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Activity intolerance from COPD

Jonathan Raskin, Ted Marks, Albert Miller
Phenotyping and the characterization of chronic obstructive pulmonary disease (COPD) is currently an active area of interest. The perspectives gleaned from evaluating COPD in the context of exercise lend new insights into this endeavor. Pulmonary rehabilitation centers are uniquely positioned to generate such clinical observations and have enhanced an understanding of the disease processes that are involved in COPD. This review and commentary discusses the various patterns of exercise intolerance and characterizes COPD from the perspectives of clinicians caring for persons with COPD...
January 2018: Journal of Cardiopulmonary Rehabilitation and Prevention
Daniel T Cannon, Ana Claudia Coelho, Robert Cao, Andrew Cheng, Janos Porszasz, Richard Casaburi, Harry B Rossiter
Muscle fatigue (a reduced power for a given activation) is common following exercise in chronic obstructive pulmonary disease (COPD). Whether muscle fatigue, and reduced maximal voluntary locomotor power, are sufficient to limit whole body exercise in COPD is unknown. We hypothesized in COPD: 1) exercise is terminated with a locomotor muscle power reserve; 2) reduction in maximal locomotor power is related to ventilatory limitation; and 3) muscle fatigue at intolerance is less than age-matched controls. We used a rapid switch from hyperbolic to isokinetic cycling to measure the decline in peak isokinetic power at the limit of incremental exercise ("performance fatigue") in 13 COPD patients (FEV1 49 ± 17%pred) and 12 controls...
December 1, 2016: Journal of Applied Physiology
Alessandra Adami, Robert Cao, Janos Porszasz, Richard Casaburi, Harry B Rossiter
Low muscle oxidative capacity contributes to exercise intolerance in chronic obstructive pulmonary disease (COPD). Near-infrared spectroscopy (NIRS) allows non-invasive determination of the muscle oxygen consumption (mV̇O2 ) recovery rate constant (k), which is proportional to oxidative capacity assuming two conditions are met: 1) exercise intensity is sufficient to fully-activate mitochondrial oxidative enzymes; 2) sufficient O2 availability. We aimed to determine reproducibility (coefficient of variation, CV; intraclass correlation coefficient, ICC) of NIRS k assessment in the gastrocnemius of 64 participants with (FEV1 64±23%predicted) or without COPD (FEV1 98±14%predicted)...
January 2017: Respiratory Physiology & Neurobiology
Richard Casaburi, Karen Duvall
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease, but it often remains undetected in its mild and moderate forms. Patients frequently remain undiagnosed and untreated until the disease has become severe and debilitating, greatly impacting their quality of life. Primary care physicians (PCPs) are most often the first point of contact, and therefore they are in the best position to identify patients at risk of COPD in the early stages. Consequently, they play a critical role in the management of the disease, particularly smoking cessation...
July 2014: Postgraduate Medicine
Roberto Aquilani, Giuseppe D'Antona, Paola Baiardi, Arianna Gambino, Paolo Iadarola, Simona Viglio, Evasio Pasini, Manuela Verri, Annalisa Barbieri, Federica Boschi
Exercise intolerance remains problematic in subjects with chronic heart failure (CHF) and/or chronic obstructive pulmonary disease (COPD). Recent studies show that supplemented essential amino acids (EAAs) may exert beneficial effects on CHF/COPD physical capacity. The results from 3 investigations (2 conducted on CHF and 1 on COPD subjects) served as the basis for this paper. The 3 studies consistently showed that elderly CHF and COPD improved exercise intolerance after 1-3 months of EAA supplementation (8 g/d)...
2014: BioMed Research International
Ioannis Vogiatzis, Spyros Zakynthinos
The major limitation to exercise performance in patients with chronic lung diseases is an issue of great importance since identifying the factors that prevent these patients from carrying out activities of daily living provides an important perspective for the choice of the appropriate therapeutic strategy. The factors that limit exercise capacity may be different in patients with different disease entities (i.e., chronic obstructive, restrictive or pulmonary vascular lung disease) or disease severity and ultimately depend on the degree of malfunction or miss coordination between the different physiological systems (i...
July 2012: Comprehensive Physiology
Yuly G Belchikov, Seth J Koenig, Elissa M Dipasquale
Ticagrelor, a recently approved platelet antagonist indicated for the reduction of thrombotic cardiovascular events in patients with acute coronary syndrome (ACS), has been reported to cause dyspnea in more than 13% of patients. Dyspnea is not a clinically relevant adverse event with other medications indicated for ACS. One suggested mechanism of ticagrelor-induced dyspnea involves an increase in systemic adenosine concentrations through adenosine deaminase inhibition. Dyspnea, a subjective finding resulting from physiologic and sensory mechanisms, may be a consequence of increased systemic adenosine concentrations, leading to amplified and prolonged receptor activity...
