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Zhou X, Ye C, Iwao Y, Okamoto T, Kawata N, Shimada A, Haneishi H. Respiratory Diaphragm Motion-Based Asynchronization and Limitation Evaluation on Chronic Obstructive Pulmonary Disease. Diagnostics (Basel) 2023; 13:3261. [PMID: 37892082 PMCID: PMC10606604 DOI: 10.3390/diagnostics13203261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/10/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) typically causes airflow blockage and breathing difficulties, which may result in the abnormal morphology and motion of the lungs or diaphragm. Purpose: This study aims to quantitatively evaluate respiratory diaphragm motion using a thoracic sagittal magnetic resonance imaging (MRI) series, including motion asynchronization and limitations. Method: First, the diaphragm profile is extracted using a deep-learning-based field segmentation approach. Next, by measuring the motion waveforms of each position in the extracted diaphragm profile, obvious differences in the independent respiration cycles, such as the period and peak amplitude, are verified. Finally, focusing on multiple breathing cycles, the similarity and amplitude of the motion waveforms are evaluated using the normalized correlation coefficient (NCC) and absolute amplitude. Results and Contributions: Compared with normal subjects, patients with severe COPD tend to have lower NCC and absolute amplitude values, suggesting motion asynchronization and limitation of their diaphragms. Our proposed diaphragmatic motion evaluation method may assist in the diagnosis and therapeutic planning of COPD.
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Affiliation(s)
- Xingyu Zhou
- Graduate School of Science and Engineering, Chiba University, Chiba 263-8522, Japan; (X.Z.)
| | - Chen Ye
- School of Communications and Information Engineering, Nanjing University of Posts and Telecommunications, Nanjing 210003, China
- Center for Frontier Medical Engineering, Chiba University, Chiba 263-8522, Japan
| | - Yuma Iwao
- Center for Frontier Medical Engineering, Chiba University, Chiba 263-8522, Japan
- National Institutes for Quantum and Radiological Science and Technology, Chiba 263-0024, Japan
| | - Takayuki Okamoto
- Center for Frontier Medical Engineering, Chiba University, Chiba 263-8522, Japan
| | - Naoko Kawata
- Graduate School of Science and Engineering, Chiba University, Chiba 263-8522, Japan; (X.Z.)
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-0856, Japan;
| | - Ayako Shimada
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-0856, Japan;
- Department of Respirology, Shin-Yurigaoka General Hospital, Kawasaki 215-0026, Japan
| | - Hideaki Haneishi
- Center for Frontier Medical Engineering, Chiba University, Chiba 263-8522, Japan
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Illidi CR, Romer LM, Johnson MA, Williams NC, Rossiter HB, Casaburi R, Tiller NB. Distinguishing science from pseudoscience in commercial respiratory interventions: an evidence-based guide for health and exercise professionals. Eur J Appl Physiol 2023; 123:1599-1625. [PMID: 36917254 PMCID: PMC10013266 DOI: 10.1007/s00421-023-05166-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/19/2023] [Indexed: 03/16/2023]
Abstract
Respiratory function has become a global health priority. Not only is chronic respiratory disease a leading cause of worldwide morbidity and mortality, but the COVID-19 pandemic has heightened attention on respiratory health and the means of enhancing it. Subsequently, and inevitably, the respiratory system has become a target of the multi-trillion-dollar health and wellness industry. Numerous commercial, respiratory-related interventions are now coupled to therapeutic and/or ergogenic claims that vary in their plausibility: from the reasonable to the absurd. Moreover, legitimate and illegitimate claims are often conflated in a wellness space that lacks regulation. The abundance of interventions, the range of potential therapeutic targets in the respiratory system, and the wealth of research that varies in quality, all confound the ability for health and exercise professionals to make informed risk-to-benefit assessments with their patients and clients. This review focuses on numerous commercial interventions that purport to improve respiratory health, including nasal dilators, nasal breathing, and systematized breathing interventions (such as pursed-lips breathing), respiratory muscle training, canned oxygen, nutritional supplements, and inhaled L-menthol. For each intervention we describe the premise, examine the plausibility, and systematically contrast commercial claims against the published literature. The overarching aim is to assist health and exercise professionals to distinguish science from pseudoscience and make pragmatic and safe risk-to-benefit decisions.
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Affiliation(s)
- Camilla R Illidi
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada
| | - Lee M Romer
- Division of Sport, Health and Exercise Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
| | - Michael A Johnson
- Exercise and Health Research Group, Sport, Health and Performance Enhancement (SHAPE) Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, Nottinghamshire, UK
| | - Neil C Williams
- Exercise and Health Research Group, Sport, Health and Performance Enhancement (SHAPE) Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, Nottinghamshire, UK
| | - Harry B Rossiter
- Institute of Respiratory Medicine and Exercise Physiology, Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W. Carson Street, CDCRC Building, Torrance, CA, 90502, USA
| | - Richard Casaburi
- Institute of Respiratory Medicine and Exercise Physiology, Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W. Carson Street, CDCRC Building, Torrance, CA, 90502, USA
| | - Nicholas B Tiller
- Institute of Respiratory Medicine and Exercise Physiology, Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W. Carson Street, CDCRC Building, Torrance, CA, 90502, USA.
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Labeix P, Court Fortune I, Muti D, Berger M, Chomette-Ballereau S, Barthelemy JC, Féasson L, Costes F. The effect of a pressure ventilatory support on quadriceps endurance is maintained after exercise training in severe COPD patients. A longitudinal randomized, cross over study. Front Physiol 2022; 13:1055023. [DOI: 10.3389/fphys.2022.1055023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose: In severe chronic obstructive pulmonary disease (COPD) patients, the application of an inspiratory pressure support (IPS) during exercise increases exercise tolerance and the benefit of exercise training during pulmonary rehabilitation (PR). Moreover, it improves quadriceps endurance after a session of cycling exercise suggesting a reduced muscle fatigue. We looked for the persistence of this effect after PR and sought an association between the improved quadriceps endurance with IPS and the training load during PR.Patients and methods: We studied 20 patients with severe COPD (6 in stage 3and 14 in stage 4 of GOLD) before and after PR. As part of a PR program, patients completed 16 cycling sessions over 6 weeks with the addition of IPS during exercise. As a surrogate of muscular fatigue, quadriceps endurance was measured at 70% of maximal strength in a control condition, after a constant work rate exercise test (CWR) with IPS (TlimQ IPS) or with a sham ventilation (TlimQsham), in a random order. These tests were repeated similarly at the end of PR.Results: PR was associated with a significant increase in maximal power output, cycling endurance, quadriceps strength and endurance. Session training load (power output x duration of the session) increased by 142% during the course of the program. Before PR, CWR duration increases with IPS compared to sham ventilation (Δtime = +244s, p = 0.001). Compared to control condition, post-exercise TlimQ reduction was lower with IPS at isotime than at the end of CWR or than with sham ventilation (−9 ± 21%, −18 ± 16% and −23 ± 18%, respectively, p = 0.09, p < 0.0001 and p < 0.0001). After PR, the post-exercise decrease of TlimQ was reduced after IPS compared to sham (−9 ± 18% vs. −21 ± 17%, respectively, p = 0.004). No relationship was found between the prevention of quadriceps fatigue and the training load.Conclusion: In severe COPD patients, the beneficial effect of a ventilator support on quadriceps endurance persisted after PR with IPS. However, it was not related to the increase in training load, and could not predict the training response to non-invasive ventilation during exercise.
