) Sarcoidosis: clinical presentation, immunopathogenesis, and therapeutics. JAMA 305(4):391–399

    Article  PubMed  CAS  Google Scholar 

  3. Baughman RP, Culver DA, Judson MA (2011) A concise review of pulmonary sarcoidosis. Am J Respir Crit Care Med 183(5):573–581

    Article  PubMed  CAS  Google Scholar 

  4. Sharma OP (2012) Fatigue in sarcoidosis: incompletely understood, inadequately treated. Curr Opin Pulm Med 18(5):470–471

    Article  PubMed  Google Scholar 

  5. Michielsen HJ, Drent M, Peros-Golubicic T, De Vries J (2006) Fatigue is associated with quality of life in sarcoidosis patients. Chest 130(4):989–994

    Article  PubMed  Google Scholar 

  6. Baydur A (2012) Recent developments in the physiological assessment of sarcoidosis: clinical implications. Curr Opin Pulm Med 18(5):499–505

    Article  PubMed  Google Scholar 

  7. Drent M, Wirnsberger RM, De Vries J, van Dieijen-Visser MP, Wouters EF, Schols AM (1999) Association of fatigue with an acute phase response in sarcoidosis. Eur Respir J 13(4):718–722

    Article  PubMed  CAS  Google Scholar 

  8. Hinz A, Fleischer M, Brahler E, Wirtz H, Bosse-Henck A (2011) Fatigue in patients with sarcoidosis, compared with the general population. Gen Hosp Psychiatry 33(5):462–468

    Article  PubMed  Google Scholar 

  9. Marcellis RG, Lenssen AF, Elfferich MD, De Vries J, Kassim S, Foerster K, Drent M (2011) Exercise capacity, muscle strength and fatigue in sarcoidosis. Eur Respir J 38(3):628–634

    Article  PubMed  CAS  Google Scholar 

  10. Alhamad EH (2009) The six-minute walk test in patients with pulmonary sarcoidosis. Ann Thorac Med 4(2):60–64

    Article  PubMed  Google Scholar 

  11. Baughman RP, Sparkman BK, Lower EE (2007) Six-minute walk test and health status assessment in sarcoidosis. Chest 132(1):207–213

    Article  PubMed  Google Scholar 

  12. Kabitz HJ, Lang F, Walterspacher S, Sorichter S, Muller-Quernheim J, Windisch W (2006) Impact of impaired inspiratory muscle strength on dyspnea and walking capacity in sarcoidosis. Chest 130(5):1496–1502

    Article  PubMed  Google Scholar 

  13. Spruit MA, Thomeer MJ, Gosselink R, Troosters T, Kasran A, Debrock AJ, Demedts MG, Decramer M (2005) Skeletal muscle weakness in patients with sarcoidosis and its relationship with exercise intolerance and reduced health status. Thorax 60(1):32–38

    Article  PubMed  CAS  Google Scholar 

  14. Baydur A, Alsalek M, Louie SG, Sharma OP (2001) Respiratory muscle strength, lung function, and dyspnea in patients with sarcoidosis. Chest 120(1):102–108

    Article  PubMed  CAS  Google Scholar 

  15. Wirnsberger RM, Drent M, Hekelaar N, Breteler MH, Drent S, Wouters EF, Dekhuijzen PN (1997) Relationship between respiratory muscle function and quality of life in sarcoidosis. Eur Respir J 10(7):1450–1455

    Article  PubMed  CAS  Google Scholar 

  16. Spruit MA, Wouters EFM, Gosselink R (2005) Rehabilitation programmes in sarcoidosis: a multidisciplinary approach. Eur Respir J 32:316–326

    Article  Google Scholar 

  17. Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC (1993) Lung volumes and forced ventilatory flows. Report working party standardization of lung function tests, European community for steel and coal. Official statement of the European Respiratory Society. Eur Respir J Suppl 16:5–40

    PubMed  CAS  Google Scholar 

  18. Rothkrantz-Kos S, van Dieijen-Visser MP, Mulder PG, Drent M (2003) Potential usefulness of inflammatory markers to monitor respiratory functional impairment in sarcoidosis. Clin Chem 49(9):1510–1517

    Article  PubMed  CAS  Google Scholar 

  19. ATS (2002) ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 166(1):111–117

    Article  Google Scholar 

  20. du Bois RM, Weycker D, Albera C et al (2011) Six-minute-walk test in idiopathic pulmonary fibrosis: test validation and minimal clinically important difference. Am J Respir Crit Care Med 183(9):1231–1237

    Article  PubMed  Google Scholar 

  21. Demers C, McKelvie RS, Negassa A, Yusuf S, RPS Investigators (2001) Reliability, validity, and responsiveness of the six-minute walk test in patients with heart failure. Am Heart J 142(4):698–703

    Article  PubMed  CAS  Google Scholar 

  22. Freedson PS, Gilliam TB, Mahoney T, Maliszewski MA, Kastango K (1993) Industrial torque levels by age group and gender. Isokinet Exerc Sci 3(1):34–42

    Google Scholar 

  23. Drouin JM, Valovich-mcLeod TC, Shultz SJ, Gansneder BM, Perrin DH (2004) Reliability and validity of the Biodex system 3 pro isokinetic dynamometer velocity, torque and position measurements. Eur J Appl Physiol 91(1):22–29