August 2013: Pharmacotherapy
Philippe Gagnon, Jean S Bussières, Fernanda Ribeiro, Serge L Gagnon, Didier Saey, Nathalie Gagné, Steeve Provencher, François Maltais
RATIONALE: Lower limb muscle dysfunction contributes to exercise intolerance in chronic obstructive pulmonary disease (COPD). We hypothesized that signaling from lower limb muscle group III/IV sensory afferents to the central motor command could be involved in premature cycling exercise termination in COPD. OBJECTIVES: To evaluate the effects of spinal anesthesia, which presumably inhibited central feedback from the lower limb muscle group III/IV sensory afferents on exercise tolerance and cardiorespiratory response during constant work-rate cycling exercise in patients with COPD...
October 1, 2012: American Journal of Respiratory and Critical Care Medicine
Didier Saey, Bruno B Lemire, Philippe Gagnon, Eric Bombardier, A Russell Tupling, Richard Debigaré, Claude H Côté, François Maltais
Impaired resting metabolism in peripheral muscles potentially contributes to exercise intolerance in chronic obstructive pulmonary disease (COPD). This study investigated the cytosolic energy metabolism of the quadriceps, from glycogen degradation to lactate accumulation, in exercising patients with COPD, in comparison to healthy controls. We measured, in 12 patients with COPD and 10 control subjects, resting and post-cycling exercise quadriceps levels of 1) energy substrates and end products of glycolysis (glycogen, glucose, pyruvate, and lactate) and intermediate markers of glycolysis (glucose-6-phosphate, glucose-1-phosphate, fructose-6-phosphate) and 2) the activity of key enzymes involved in the regulation of glycolysis (phosphofructokinase, lactate dehydrogenase)...
January 2011: Journal of Applied Physiology
Philippe Gagnon, Didier Saey, Isabelle Vivodtzev, Louis Laviolette, Vincent Mainguy, Julie Milot, Steeve Provencher, François Maltais
Exercise intolerance in chronic obstructive pulmonary disease (COPD) results from a complex interaction between central (ventilatory) and peripheral (limb muscles) components of exercise limitation. The purpose of this study was to evaluate the influence of quadriceps muscle fatigue on exercise tolerance and ventilatory response during constant-workrate cycling exercise testing (CWT) in patients with COPD and healthy subjects. Fifteen patients with COPD and nine age-matched healthy subjects performed, 7 days apart, two CWTs up to exhaustion at 80% of their predetermined maximal work capacity...
September 2009: Journal of Applied Physiology
Bernard Aguilaniu, Agnès Plaindoux, Christophe Brosson, Michel Jeanmart, Jocelyne Maitre, Samia Diab
Today, dyspnea in chronic obstructive pulmonary disease (COPD) is attributed to thoracic distention secondary to bronchial obstruction and hyperventilation. It inevitably occurs during exercise, even in patients with little obstruction, when they are capable of the elevated and prolonged power output that necessitates substantial hyperventilation. Exercise intolerance is due mainly to dyspnea, but muscle fatigue is also involved, especially in COPD patients who are malnourished. Deterioration of muscle function follows a substantial reduction in daily physical activity...
March 2009: La Presse Médicale
Rob C I Wüst, Hans Degens
Many patients with chronic obstructive pulmonary disease (COPD) suffer from exercise intolerance. In about 40% of the patients exercise capacity is limited by alterations in skeletal muscle rather than pulmonary problems. Indeed, COPD is often associated with muscle wasting and a slow-to-fast shift in fiber type composition resulting in weakness and an earlier onset of muscle fatigue, respectively. Clearly, limiting muscle wasting during COPD benefits the patient by improving the quality of life and also the chance of survival...
2007: International Journal of Chronic Obstructive Pulmonary Disease
H R Gosker, M K C Hesselink, H Duimel, K A Ward, A M W J Schols
Skeletal muscle dysfunction is a well-recognised hallmark of chronic obstructive pulmonary disease (COPD) leading to exercise intolerance. The vastus lateralis of COPD patients is characterised by reduced mitochondrial enzyme activity; however, this is not the case in the tibialis anterior. It is, however, unclear whether the compromised oxidative capacity in the vastus is due to reduced mitochondrial volume density. Muscle biopsies were obtained from the vastus lateralis of six COPD patients and four healthy age-matched controls, and from the tibialis anterior of another six COPD patients and six controls...
