ECSS Paris 2023: OP-MH36
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide, with muscle dysfunction in the lower limbs being a significant extrapulmonary manifestation (1). Muscle dysfunction is characterized by loss of muscle mass and function, resulting in limited exercise capacity and reduced quality of life. Systemic inflammation and oxidative stress are common manifestations of COPD and could impair muscle energy metabolism and oxygen utilization (2). These factors compromise oxygen delivery to muscles during exercise, affecting exercise performance in patients. In COPD patients, these factors likely contribute to early fatigue and reduced maximal aerobic capacity. Near-infrared spectroscopy (NIRS) provides a non-invasive method to assess muscle oxygenation in real time, offering insight into oxygen supply and utilization during exercise (3). This study aimed to compare muscle oxygen supply and uptake during a submaximal time to exhaustion (TTE) cycling test in COPD patients and healthy individuals. METHODS: A cross-sectional observational study compared 12 healthy individuals (64 ± 6.7 years and FEV1 104.67% ± 7.63) and 12 patients with severe COPD (65 ± 5.3 years and FEV1 40.67% ± 15.67). Maximal aerobic capacity (VO2peak) and power output (POmax) were measured using an incremental cycling test. The time-to-exhaustion (TTE) test was assessed with a constant-load test at 70% of the POmax. During TTE, muscle oxygenation was measured using NIRS in the vastus medialis, which assesses the concentration of total hemoglobin plus the concentration of myoglobin (tHbMb) in the muscle in real time and the percentage of muscle oxygen saturation (SmO2). Furthermore, deoxyhemoglobin (HHb) was calculated as the tHbMb multiplied by the SmO₂ fraction. The area under the curve (AUC) of the variables SmO₂, tHbMb, and HHb over time of TTE was calculated to represent the cumulative response. Additionally, heart rate, peripheral oxygen saturation (SpO2), and perceived exertion (Borg´s scale) were recorded during TTE. Data analysis was performed in RStudio using Student’s t-test and analysis of variance (ANOVA). RESULTS: COPD patients show a 29.1% lesser VO₂peak (p=0.02) compared to healthy individuals. COPD patients performed 43.6% lesser time in the TTE than healthy individuals. The AUC during exercise time in TTE of HHb was 44.9% (p=0.04) lower in COPD patients, likely due to the significantly shorter TTE duration (p<0.01). The SmO2 was similar (56.4% vs 51.2%, respectively) between groups (p=0.28). However, SmO2 at 10% of the total time was 15% lower (p = 0.02) in healthy individuals than COPD, indicating reduced muscle oxygen uptake. The tHbMb increased similarly in both groups (p=0.94), reflecting comparable vascular responses. CONCLUSION: This suggests that COPD patients have a reduced capacity to sustain submaximal effort, potentially due to lesser maximal oxidative capacity and impaired muscle oxygen delivery and utilization during exercise, which may lead to early fatigue.
Read CV Sebastian GutierrezECSS Paris 2023: OP-MH36
INTRODUCTION: Numerous studies have demonstrated postural balance impairments in patients with chronic obstructive pulmonary disease (COPD). To address this, pulmonary rehabilitation (PR) has been recommended, either alone or combined with traditional muscle-strengthening exercises. However, no study has explored the use of electrostimulation (ES) to improve postural balance in COPD patients. This study aims to assess the effectiveness of neuromuscular electrical stimulation (NMES) combined with pulmonary rehabilitation in enhancing walking tolerance and balance in COPD patients. METHODS: Forty-five COPD patients were randomly assigned to either an intervention group (n = 25) or a control group (n = 20). The intervention group received neuromuscular electrical stimulation in addition to pulmonary rehabilitation, while the control group received only pulmonary rehabilitation, both three times per week over six months. Assessments were performed at baseline and after six months using a stabilometric platform, the Timed Up and Go test, the Berg Balance Scale, the 6-minute walking test, and maximal voluntary contraction measurements. RESULTS: The intervention group showed significant improvements in exercise tolerance, with a greater distance walked on the 6-minute walking test (619.5 ± 39.6 m) compared to the control group (576.3 ± 31.5 m). The intervention group also demonstrated significant improvements in the Timed Up and Go test, the Berg Balance Scale, and maximal voluntary contraction (P = 0.02, P = 0.01, P = 0.0002, respectively). Additionally, there were significant improvements in the center of pressure (COP) in both mediolateral and anteroposterior directions, as well as in the COP area, with both eyes open and closed, in the intervention group compared to the control group (P < 0.001). CONCLUSION: The use of neuromuscular electrical stimulation of lower-limb muscles added to pulmonary rehabilitation is more effective in improving walking tolerance and generating a better control of postural balance for patients with COPD than pulmonary rehabilitation alone. These findings may assist clinicians in designing more effective rehabilitation programs for patients with COPD.
Read CV Yassine TrabelsiECSS Paris 2023: OP-MH36
INTRODUCTION: Chronic obstructive pulmonary disease (COPD), a progressive respiratory disorder marked by irreversible airflow limitation and dyspnea, significantly reduces life quality and imposes global health burdens. Its clinical progression spans early symptoms (chronic cough, sputum production), intermediate-stage dyspnea, and advanced systemic manifestations (cyanosis, cardiopulmonary dysfunction), with mortality rates ranking third worldwide. While exercise interventions improve lung function, cardiovascular health, and psychological well-being in COPD patients, debates persist regarding optimal exercise modalities, intensity thresholds, and long-term efficacy. Excessive exertion may exacerbate dyspnea, cardiopulmonary strain, and muscle fatigue, underscoring the need for evidence-based exercise prescriptions. This study employs bibliometric analysis (2000–2024) to map global research trends in COPD exercise interventions, examining publication patterns, collaborative networks, and thematic evolution. By identifying knowledge gaps and fostering interdisciplinary collaboration, we aim to optimize exercise strategies for COPD management. METHODS: We searched the Web of Science Core Collection database for literature related to COPD exercise prescriptions . The manual screening criteria applied were as follows: date range, January 01, 2000, to June 01, 2024; language, English; article type, article and review article. Finally, 738 articles were included in this study. CiteSpace, VOSviewer, and Bibliometrix R-package software were used to analyze the literature. RESULTS: Research output in the field of exercise prescriptions for COPD can be divided into four phases: the exploratory period (2000-2008), surge period (2009-2016), exponential growth phase (2017-2020), and fluctuation period (2021-2024). The US leads the world in terms of the total number of publications, while BMJ OPEN from the UK has the highest number of publications. The longest-standing research topic is dyspnea, and airflow limitation has been identified as the core issue in this field. Anxiety, oxidative stress, inflammation, and dynamic pulmonary hyperinflation are practical challenges facing this domain. Respiratory pattern training, including diaphragmatic breathing, Pilates breathing, unidirectional breathing, pursed-lip breathing, and paced breathing, constitutes the primary exercise prescription for patients with COPD. CONCLUSION: The number of publications on COPD has grown rapidly. Key research areas include quality of life, dyspnea, lung rehabilitation, and lung capacity. Future research directions include exercise prescription, resistance training, muscle function, anxiety, evaluating intervention effects, and optimizing respiratory patterns. Future studies should prioritize macro-level integrated exercise prescriptions highlighting multiple types of exercise and micro-level specifications of resistance training intensity, density, frequency, and period.
Read CV TE FUECSS Paris 2023: OP-MH36