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Pichon R, Van Hove O, Ménard M, Hearing D, Crétual A. Impairment and characteristics of postural control sub-components in people with COPD: a scoping review. Disabil Rehabil 2022:1-16. [PMID: 36000464 DOI: 10.1080/09638288.2022.2107083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Purpose: Impairment of postural control is common in people with COPD. However, the precise characteristics of this alteration are not clearly known. The "Systems Framework for Postural Control" which define postural control sub-components, represents an interesting tool to explore this field. The main aim of this review was to identify which postural control sub-components are impaired in people with COPD and to summarise characteristics for each sub-component. A secondary aim was to precise the relation between postural control and activities of daily living (ADL).Materials and methods: A scoping review was conducted, according to the JBI methodology. Medline, Cochrane Library, Scielo, Google Scholar, OpenGrey, and HAL were searched from inception to May 2022. The search was performed in English and French.Results: Eighty-nine articles were included. There was evidence of a potential impairment for most of the postural control sub-components. Characteristics of every sub-component alteration were heterogeneous. Reduced postural control could be associated with difficulties in ADL.Conclusions: People with COPD may have impairment in a wide range of postural control sub-components. Further research is needed to clarify if a common pattern of modification exits for this alteration and to precise the link with ADL.Implications for rehabilitationImpairment of postural control is a common extra-respiratory manifestation in people with COPD and so clinicians must include it in their clinical reasoning.Numerous postural control sub-components could be altered in people with COPD, suggesting that postural control assessment must be holistic.This scoping review shows that characteristics of postural control impairment are varied and that there may be no common pattern at the COPD population level.The relationship between impaired postural control and activities of daily living remains unclear, but clinicians should be alert to potential negative interactions between these two areas.
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Affiliation(s)
- Romain Pichon
- Institut de Formation en Pédicurie-Podologie, Ergothérapie et Kinésithérapie (IFPEK), Rennes, France.,M2S Laboratory - EA 7470, University Rennes 2, Rennes, France
| | | | - Mathieu Ménard
- M2S Laboratory - EA 7470, University Rennes 2, Rennes, France.,Institut d'Ostéopathie de Rennes - Bretagne (IO-RB), Bruz, France
| | - Diane Hearing
- M2S Laboratory - EA 7470, University Rennes 2, Rennes, France
| | - Armel Crétual
- M2S Laboratory - EA 7470, University Rennes 2, Rennes, France
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Taivassalo T, Hepple RT. Integrating Mechanisms of Exacerbated Atrophy and Other Adverse Skeletal Muscle Impact in COPD. Front Physiol 2022; 13:861617. [PMID: 35721564 PMCID: PMC9203961 DOI: 10.3389/fphys.2022.861617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
The normal decline in skeletal muscle mass that occurs with aging is exacerbated in patients with chronic obstructive pulmonary disease (COPD) and contributes to poor health outcomes, including a greater risk of death. There has been controversy about the causes of this exacerbated muscle atrophy, with considerable debate about the degree to which it reflects the very sedentary nature of COPD patients vs. being precipitated by various aspects of the COPD pathophysiology and its most frequent proximate cause, long-term smoking. Consistent with the latter view, recent evidence suggests that exacerbated aging muscle loss with COPD is likely initiated by decades of smoking-induced stress on the neuromuscular junction that predisposes patients to premature failure of muscle reinnervation capacity, accompanied by various alterations in mitochondrial function. Superimposed upon this are various aspects of COPD pathophysiology, such as hypercapnia, hypoxia, and inflammation, that can also contribute to muscle atrophy. This review will summarize the available knowledge concerning the mechanisms contributing to exacerbated aging muscle affect in COPD, consider the potential role of comorbidities using the specific example of chronic kidney disease, and identify emerging molecular mechanisms of muscle impairment, including mitochondrial permeability transition as a mechanism of muscle atrophy, and chronic activation of the aryl hydrocarbon receptor in driving COPD muscle pathophysiology.
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Affiliation(s)
- Tanja Taivassalo
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL, United States
| | - Russell T. Hepple
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL, United States
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States
- *Correspondence: Russell T. Hepple,
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Identification of Macrophage Polarization-Related Genes as Biomarkers of Chronic Obstructive Pulmonary Disease Based on Bioinformatics Analyses. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9921012. [PMID: 34250093 PMCID: PMC8238569 DOI: 10.1155/2021/9921012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/04/2021] [Indexed: 12/15/2022]
Abstract
Objectives Chronic obstructive pulmonary disease (COPD) is characterized by lung inflammation and remodeling. Macrophage polarization is associated with inflammation and tissue remodeling, as well as immunity. Therefore, this study attempts to investigate the diagnostic value and regulatory mechanism of macrophage polarization-related genes for COPD by bioinformatics analysis and to provide a new theoretical basis for experimental research. Methods The raw gene expression profile dataset (GSE124180) was collected from the Gene Expression Omnibus (GEO) database. Next, a weighted gene coexpression network analysis (WGCNA) was conducted to screen macrophage polarization-related genes. The differentially expressed genes (DEGs) between the COPD and normal samples were generated using DESeq2 v3.11 and overlapped with the macrophage polarization-related genes. Moreover, functional annotations of overlapped genes were conducted by Database for Annotation, Visualization and Integrated Discovery (DAVID) Bioinformatics Resource. The immune-related genes were selected, and their correlation with the differential immune cells was analyzed by Pearson. Finally, receiver operating characteristic (ROC) curves were used to verify the diagnostic value of genes. Results A total of 4922 coexpressed genes related to macrophage polarization were overlapped with the 203 DEGs between the COPD and normal samples, obtaining 25 genes related to COPD and macrophage polarization. GEM, S100B, and GZMA of them participated in the immune response, which were considered the candidate biomarkers. GEM and S100B were significantly correlated with marker genes of B cells which had a significant difference between the COPD and normal samples. Moreover, GEM was highly associated with the genes in the PI3K/Akt/GSK3β signaling pathway, regulation of actin cytoskeleton, and calcium signaling pathway based on a Pearson correlation analysis of the candidate genes and the genes in the B cell receptor signaling pathway. PPI network analysis also indicated that GEM might participate in the regulation of the PI3K/Akt/GSK3β signaling pathway. The ROC curve showed that GEM possessed an excellent accuracy in distinguishing COPD from normal samples. Conclusions The data provide a transcriptome-based evidence that GEM is related to COPD and macrophage polarization likely contributes to COPD diagnosis. At the same time, it is hoped that in-depth functional mining can provide new ideas for exploring the COPD pathogenesis.