    Article  PubMed  Google Scholar 

  24. McCleary RW, Andersen JC (1992) Test-retest reliability of reciprocal isokinetic knee extension and flexion peak torque measurements. J Athl Train 27(4):362–365

    PubMed  CAS  Google Scholar 

  25. Bohannon RW (1988) Make tests and break tests of elbow flexor muscle strength. Phys Ther 68(2):193–194

    PubMed  CAS  Google Scholar 

  26. Bohannon RW, Andrews AW (1987) Interrater reliability of hand-held dynamometry. Phys Ther 67(6):931–933

    PubMed  CAS  Google Scholar 

  27. Black LF, Hyatt RE (1969) Maximal respiratory pressures: normal values and relationship to age and sex. Am Rev Respir Dis 99(5):696–702

    PubMed  CAS  Google Scholar 

  28. Drent M, Lower EE, De Vries J (2012) Sarcoidosis-associated fatigue. Eur Respir J 40(1):255–263

    Article  PubMed  Google Scholar 

  29. de Kleijn WP, De Vries J, Wijnen PA, Drent M (2011) Minimal (clinically) important differences for the Fatigue Assessment Scale in sarcoidosis. Respir Med 105(9):1388–1395

    Article  PubMed  Google Scholar 

  30. Michielsen HJ, De Vries J, Van Heck GL, Van de Vijver FJR, Sijtsma K (2004) Examination of the dimensionality of fatigue: the construction of the Fatigue Assessment Scale (FAS). EJPA 20(1):39–48

    Google Scholar 

  31. Trompenaars FJ, Masthoff ED, Van Heck GL, Hodiamont PP, De Vries J (2005) Content validity, construct validity, and reliability of the WHOQOL-Bref in a population of Dutch adult psychiatric outpatients. Qual Life Res 14(1):151–160

    Article  PubMed  Google Scholar 

  32. Harik-Khan RI, Wise RA, Fozard JL (1998) Determinants of maximal inspiratory pressure. The Baltimore Longitudinal Study of Aging. Am J Respir Crit Care Med 158(5 Pt 1):1459–1464

    Article  PubMed  CAS  Google Scholar 

  33. Al-Nozha MM, Al-Hazzaa HM, Arafah MR et al (2007) Prevalence of physical activity and inactivity among Saudis aged 30–70 years. A population-based cross-sectional study. Saudi Med J 28(4):559–568

    PubMed  Google Scholar 

  34. Miller A, Brown LK, Sloane MF, Bhuptani A, Teirstein AS (1995) Cardiorespiratory responses to incremental exercise in sarcoidosis patients with normal spirometry. Chest 107(2):323–329

    Article  PubMed  CAS  Google Scholar 

  35. Fayad F, Liote F, Berenbaum F, Orcel P, Bardin T (2006) Muscle involvement in sarcoidosis: a retrospective and followup studies. J Rheumatol 33(1):98–103

    PubMed  Google Scholar 

  36. de Kleijn WP, Elfferich MD, De Vries J, Jonker GJ, Lower EE, Baughman RP, King TE Jr, Drent M (2009) Fatigue in sarcoidosis: American versus Dutch patients. Sarcoidosis Vasc Diffuse Lung Dis 26(2):92–97

    PubMed  Google Scholar 

  37. Marcellis RG, Lenssen AF, de Vries GJ, Baughman RP, van der Grinten CP, Verschakelen JA, De Vries J, Drent M (2013) Is there an added value of cardiopulmonary exercise testing in sarcoidosis patients? Lung 191(1):43–52

    Article  PubMed  Google Scholar 

  38. Huppmann P, Sczepanski B, Boensch M, Winterkamp S, Schonheit-Kenn U, Neurohr C, Behr J, Kenn K (2012) Effects of in-patient pulmonary rehabilitation in patients with interstitial lung disease. Eur Respir J. doi:10.1183/09031936.00081512

    PubMed  Google Scholar 

  39. Kozu R, Senjyu H, Jenkins SC, Mukae H, Sakamoto N, Kohno S (2011) Differences in response to pulmonary rehabilitation in idiopathic pulmonary fibrosis and chronic obstructive pulmonary disease. Respiration 81(3):196–205

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was financially supported by a grant from the ild care foundation (Maastricht, the Netherlands; www.ildcare.eu). This is a nonrestricted educational grant.

Conflict of interest

The authors have reported to ‘Lung’ that no conflicts of interests exist with any companies/organizations whose products or services may be discussed in this article.

Clinical Trial

This study is registered at www.ClinicalTrials.gov with trial number NCT00854672.

Medical Ethics Committee

The study was approved by the Medical Ethics Committee of the Maastricht University Medical Centre (MEC 09-4-007).

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Correspondence to Marjolein Drent.

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Marcellis, R.G.J., Lenssen, A.F., Kleynen, S. et al. Exercise Capacity, Muscle Strength, and Fatigue in Sarcoidosis: A Follow-Up Study. Lung 191, 247–256 (2013). https://doi.org/10.1007/s00408-013-9456-6

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  • DOI: https://doi.org/10.1007/s00408-013-9456-6

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