- •Recovery of exercise capacity is variable after COPD exacerbation.
- •Quadriceps weakness at hospitalization predicts a poor recovery after 30 days.
- •No influence of respiratory and handgrip strength was observed.
- •Early rehabilitation should improve leg strength to accelerate functional recovery.
Patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) have decreased exercise tolerance, which may persist for months. In this context, little is known about the associations between muscle strength and recovery of exercise capacity.
To assess whether respiratory and peripheral muscle strength influence recovery of exercise capacity in patients hospitalized due to AECOPD.
Twenty-seven AECOPD patients (aged 69 ± 7 years, 56% male) were included. The following assessments were performed within 24 to 72 h of hospital admission: (i) respiratory muscle strength, measured by maximal inspiratory and expiratory pressures (MIP and MEP); (ii) peripheral muscle strength, assessed by handgrip and quadriceps muscle strength; and (iii) exercise capacity, measured by 6-min walking distance (6MWD). The 6MWD was reassessed 30 days later to determine the recovery of exercise capacity.
After 30 days, while 63% of the patients showed clinically important improvement in the 6MWD (recovery ≥ 30 m), 37% showed no change (recovery < 30 m). During hospital stay, the non-recovered group had lower quadriceps muscle strength compared to the recovered group (15 ± 5 vs. 22 ± 6 kgf; P = 0.006), with no significant difference for MIP, MEP and handgrip strength. Only quadriceps muscle strength was associated with recovery of exercise capacity (r = 0.56; P = 0.003).
AECOPD patients with quadriceps muscle weakness during hospitalization have poor recovery of exercise capacity after 30 days. This finding suggests the importance of early rehabilitation to improve quadriceps strength and accelerate functional recovery after AECOPD.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Heart & Lung: The Journal of Cardiopulmonary and Acute Care
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- COPD exacerbations: defining their cause and prevention.Lancet. 2007; 370: 786-796https://doi.org/10.1016/S0140-6736(07)61382-8
Global Initiative for Chronic Obstructive Lung Disease (GOLD), Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease –2022 report, 2022. Accessed 1 October 2022. https://goldcopd.org/2022-gold-reports-2/.
- Rehabilitation and acute exacerbations.Eur Respir J. 2011; 38: 702-712https://doi.org/10.1183/09031936.00079111
- Impact of COPD exacerbations on patient-centered outcomes.Chest. 2007; 131: 696-704https://doi.org/10.1378/chest.06-1610
- Recovery following acute exacerbations of chronic obstructive pulmonary disease - a review.COPD. 2019; 16: 93-103https://doi.org/10.1080/15412555.2019.1598965
- Physical activity and exercise capacity in patients with moderate COPD exacerbations.Eur Respir J. 2016; 48: 340-349https://doi.org/10.1183/13993003.01105-2015
- Physical activity and hospitalization for exacerbation of COPD.Chest. 2006; 129: 536-544https://doi.org/10.1378/chest.129.3.536
- Global muscle dysfunction as a risk factor of readmission to hospital due to COPD exacerbations.Respir Med. 2010; 104: 1896-1902https://doi.org/10.1016/j.rmed.2010.05.001
- Respiratory and skeletal muscle strength in chronic obstructive pulmonary disease: impact on exercise capacity and lower extremity function.J Cardiopulm Rehabil Prev. 2011; 31: 111-119https://doi.org/10.1097/HCR.0b013e3182033663
- Muscle strength as a predictor of loss of functional status in hospitalized patients.Nutrition. 2002; 18: 616-620https://doi.org/10.1016/s0899-9007(02)00756-6
- Reference values for lung function tests. II. Maximal respiratory pressures and voluntary ventilation.Braz J Med Biol Res. 1999; 32: 719-727https://doi.org/10.1590/s0100-879x1999000600007
- Reference equations for predicting of handgrip strength in brazilian middle-aged and elderly subjects.Fisioterapia e Pesquisa. 2009; 16 (217-2)https://doi.org/10.1590/S1809-29502009000300005
- Reliability of Quadriceps Femoris Muscle Strength Assessment Using a Portable Dynamometer and Protocol Tolerance in Patients With Chronic Obstructive Pulmonary Disease.Phys Ther. 2021; 101: 107https://doi.org/10.1093/ptj/pzab107
- technical standard: field walking tests in chronic respiratory disease.Eur Respir J. 2014; 44: 1428-1446https://doi.org/10.1183/09031936.00150314
- Reference equations for the six-minute walk distance based on a Brazilian multicenter study.Braz J Phys Ther. 2013; 17: 556-563https://doi.org/10.1590/S1413-35552012005000122
- Diretrizes para Testes de Função Pulmonar.J Bras Pneumol. 2002; 28 (Accessed 1 September 2022): 1-82
- Does hand grip strength decrease in chronic obstructive pulmonary disease exacerbation? A cross-sectional study.Turk J Med Sci. 2019; 49: 802-808https://doi.org/10.3906/sag-1811-22
- Cardiopulmonary endurance of hospitalized older adults with chronic obstructive pulmonary disease.Nurs Res. 2020; 69: E27-E36https://doi.org/10.1097/NNR.0000000000000429
- Deterioration of limb muscle function during acute exacerbation of chronic obstructive pulmonary disease.Am J Respir Crit Care Med. 2018; 197: 433-449https://doi.org/10.1164/rccm.201703-0615CI
- The 6-min walk distance: change over time and value as a predictor of survival in severe COPD.Eur Respir J. 2004; 23: 28-33https://doi.org/10.1183/09031936.03.00034603
- An official systematic review of the european respiratory society/american thoracic society: measurement properties of field walking tests in chronic respiratory disease.Eur Respir J. 2014; 44: 1447-1478https://doi.org/10.1183/09031936.00150414
- Characteristics of physical activities in daily life in chronic obstructive pulmonary disease.Am J Respir Crit Care Med. 2005; 171: 972-977https://doi.org/10.1164/rccm.200407-855OC
- Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) Study Investigators. Six-minute-walk test in chronic obstructive pulmonary disease: minimal clinically important difference for death or hospitalization.Am J Respir Crit Care Med. 2013; 187: 382-386https://doi.org/10.1164/rccm.201209-1596OC
- Initiating exercise training early during the hospitalisation for an exacerbation of chronic obstructive pulmonary disease improves exercise capacity and quadriceps strength: a randomised controlled trial.Respir Med. 2020; 2100024https://doi.org/10.1016/j.yrmex.2020.100024
- Two 6-minute walk tests are required during hospitalisation for acute exacerbation of COPD.COPD. 2016; 13: 288-292https://doi.org/10.3109/15412555.2015
Published online: November 23, 2022
Accepted: November 18, 2022
Received in revised form: November 6, 2022
Received: October 11, 2022
© 2022 Elsevier Inc. All rights reserved.