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Sarmento A, Fregonezi G, Lira M, Marques L, Pennati F, Resqueti V, Aliverti A. Changes in electromyographic activity, mechanical power, and relaxation rates following inspiratory ribcage muscle fatigue. Sci Rep 2021; 11:12475. [PMID: 34127754 PMCID: PMC8203654 DOI: 10.1038/s41598-021-92060-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/01/2021] [Indexed: 11/19/2022] Open
Abstract
Muscle fatigue is a complex phenomenon enclosing various mechanisms. Despite technological advances, these mechanisms are still not fully understood in vivo. Here, simultaneous measurements of pressure, volume, and ribcage inspiratory muscle activity were performed non-invasively during fatigue (inspiratory threshold valve set at 70% of maximal inspiratory pressure) and recovery to verify if inspiratory ribcage muscle fatigue (1) leads to slowing of contraction and relaxation properties of ribcage muscles and (2) alters median frequency and high-to-low frequency ratio (H/L). During the fatigue protocol, sternocleidomastoid showed the fastest decrease in median frequency and slowest decrease in H/L. Fatigue was also characterized by a reduction in the relative power of the high-frequency and increase of the low-frequency. During recovery, changes in mechanical power were due to changes in shortening velocity with long-lasting reduction in pressure generation, and slowing of relaxation [i.e., tau (τ), half-relaxation time (½RT), and maximum relaxation rate (MRR)] was observed with no significant changes in contractile properties. Recovery of median frequency was faster than H/L, and relaxation rates correlated with shortening velocity and mechanical power of inspiratory ribcage muscles; however, with different time courses. Time constant of the inspiratory ribcage muscles during fatigue and recovery is not uniform (i.e., different inspiratory muscles may have different underlying mechanisms of fatigue), and MRR, ½RT, and τ are not only useful predictors of inspiratory ribcage muscle recovery but may also share common underlying mechanisms with shortening velocity.
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Affiliation(s)
- Antonio Sarmento
- PneumoCardioVascular Laboratory - Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH) and Laboratório de Inovação Tecnológica Em Reabilitação, Departamento de Fisioterapia, Universidade Federal Do Rio Grande Do Norte, Natal, Brazil
| | - Guilherme Fregonezi
- PneumoCardioVascular Laboratory - Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH) and Laboratório de Inovação Tecnológica Em Reabilitação, Departamento de Fisioterapia, Universidade Federal Do Rio Grande Do Norte, Natal, Brazil.
| | - Maria Lira
- PneumoCardioVascular Laboratory - Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH) and Laboratório de Inovação Tecnológica Em Reabilitação, Departamento de Fisioterapia, Universidade Federal Do Rio Grande Do Norte, Natal, Brazil
| | - Layana Marques
- PneumoCardioVascular Laboratory - Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH) and Laboratório de Inovação Tecnológica Em Reabilitação, Departamento de Fisioterapia, Universidade Federal Do Rio Grande Do Norte, Natal, Brazil
| | - Francesca Pennati
- Dipartimento Di Elettronica, Informazione E Bioingegneria, Politecnico Di Milano, Milan, Italy
| | - Vanessa Resqueti
- PneumoCardioVascular Laboratory - Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares (EBSERH) and Laboratório de Inovação Tecnológica Em Reabilitação, Departamento de Fisioterapia, Universidade Federal Do Rio Grande Do Norte, Natal, Brazil
| | - Andrea Aliverti
- Dipartimento Di Elettronica, Informazione E Bioingegneria, Politecnico Di Milano, Milan, Italy
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Gouraud E, Connes P, Gauthier-Vasserot A, Faes C, Merazga S, Poutrel S, Renoux C, Boisson C, Joly P, Bertrand Y, Hot A, Cannas G, Hautier C. Is Skeletal Muscle Dysfunction a Limiting Factor of Exercise Functional Capacity in Patients with Sickle Cell Disease? J Clin Med 2021; 10:jcm10112250. [PMID: 34067352 PMCID: PMC8196873 DOI: 10.3390/jcm10112250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 02/02/2023] Open
Abstract
Patients with sickle cell disease (SCD) have reduced functional capacity due to anemia and cardio-respiratory abnormalities. Recent studies also suggest the presence of muscle dysfunction. However, the interaction between exercise capacity and muscle function is currently unknown in SCD. The aim of this study was to explore how muscle dysfunction may explain the reduced functional capacity. Nineteen African healthy subjects (AA), and 24 sickle cell anemia (SS) and 18 sickle cell hemoglobin C (SC) patients were recruited. Maximal isometric torque (Tmax) was measured before and after a self-paced 6-min walk test (6-MWT). Electromyographic activity of the Vastus Lateralis was recorded. The 6-MWT distance was reduced in SS (p < 0.05) and SC (p < 0.01) patients compared to AA subjects. However, Tmax and root mean square value were not modified by the 6-MWT, showing no skeletal muscle fatigue in all groups. In a multiple linear regression model, genotype, step frequency and hematocrit were independent predictors of the 6-MWT distance in SCD patients. Our results suggest that the 6-MWT performance might be primarily explained by anemia and the self-paced step frequency in SCD patients attempting to limit metabolic cost and fatigue, which could explain the absence of muscle fatigue.
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Affiliation(s)
- Etienne Gouraud
- Inter-University Laboratory of Human Movement Sciences (LIBM) EA7424, Team “Vascular Biology and Red Blood Cell”, University Claude Bernard Lyon 1, 69100 Villeurbanne, France; (P.C.); (A.G.-V.); (C.F.); (C.R.); (C.B.); (P.J.); (G.C.); (C.H.)
- Laboratory of Excellence “GR-Ex”, 75015 Paris, France
- Correspondence:
| | - Philippe Connes
- Inter-University Laboratory of Human Movement Sciences (LIBM) EA7424, Team “Vascular Biology and Red Blood Cell”, University Claude Bernard Lyon 1, 69100 Villeurbanne, France; (P.C.); (A.G.-V.); (C.F.); (C.R.); (C.B.); (P.J.); (G.C.); (C.H.)
- Laboratory of Excellence “GR-Ex”, 75015 Paris, France
- Institute of Universities of France, CEDEX 05, 75231 Paris, France
| | - Alexandra Gauthier-Vasserot
- Inter-University Laboratory of Human Movement Sciences (LIBM) EA7424, Team “Vascular Biology and Red Blood Cell”, University Claude Bernard Lyon 1, 69100 Villeurbanne, France; (P.C.); (A.G.-V.); (C.F.); (C.R.); (C.B.); (P.J.); (G.C.); (C.H.)
- Laboratory of Excellence “GR-Ex”, 75015 Paris, France
- Hematology and Oncology Pediatric Unit, University Hospital of Lyon, 69008 Lyon, France;
- Reference Centre in Sickle Cell Disease, Thalassemia and Rare Red Blood Cell and Erythropoiesis Diseases, Hospices Civils de Lyon, 69003 Lyon, France; (S.M.); (S.P.); (A.H.)
| | - Camille Faes
- Inter-University Laboratory of Human Movement Sciences (LIBM) EA7424, Team “Vascular Biology and Red Blood Cell”, University Claude Bernard Lyon 1, 69100 Villeurbanne, France; (P.C.); (A.G.-V.); (C.F.); (C.R.); (C.B.); (P.J.); (G.C.); (C.H.)