July 2007: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
John P Mattson, James C Martin
Patients with COPD suffer from locomotory skeletal muscle contractile dysfunction. This may be due to the disease per se or as a result of some confounding factor. Therefore, the purpose of this investigation was to determine whether emphysema: (1) reduces force production; (2) increases fatigability; and (3) impairs the speed of recovery in locomotory skeletal muscle in an accepted animal model in which many confounding variables can be controlled. To explore this issue, in situ mechanical properties of gastrocnemius were measured in Syrian Golden hamsters 8 months after intratracheal instillation of either saline (control, n = 5) or elastase (emphysema, n = 7)...
July 2005: Experimental Physiology
Carolyn L Rochester
Exercise and activity limitation are characteristic features of chronic obstructive pulmonary disease (COPD). Exercise intolerance may result from ventilatory limitation, cardiovascular impairment, and/or skeletal muscle dysfunction. Exercise training, a core component of pulmonary rehabilitation, improves the exercise capacity (endurance and, to a lesser degree, maximal work capacity) of patients with COPD in spite of the irreversible abnormalities in lung function. Dyspnea and health-related quality of life also improve following pulmonary rehabilitation...
September 2003: Journal of Rehabilitation Research and Development
R Antonucci, E Berton, A Huertas, P Laveneziana, P Palange
Multiple mechanisms contribute to exercise limitation in chronic obstructive pulmonary disease (COPD). The ability to increase ventilation during exercise is reduced; the more advanced the disease, the more impaired the exercise tolerance is. However, factors other than ventilatory limitation play an important role in reducing the exercise capacity in COPD. Data implicating peripheral muscle atrophy and muscle weakness as cofactors have been reported in individuals with advanced disease. At this stage daily activities are curtailed to avoid exertional respiratory discomfort...
April 2003: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
Takashi Okamoto, Hiroshi Kanazawa, Kazuto Hirata, Junichi Yoshikawa
The biochemical features of skeletal muscle and its contribution to exercise intolerance in patients with chronic obstructive pulmonary disease (COPD) is under active investigation. Near-infrared spectroscopy (NIRS) can non-invasively provide information on the oxidative capacity of muscle. To clarify whether oxygenation of peripheral muscle is one determinant of exercise tolerance, we simultaneously examined the oxygen uptake (V O 2off) kinetics and oxygen kinetics of peripheral skeletal muscle evaluated by NIRS during recovery from exercise in COPD patients...
September 2003: Clinical Physiology and Functional Imaging
Nadège Gosselin, Stéphane Matecki, Magali Poulain, Michèle Ramonatxo, François Ceugniet, Christian Préfaut, Alain Varray
To determine whether skeletal muscle is involved in the exercise limitation of chronic obstructive pulmonary disease (COPD), we investigated electrical adaptations in muscle during incremental cycling exercise testing. Changes in quadriceps activity were compared using surface electromyography (SEMG) and motor point stimulation in ten COPD patients and ten healthy subjects. Patients showed significantly lower exercise capacity, and M-wave duration was increased from exercise onset (P < 0.05) with a parallel decrease in amplitude (P < 0...
February 2003: Muscle & Nerve
T Peter Stein, Charles E Wade
PURPOSE OF REVIEW: In response to decreased usage, skeletal muscle undergoes adaptive reductive remodeling due to the decrease in tension on the weight bearing components of the musculo-skeletal system. This response occurs with uncomplicated disuse (e.g. bed rest, space flight), as a secondary consequence of several widely prevalent chronic diseases for which activity is reduced (e.g. chronic obstructive pulmonary disease and chronic heart failure) and is part of the aging process. The problem is therefore one of considerable clinical importance...
January 2003: Current Opinion in Clinical Nutrition and Metabolic Care
S E Sherman, R B D'Agostino, H Silbershatz, W B Kannel
BACKGROUND: People who are physically active live longer, but it is unclear whether this is because of physical activity in the distant or more recent past. METHODS: We assessed activity levels in 5209 men and women in the Framingham Heart Study from 1956 to 1958 and again from 1969 to 1973. We included individuals who were alive and without cardiovascular disease in the period 1969 to 1973. The primary outcome was death from all causes during the 16 years after the 1969 to 1973 assessment...
November 1999: American Heart Journal
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