Chest
Volume 128, Issue 5, November 2005, Pages 3183-3190
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Clinical Investigations: COPD
Low-Grade Systemic Inflammation and the Response to Exercise Training in Patients With Advanced COPD

https://doi.org/10.1378/chest.128.5.3183Get rights and content

Study objective: Low-grade systemic inflammation may cause a chronic catabolic state that may affect trainability in patients with COPD as has been seen previously in healthy elderly. Therefore, the aim of the present study was to study the relationship between baseline circulating levels of inflammatory markers and the response to exercise training in clinically stable patients with COPD.

Design: An open prospective intervention study.

Setting: Tertiary care setting, University Hospital Gasthuisberg, Leuven, Belgium.

Patients: Seventy-eight clinically stable outpatients with COPD.

Intervention: A 12-week outpatient exercise-training program consisting of strengthening and endurance types of exercises.

Measurements and results: Circulating levels of inflammatory markers were assessed at baseline. Moreover, lung function, quadriceps force (QF), peak and functional exercise capacity, and health-related quality of life were determined at baseline and after the intervention. Sixty-five of the 78 consecutive outpatients completed the study protocol. QF, peak and functional exercise capacity and health-related quality of life improved significantly compared to baseline. The absolute changes in health-related quality of life showed weak relationships with baseline circulating levels of interleukin-8 (CXCL8) in the whole group (n = 65;r= -0.26; p = 0.04). In addition, soluble tumor necrosis factor receptor p55 was strongly and positively related to the absolute changes in QF in the female patients only (n = 18;r= 0.81; p = 0.0001), while CXCL8 was inversely related to the absolute change in the total score of the Chronic Respiratory Disease Questionnaire (r= -0.65; p = 0.004).

Conclusion: Baseline markers of low-grade systemic inflammation did not clearly explain the variances in absolute changes in QF, the distance walked in 6 min, peak external load, or health-related quality of life following a 12-week exercise-training program. Hence, they seem not very constructive in the characterization of patients with advanced COPD who do or do not respond to exercise training.

Section snippets

Patients

Seventy-eight consecutive patients with COPD who attended the respiratory outpatient clinic between May 2002 and October 2003 with complaints of dyspnea and poor exercise performance volunteered to participate (Table 1). Patients had no cardiovascular, renal, or neurologic disorders, and did not experience an acute COPD exacerbation in the 3-month period before baseline testing. The Medical Ethical Board of the University Hospitals Leuven approved this open prospective intervention study. All

Baseline

Table 1 shows the baseline characteristics of the patients who completed the exercise-training program (n = 65) and of those who did not complete it (eg, no 12-week assessment). Patients who dropped out due to various reasons (Fig 1 of the online data supplement) had similar baseline characteristics as those who completed the protocol.

Patients who completed the program generally had moderate-to-severe airway obstruction, normal body mass index, and a moderately reduced arterial oxygen tension(

DISCUSSION

Previously, studies have shown that the response to exercise training in patients with COPD was independent of baseline age,24 baseline FEV1,25 and baseline arterial blood gas levels.26 On the contrary, worse baseline physical fitness and muscle weakness, and somewhat worse ventilatory reserve could partially explain the relative response to a 12-week exercise-training program.5, 27 This, however, appears to be common sense.

This is the first clinical study to investigate whether and to what

CONCLUSIONS

In the present study, baseline low-grade systemic inflammation did not explain many of the effects following a 12-week exercise-training program in patients with COPD, except for sTNFR-p55 in the female patients.

ACKNOWLEDGMENTS

The authors are grateful to physiotherapists V. Barbier, I. Coosemans, and A. Cattaert, and to chest physicians P. Bogaerts and A.J.T. Debrock for testing all of the subjects and for their professional guidance of the exercise-training sessions; and to physiotherapist A. Van Severen for gathering all the data. Furthermore, they are indebted to all participants who graciously consented to participate.

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