- Laboratory of Excellence “GR-Ex”, 75015 Paris, France
| | - Salima Merazga
- Reference Centre in Sickle Cell Disease, Thalassemia and Rare Red Blood Cell and Erythropoiesis Diseases, Hospices Civils de Lyon, 69003 Lyon, France; (S.M.); (S.P.); (A.H.)
| | - Solène Poutrel
- Reference Centre in Sickle Cell Disease, Thalassemia and Rare Red Blood Cell and Erythropoiesis Diseases, Hospices Civils de Lyon, 69003 Lyon, France; (S.M.); (S.P.); (A.H.)
- Internal Medicine Department, Edouard-Herriot Hospital, 69003 Lyon, France
| | - Céline Renoux
- Inter-University Laboratory of Human Movement Sciences (LIBM) EA7424, Team “Vascular Biology and Red Blood Cell”, University Claude Bernard Lyon 1, 69100 Villeurbanne, France; (P.C.); (A.G.-V.); (C.F.); (C.R.); (C.B.); (P.J.); (G.C.); (C.H.)
- Laboratory of Excellence “GR-Ex”, 75015 Paris, France
- Laboratory of Biochemistry of Erythrocyte Pathologies, Biology Centre East, 69500 Bron, France
| | - Camille Boisson
- Inter-University Laboratory of Human Movement Sciences (LIBM) EA7424, Team “Vascular Biology and Red Blood Cell”, University Claude Bernard Lyon 1, 69100 Villeurbanne, France; (P.C.); (A.G.-V.); (C.F.); (C.R.); (C.B.); (P.J.); (G.C.); (C.H.)
- Laboratory of Excellence “GR-Ex”, 75015 Paris, France
| | - Philippe Joly
- Inter-University Laboratory of Human Movement Sciences (LIBM) EA7424, Team “Vascular Biology and Red Blood Cell”, University Claude Bernard Lyon 1, 69100 Villeurbanne, France; (P.C.); (A.G.-V.); (C.F.); (C.R.); (C.B.); (P.J.); (G.C.); (C.H.)
- Laboratory of Excellence “GR-Ex”, 75015 Paris, France
- Laboratory of Biochemistry of Erythrocyte Pathologies, Biology Centre East, 69500 Bron, France
| | - Yves Bertrand
- Hematology and Oncology Pediatric Unit, University Hospital of Lyon, 69008 Lyon, France;
- Reference Centre in Sickle Cell Disease, Thalassemia and Rare Red Blood Cell and Erythropoiesis Diseases, Hospices Civils de Lyon, 69003 Lyon, France; (S.M.); (S.P.); (A.H.)
| | - Arnaud Hot
- Reference Centre in Sickle Cell Disease, Thalassemia and Rare Red Blood Cell and Erythropoiesis Diseases, Hospices Civils de Lyon, 69003 Lyon, France; (S.M.); (S.P.); (A.H.)
- Internal Medicine Department, Edouard-Herriot Hospital, 69003 Lyon, France
| | - Giovanna Cannas
- Inter-University Laboratory of Human Movement Sciences (LIBM) EA7424, Team “Vascular Biology and Red Blood Cell”, University Claude Bernard Lyon 1, 69100 Villeurbanne, France; (P.C.); (A.G.-V.); (C.F.); (C.R.); (C.B.); (P.J.); (G.C.); (C.H.)
- Laboratory of Excellence “GR-Ex”, 75015 Paris, France
- Reference Centre in Sickle Cell Disease, Thalassemia and Rare Red Blood Cell and Erythropoiesis Diseases, Hospices Civils de Lyon, 69003 Lyon, France; (S.M.); (S.P.); (A.H.)
- Internal Medicine Department, Edouard-Herriot Hospital, 69003 Lyon, France
| | - Christophe Hautier
- Inter-University Laboratory of Human Movement Sciences (LIBM) EA7424, Team “Vascular Biology and Red Blood Cell”, University Claude Bernard Lyon 1, 69100 Villeurbanne, France; (P.C.); (A.G.-V.); (C.F.); (C.R.); (C.B.); (P.J.); (G.C.); (C.H.)
- Laboratory of Excellence “GR-Ex”, 75015 Paris, France
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Allado E, Poussel M, Hily O, Chenuel B. The interest of rehabilitation of respiratory disorders in athletes: Myth or reality? Ann Phys Rehabil Med 2020; 65:101461. [PMID: 33271343 DOI: 10.1016/j.rehab.2020.101461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 10/19/2022]
Abstract
BACKGROUND Healthy trained athletes generally have an "overbuilt" respiratory system in order to face the huge ventilation and gas-exchange demand imposed by strenuous exercise. Athletes frequently complain of respiratory symptoms regardless of whether they have a diagnosed respiratory disease, therefore evoking a kind of respiratory limitation during exercise. Some respiratory pathologies athletes present are closely linked to exercise and include asthma, exercise-induced bronchoconstriction (EIB) or exercise-induced laryngeal obstruction. Management of asthma and EIB are mainly based on pharmacological treatments. However, many athletes still complain of respiratory symptoms despite optimal pharmacological treatments, which highlights the need for non-pharmacological approaches including breathing retraining, inspiratory muscle training and/or laryngeal exercise performed under the guidance of a physiotherapist in this specific population. OBJECTIVES With this literature overview, we aimed to report evidence supporting the interest of rehabilitation for athletes with respiratory disorders and discuss whether inspiratory muscle training programs can improve performance in healthy athletes. METHODS We searched MEDLINE and Cochrane databases for trials, reviews and meta-analyses assessing respiratory rehabilitation and muscle training programs in athletes by using the MesH terms "athletes", "asthma", "dyspnea", "rehabilitation" and "education" published from January 2010 to March 2020. The selection of articles was based on the author's expertise to elaborate this review of the literature. RESULTS Major findings suggest that breathing retraining may help asthmatic athletes better control their respiratory symptoms and that inspiratory muscle training may improve respiratory symptoms of exercise-induced laryngeal obstruction in athletes. Improvement of performance by respiratory muscle training still remains controversial. CONCLUSIONS Respiratory rehabilitation could be of interest in the specific population of athletes but should be further evaluated to improve the level of evidence of such strategies.
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Affiliation(s)
- Edem Allado
- CHRU-Nancy, University Centre of Sports Medicine and Adapted Physical Activity, F-54000 Nancy, France; Université de Lorraine, DevAH, Department of Physiology, F-54000 Nancy, France
| | - Mathias Poussel
- CHRU-Nancy, University Centre of Sports Medicine and Adapted Physical Activity, F-54000 Nancy, France; Université de Lorraine, DevAH, Department of Physiology, F-54000 Nancy, France.
| | - Oriane Hily
- CHRU-Nancy, University Centre of Sports Medicine and Adapted Physical Activity, F-54000 Nancy, France; Université de Lorraine, DevAH, Department of Physiology, F-54000 Nancy, France
| | - Bruno Chenuel
- CHRU-Nancy, University Centre of Sports Medicine and Adapted Physical Activity, F-54000 Nancy, France; Université de Lorraine, DevAH, Department of Physiology, F-54000 Nancy, France
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10
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Marillier M, Bernard AC, Verges S, Neder JA. The role of peripheral muscle fatigability on exercise intolerance in COPD. Expert Rev Respir Med 2020; 15:117-129. [PMID: 33148059 DOI: 10.1080/17476348.2021.1836964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Exercise limitation in chronic obstructive pulmonary disease (COPD) is multi-factorial; however, growing evidence indicates that muscle dysfunction may contribute in some patients. AREAS COVERED This work outlines current evidence for and against increased peripheral muscle fatigability in COPD through a comprehensive review of relevant literature available on PubMed/MEDLINE until May 2020. The authors first discuss key methodological issues relative to muscle fatigue assessment by non-volitional techniques, particularly magnetic stimulation. The authors then provide a detailed discussion of critical studies to have objectively measured skeletal muscle fatigue in individuals with COPD. EXPERT OPINION Current evidence indicates that localized (knee extension) and cycling exercise are associated with increased quadriceps fatigability in most COPD patients. Increased fatigability, however, has not been consistently found in response to walking, likely reflecting the tendency of 'central' respiratory constraints to overshadow potential functional impairments in the appendicular muscles in this form of exercise. Thus, addressing skeletal muscle abnormalities may be critical to translate improvements in lung mechanics (e.g., due to bronchodilator therapy) into better exercise tolerance. The positive effects of pulmonary rehabilitation on muscle fatigability are particularly encouraging and suggest a role for these measurements to test the efficacy of emerging adjunct training strategies focused on the peripheral muscles.
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Affiliation(s)
- Mathieu Marillier
- Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital , Kingston, ON, Canada.,HP2 Laboratory, INSERM U1042, Grenoble Alpes University , Grenoble, France
| | - Anne-Catherine Bernard
- Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital , Kingston, ON, Canada.,HP2 Laboratory, INSERM U1042, Grenoble Alpes University , Grenoble, France
| | - Samuel Verges
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University , Grenoble, France
| | - J Alberto Neder
- Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital , Kingston, ON, Canada
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11
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Skopas V, Papadopoulos D, Trakas N, Papaefstathiou E, Koufopoulos C, Makris D, Daniil Z, Gourgoulianis K. Lactate dehydrogenase isoenzymes in patients with acute exacerbation of chronic obstructive pulmonary disease: An exploratory cross-sectional study. Respir Physiol Neurobiol 2020; 283:103562. [PMID: 33038523 DOI: 10.1016/j.resp.2020.103562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/18/2020] [Accepted: 10/02/2020] [Indexed: 10/23/2022]
Abstract
We aimed to evaluate differences in serum lactate dehydrogenase (LDH) isoenzymes between patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and other lower respiratory tract infections (LRTIs). Based on self-reported COPD diagnosis, 71 participants were divided into AECOPD (n = 38, 29 males, mean age 70.5 years) and LRTI (n = 33, 12 males, mean age 70.4 years) groups. Information on demographics, comorbidities, and COPD severity markers, as well as arterial blood gases and laboratory data were collected, while serum LDH electrophoresis was performed to examine the LDH isoenzymes. Adjusting for sex, age, comorbidities, degree of hypoxemia, inflammation markers, muscle and myocardial enzymes, and total serum LDH, the mean differences (95 % confidence intervals) in the ratios of serum LDH isoenzymes to total serum LDH between groups (LDHxAECOPD - LDHxLRTI) were statistically significant for LDH1 [4.9 (1.4 to 8.3)], LDH2 [3.0 (0.1 to 5.8)], LDH3 [-4.3 (-6.3 to -2.3)], and LDH4 [-3.2 (-4.9 to -1.5)]. A sum of LDH3 and LDH4 ratios below 29 % had the highest discriminative ability to classify a subject in the AECOPD group (AUC 0.841, sensitivity 76 %, specificity 87 %). Aerobic metabolic adaptive mechanisms in respiratory muscles during AECOPD could explain the above differences.
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Affiliation(s)
- Vlasios Skopas
- 2nd Pulmonary Department, "Sismanogleion" General Hospital of Attica, Marousi, Greece; Respiratory Medicine Department, School of Medicine, University of Thessaly, University Hospital of Larissa, Larissa, Greece.
| | | | - Nikolaos Trakas
- Clinical Chemistry Department, "Sismanogleion" General Hospital of Attica, Marousi, Greece
| | - Eleni Papaefstathiou
- Clinical Chemistry Department, "Sismanogleion" General Hospital of Attica, Marousi, Greece
| | | | - Demosthenes Makris
- Critical Care Department, School of Medicine, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Zoe Daniil
- Respiratory Medicine Department, School of Medicine, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Konstantinos Gourgoulianis
- Respiratory Medicine Department, School of Medicine, University of Thessaly, University Hospital of Larissa, Larissa, Greece
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12
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Taya M, Amiya E, Hatano M, Saito A, Nitta D, Maki H, Hosoya Y, Minatsuki S, Tsuji M, Sato T, Murakami H, Narita K, Konishi Y, Watanabe S, Yokota K, Haga N, Komuro I. Clinical importance of respiratory muscle fatigue in patients with cardiovascular disease. Medicine (Baltimore) 2020; 99:e21794. [PMID: 32846812 PMCID: PMC7447364 DOI: 10.1097/md.0000000000021794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Patients with cardiovascular diseases frequently experience exertional dyspnea. However, the relationship between respiratory muscle strength including its fatigue and cardiovascular dysfunctions remains to be clarified.The maximal inspiratory pressure/maximal expiratory pressure (MIP/MEP) before and after cardiopulmonary exercise testing (CPX) in 44 patients with heart failure and ischemic heart disease were measured. Respiratory muscle fatigue was evaluated by calculating MIP (MIPpost/MIPpre) and MEP (MEPpost/MEPpre) changes.The mean MIPpre and MEPpre values were 67.5 ± 29.0 and 61.6 ± 23.8 cm H2O, respectively. After CPX, MIP decreased in 25 patients, and MEP decreased in 22 patients. We evaluated the correlation relationship between respiratory muscle function including respiratory muscle fatigue and exercise capacity evaluated by CPX such as peak VO2 and VE/VCO2 slope. Among MIP, MEP, change in MIP, and change in MEP, only the value of change in MIP had an association with the value of VE/VCO2 slope (R = -0.36, P = .017). In addition, multivariate analysis for determining factor of change in MIP revealed that the association between the change in MIP and eGFR was independent from other confounding parameters (beta, 0.40, P = .017). The patients were divided into 2 groups, with (MIP change < 0.9) and without respiratory muscle fatigue (MIP change > 0.9), and a significant difference in peak VO2 (14.2 ± 3.4 [with fatigue] vs 17.4 ± 4.7 [without fatigue] mL/kg/min; P = .020) was observed between the groups.Respiratory muscle fatigue demonstrated by the change of MIP before and after CPX significantly correlated with exercise capacity and renal function in patients with cardiovascular disease.
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Affiliation(s)
- Masanobu Taya
- Department of Cardiovascular Medicine, Graduate School of Medicine, the University of Tokyo
- Department of Rehabilitation Medicine, the University of Tokyo Hospital
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, Graduate School of Medicine, the University of Tokyo
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo, Tokyo
| | - Masaru Hatano
- Department of Cardiovascular Medicine, Graduate School of Medicine, the University of Tokyo
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo, Tokyo
| | - Akihito Saito
- Department of Cardiovascular Medicine, Graduate School of Medicine, the University of Tokyo
| | - Daisuke Nitta
- Department of Cardiovascular Medicine, Graduate School of Medicine, the University of Tokyo
| | - Hisataka Maki
- Department of Cardiovascular Medicine, Graduate School of Medicine, the University of Tokyo
| | - Yumiko Hosoya
- Department of Cardiovascular Medicine, Graduate School of Medicine, the University of Tokyo
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo, Tokyo
| | - Shun Minatsuki
- Department of Cardiovascular Medicine, Graduate School of Medicine, the University of Tokyo
| | - Masaki Tsuji
- Department of Cardiovascular Medicine, Graduate School of Medicine, the University of Tokyo
| | - Tatsuyuki Sato
- Department of Cardiovascular Medicine, Graduate School of Medicine, the University of Tokyo
| | - Haruka Murakami
- Department of Cardiovascular Medicine, Graduate School of Medicine, the University of Tokyo
| | - Koichi Narita
- Department of Cardiovascular Medicine, Graduate School of Medicine, the University of Tokyo
| | - Yuto Konishi
- Department of Cardiovascular Medicine, Graduate School of Medicine, the University of Tokyo
- Department of Rehabilitation Medicine, the University of Tokyo Hospital
| | - Shogo Watanabe
- Department of Medical Technology, Graduate School of Health Sciences, Okayama University, Okayama Prefecture, Japan
| | - Kazuhiko Yokota
- Department of Rehabilitation Medicine, the University of Tokyo Hospital
| | - Nobuhiko Haga
- Department of Rehabilitation Medicine, the University of Tokyo Hospital
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, the University of Tokyo
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13
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Gruet M. Fatigue in Chronic Respiratory Diseases: Theoretical Framework and Implications For Real-Life Performance and Rehabilitation. Front Physiol 2018; 9:1285. [PMID: 30283347 PMCID: PMC6156387 DOI: 10.3389/fphys.2018.01285] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 08/27/2018] [Indexed: 12/13/2022] Open
Abstract
Fatigue is a primary disabling symptom in chronic respiratory diseases (CRD) with major clinical implications. However, fatigue is not yet sufficiently explored and is still poorly understood in CRD, making this symptom underdiagnosed and undertreated in these populations. Fatigue is a dynamic phenomenon, particularly in such evolving diseases punctuated by acute events which can, alone or in combination, modulate the degree of fatigue experienced by the patients. This review supports a comprehensive inter-disciplinary approach of CRD-related fatigue and emphasizes the need to consider both its performance and perceived components. Most studies in CRD evaluated perceived fatigue as a trait characteristic using multidimensional scales, providing precious information about its prevalence and clinical impact. However, these scales are not adapted to understand the complex dynamics of fatigue in real-life settings and should be augmented with ecological assessment of fatigue. The state level of fatigue must also be considered during physical tasks as severe fatigue can emerge rapidly during exercise. CRD patients exhibit alterations in both peripheral and central nervous systems and these abnormalities can be exacerbated during exercise. Laboratory tests are necessary to provide mechanistic insights into how and why fatigue develops during exercise in CRD. A better knowledge of the neurophysiological mechanisms underlying perceived and performance fatigability and their influence on real-life performance will enable the development of new individualized countermeasures. This review aims first to shed light on the terminology of fatigue and then critically considers the contemporary models of fatigue and their relevance in the particular context of CRD. This article then briefly reports the prevalence and clinical consequences of fatigue in CRD and discusses the strengths and weaknesses of various fatigue scales. This review also provides several arguments to select the ideal test of performance fatigability in CRD and to translate the mechanistic laboratory findings into the clinical practice and real-world performance. Finally, this article discusses the dose-response relationship to training and the feasibility and validity of using the fatigue produced during exercise training sessions in CRD to optimize exercise training efficiency. Methodological concerns, examples of applications in selected diseases and avenues for future research are also provided.
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14
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Sheel AW, Boushel R, Dempsey JA. Competition for blood flow distribution between respiratory and locomotor muscles: implications for muscle fatigue. J Appl Physiol (1985) 2018; 125:820-831. [PMID: 29878876 DOI: 10.1152/japplphysiol.00189.2018] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Sympathetically induced vasoconstrictor modulation of local vasodilation occurs in contracting skeletal muscle during exercise to ensure appropriate perfusion of a large active muscle mass and to maintain also arterial blood pressure. In this synthesis, we discuss the contribution of group III-IV muscle afferents to the sympathetic modulation of blood flow distribution to locomotor and respiratory muscles during exercise. This is followed by an examination of the conditions under which diaphragm and locomotor muscle fatigue occur. Emphasis is given to those studies in humans and animal models that experimentally changed respiratory muscle work to evaluate blood flow redistribution and its effects on locomotor muscle fatigue, and conversely, those that evaluated the influence of coincident limb muscle contraction on respiratory muscle blood flow and fatigue. We propose the concept of a "two-way street of sympathetic vasoconstrictor activity" emanating from both limb and respiratory muscle metaboreceptors during exercise, which constrains blood flow and O2 transport thereby promoting fatigue of both sets of muscles. We end with considerations of a hierarchy of blood flow distribution during exercise between respiratory versus locomotor musculatures and the clinical implications of muscle afferent feedback influences on muscle perfusion, fatigue, and exercise tolerance.
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Affiliation(s)
- A William Sheel
- School of Kinesiology, University of British Columbia , Vancouver, British Columbia , Canada
| | - Robert Boushel
- School of Kinesiology, University of British Columbia , Vancouver, British Columbia , Canada
| | - Jerome A Dempsey
- Department of Population Health Sciences, John Rankin Laboratory of Pulmonary Medicine, School of Medicine and Public Health, University of Wisconsin , Madison, Wisconsin
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15
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Barreiro E, Jaitovich A. Muscle atrophy in chronic obstructive pulmonary disease: molecular basis and potential therapeutic targets. J Thorac Dis 2018; 10:S1415-S1424. [PMID: 29928523 DOI: 10.21037/jtd.2018.04.168] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) experience several systemic manifestations such skeletal muscle dysfunction with and without muscle mass loss. Moreover, frequent comorbidities such as nutritional abnormalities, heart failure, and pulmonary hypertension, which are frequently associated with COPD may further contribute to skeletal muscle mass loss and dysfunction. Muscle dysfunction impairs the patients' exercise capacity and quality of life as daily life activities may be hampered by this problem. Importantly, impaired muscle function and mass loss have been shown to impact negatively on the patients' prognosis and survival in several studies. Thus, this is a major clinical problem that deserves special attention in clinical settings. During the course of exacerbations muscle mass loss takes place, hence aggravating muscle status and performance even after hospital discharge, especially in the frequently exacerbator patients. Several factors and biological mechanisms are involved in the etiology of COPD muscle dysfunction. The biological mechanisms identified so far offer a niche for therapeutic interventions in the patients. In the current review, a general overview of the most relevant etiologic factors and their target biological mechanisms through which muscle mass loss and dysfunction take place in both the respiratory and lower limb muscles in COPD patients is provided. We conclude that more clinical research is still needed targeted to test several therapeutic interventions. Given its prognostic value, the assessment of skeletal muscle dysfunction should be included in the routine evaluation of patients with chronic respiratory disorders and in critical care settings.
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Affiliation(s)
- Esther Barreiro
- Respiratory Medicine Department-Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Institute of Medical Research of Hospital del Mar (IMIM)-Hospital del Mar, Parc de Salut Mar, Barcelona Biomedical Research Park (PRBB), Barcelona, Spain.,Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Ariel Jaitovich
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA.,Department of Molecular and Cellular Physiology, Albany Medical College, Albany, NY, USA
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16
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Bordoni B, Marelli F, Morabito B, Castagna R. Chest pain in patients with COPD: the fascia's subtle silence. Int J Chron Obstruct Pulmon Dis 2018; 13:1157-1165. [PMID: 29695899 PMCID: PMC5903840 DOI: 10.2147/copd.s156729] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
COPD is a progressive condition that leads to a pathological degeneration of the respiratory system. It represents one of the most important causes of mortality and morbidity in the world, and it is characterized by the presence of many associated comorbidities. Recent studies emphasize the thoracic area as one of the areas of the body concerned by the presence of pain with percentages between 22% and 54% in patients with COPD. This article analyzes the possible causes of mediastinal pain, including those less frequently taken into consideration, which concern the role of the fascial system of the mediastinum. The latter can be a source of pain especially when a chronic pathology is altering the structure of the connective tissue. We conclude that to consider the fascia in daily clinical activity may improve the therapeutic approach toward the patient.
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Affiliation(s)
- Bruno Bordoni
- Foundation Don Carlo Gnocchi IRCCS, Department of Cardiology, Institute of Hospitalization and Care with Scientific Address, Milan, Italy
| | - Fabiola Marelli
- CRESO, School of Osteopathic Centre for Research and Studies, Gorla Minore, Italy
- CRESO, School of Osteopathic Centre for Research and Studies, Fano, Italy
| | - Bruno Morabito
- CRESO, School of Osteopathic Centre for Research and Studies, Gorla Minore, Italy
- CRESO, School of Osteopathic Centre for Research and Studies, Fano, Italy
- Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Roberto Castagna
- CRESO, School of Osteopathic Centre for Research and Studies, Gorla Minore, Italy
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17
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Charususin N, Dacha S, Gosselink R, Decramer M, Von Leupoldt A, Reijnders T, Louvaris Z, Langer D. Respiratory muscle function and exercise limitation in patients with chronic obstructive pulmonary disease: a review. Expert Rev Respir Med 2017; 12:67-79. [DOI: 10.1080/17476348.2018.1398084] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Noppawan Charususin
- Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Physical Therapy, Thammasat University, Pathumthani, Thailand
| | - Sauwaluk Dacha
- Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Rik Gosselink
- Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Marc Decramer
- Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
| | - Andreas Von Leupoldt
- Department of Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Thomas Reijnders
- Department of Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Zafeiris Louvaris
- Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, “M. Simou, and G.P. Livanos Laboratories”, National and Kapodistrian University of Athens, Athens, Greece
| | - Daniel Langer
- Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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18
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Ju S, Lee SJ, Park MJ, Cho YJ, Jeong YY, Jeon KN, Bae K, Lee JD, Kim HC. Clinical importance of cross-sectional area of intercostal muscles in patients with chronic obstructive pulmonary disease. CLINICAL RESPIRATORY JOURNAL 2017; 12:939-947. [PMID: 28054460 DOI: 10.1111/crj.12609] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 11/26/2016] [Accepted: 12/21/2016] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Limb muscle wasting is one of main systemic manifestation of chronic obstructive pulmonary disease (COPD). However, the change of respiratory muscle is unclear. OBJECTIVES This study assessed the cross-sectional area (CSA) of the intercostal muscles (ICMs) in patients with COPD, using chest computed tomography (CT) and determined its association with the clinical characteristics of COPD. METHODS They retrospectively reviewed 60 patients with stable COPD and compared them with 30 controls. CSA (mm2 ) of the ICM on chest CT was measured at the midline level of the lateral arch of the bilateral first rib with a 3-mm slice thickness by using CT histogram software. The association with the clinical characteristics of COPD and with the control groups was assessed. RESULTS CSA of the ICM and the CSA/body mass index (BMI) were lower in the COPD group than in the control group. Patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 4 had a significantly lower CSA of the ICM than patients with stage 1, 2, and 3. CSA of the ICM was positively associated with FEV1 , %FEV1 predicted, FEV1 /FVC ratio, and BMI and negatively associated with age. However, there were no associations with PaO2 , PaCO2 , smoking status, 6-minute walk test, frequency of acute exacerbation of COPD, and serum C-reactive protein level. CONCLUSION Intercostal muscle atrophy occurs in COPD patients and is associated with severity of airway obstruction, BMI, and increasing age.
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Affiliation(s)
- Sunmi Ju
- Division Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Seung Jun Lee
- Division Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Mi Jung Park
- Department of Diagnostic Radiology, College of Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Yu Ji Cho
- Division Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Yi Yeong Jeong
- Division Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Kyung Nyeo Jeon
- Department of Diagnostic Radiology, College of Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Kyungsoo Bae
- Department of Diagnostic Radiology, College of Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jong Deog Lee
- Division Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ho Cheol Kim
- Division Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
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19
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Pietro KM, Ricardo G, Rui GPND, Marcelo BG, Fernando FG, Bruno H, Samuel V, Danilo CB. Relationship of pectoralis muscle area and skeletal muscle strength with exercise tolerance and dyspnea in interstitial lung disease. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2017; 34:200-208. [PMID: 32476847 PMCID: PMC7170103 DOI: 10.36141/svdld.v34i3.5384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 03/20/2017] [Indexed: 11/16/2022]
Abstract
Background: Pectoralis muscle area (PMA) is an easily derived computed tomography-based assessment that can provide insight into clinical features of other skeletal muscles. Respiratory and locomotor muscle dysfunction has been increasingly recognized in patients with interstitial lung disease (ILD). Its contribution to exercise performance has been controversial. Objective: We aimed to investigate if PMA is related with respiratory and locomotor skeletal muscle strength in ILD patients, and if skeletal muscle function is compromised and independently related with exercise capacity and dyspnea. Methods: Cross-sectional study where subjects performed incremental cycling cardiopulmonary exercise testing with maximal inspiratory (MIP) and expiratory (MEP) pressure measurements, and quadriceps maximal voluntary contraction (MVC) before and after exercise. Results: Thirty ILD patients (forced vital capacity [FVC] and lung diffusing capacity [DLCO] of 60±15% and 38±10% of predicted, respectively) and 15 healthy control subjects were studied. Patients presented significantly lower MIP and qMVC compared to controls. PMA was significantly associated with qMVC only (r=0.506; p<0.01). Only expiratory muscles showed a significant strength decline after exercise, both in patients and controls. In multivariate regression analysis, only FVC remained as independent predictor of peak aerobic capacity and MEP post exercise remained as independent predictor of peak exercise dyspnea even adjusting for FVC. Conclusion: ILD patients exhibited reduced inspiratory and quadriceps strength, but PMA was associated with the later only. Muscle strength was not associated with exercise capacity while expiratory muscle fatigue might underlie exertional dyspnea. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 200-208)
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Affiliation(s)
- Krauspenhar Merola Pietro
- Graduation Program in Pulmonology, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Gass Ricardo
- Graduation Program in Pulmonology, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Gustavo Paulus Nenê Dorneles Rui
- Graduation Program in Pulmonology, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Respiratory Division, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Basso Gazzana Marcelo
- Graduation Program in Pulmonology, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Respiratory Division, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | - Hochhegger Bruno
- Medical Imaging Research Lab, Santa Casa de Porto Alegre/Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Verges Samuel
- Université Grenoble Alpes, HP2 laboratory, Grenoble, France.,INSERM, U1042, Grenoble, France
| | - C Berton Danilo
- Graduation Program in Pulmonology, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Respiratory Division, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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20
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Cannon DT, Coelho AC, Cao R, Cheng A, Porszasz J, Casaburi R, Rossiter HB. Skeletal muscle power and fatigue at the tolerable limit of ramp-incremental exercise in COPD. J Appl Physiol (1985) 2016; 121:1365-1373. [PMID: 27660300 DOI: 10.1152/japplphysiol.00660.2016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 08/30/2016] [Accepted: 09/19/2016] [Indexed: 11/22/2022] Open
Abstract
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. By establishing the baseline relationship between muscle activity and isokinetic power, we apportioned performance fatigue into the reduction in muscle activation and muscle fatigue. Peak isokinetic power at intolerance was ~130% of peak incremental power in controls (274 ± 73 vs. 212 ± 84 W, P < 0.05), but ~260% in COPD patients (187 ± 141 vs. 72 ± 34 W, P < 0.05), greater than controls (P < 0.05). Muscle fatigue as a fraction of baseline peak isokinetic power was not different in COPD patients vs. controls (0.11 ± 0.20 vs. 0.19 ± 0.11). Baseline to intolerance, the median frequency of maximal isokinetic muscle activity, was unchanged in COPD patients but reduced in controls (+4.3 ± 11.6 vs. -5.5 ± 7.6%, P < 0.05). Performance fatigue as a fraction of peak incremental power was greater in COPD vs. controls and related to resting (FEV1/FVC) and peak exercise (V̇E/maximal voluntary ventilation) pulmonary function (r2 = 0.47 and 0.55, P < 0.05). COPD patients are more fatigable than controls, but this fatigue is insufficient to constrain locomotor power and define exercise intolerance.
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Affiliation(s)
- Daniel T Cannon
- Division of Respiratory & Critical Care Physiology & Medicine, Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California.,School of Exercise & Nutritional Sciences, San Diego State University, San Diego, California
| | - Ana Claudia Coelho
- Division of Respiratory & Critical Care Physiology & Medicine, Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California.,Department of Pulmonology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; and
| | - Robert Cao
- Division of Respiratory & Critical Care Physiology & Medicine, Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Andrew Cheng
- Division of Respiratory & Critical Care Physiology & Medicine, Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Janos Porszasz
- Division of Respiratory & Critical Care Physiology & Medicine, Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Richard Casaburi
- Division of Respiratory & Critical Care Physiology & Medicine, Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Harry B Rossiter
- Division of Respiratory & Critical Care Physiology & Medicine, Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; .,Faculty of Biological Sciences, School of Biomedical Sciences, University of Leeds, Leeds, United Kingdom
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The presence of respiratory disorders in individuals with low back pain: A systematic review. ACTA ACUST UNITED AC 2016; 26:77-86. [PMID: 27501326 DOI: 10.1016/j.math.2016.07.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 07/14/2016] [Accepted: 07/16/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Inspiratory muscles, such as the diaphragm, play a key role in both respiration and spinal control. Therefore, diaphragm dysfunctions are often related to low back pain (LBP). However, few is known on the association between the presence of LBP and the presence of respiratory disorders (RD). OBJECTIVES To perform a systematic review on the relation between RD and LBP. STUDY DESIGN Systematic review. METHODS Two reviewers searched on PubMed/MEDLINE for studies concerning LBP and RD, from 1950 up to January 2016. The search string consisted of the following key words: low back pain, dyspnea, respiratory problems, lung diseases, comorbidity, pulmonary disease, chronic obstructive, smoking, asthma, allergy, sinusitis, respiratory tract infection and hyperventilation. The aim was to evaluate a potential correlation, co-occurrence or causality between RD and LBP. RESULTS A total of 16 articles were included. A significant correlation between the presence of LBP and the presence of RD such as dyspnea, asthma, different forms of allergy, and respiratory infections was found. No correlation was found between Chronic Obstructive Pulmonary Disease (COPD) and LBP, and no articles were found on the correlation between hyperventilation and LBP. CONCLUSIONS This is the first study providing an overview of the literature on the relation between LBP and RD. Immunological, biomechanical, psychosocial and socio-economic factors might explain this correlation. Smoking is likely to contribute. Future studies must reveal the causative relationship. LEVEL OF EVIDENCE Therapy, level 2a.
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Barreiro E, Gea J. Molecular and biological pathways of skeletal muscle dysfunction in chronic obstructive pulmonary disease. Chron Respir Dis 2016; 13:297-311. [PMID: 27056059 DOI: 10.1177/1479972316642366] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) will be a major leading cause of death worldwide in the near future. Weakness and atrophy of the quadriceps are associated with a significantly poorer prognosis and increased mortality in COPD. Despite that skeletal muscle dysfunction may affect both respiratory and limb muscle groups in COPD, the latter are frequently more severely affected. Therefore, muscle dysfunction in COPD is a common systemic manifestation that should be evaluated on routine basis in clinical settings. In the present review, several aspects of COPD muscle dysfunction are being reviewed, with special emphasis on the underlying biological mechanisms. Figures on the prevalence of COPD muscle dysfunction and the most relevant etiologic contributors are also provided. Despite that ongoing research will shed light into the contribution of additional mechanisms to COPD muscle dysfunction, current knowledge points toward the involvement of a wide spectrum of cellular and molecular events that are differentially expressed in respiratory and limb muscles. Such mechanisms are thoroughly described in the article. The contribution of epigenetic events on COPD muscle dysfunction is also reviewed. We conclude that in view of the latest discoveries, from now, on new avenues of research should be designed to specifically target cellular mechanisms and pathways that impair muscle mass and function in COPD using pharmacological strategies and/or exercise training modalities.
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Affiliation(s)
- Esther Barreiro
- Department of Respiratory Medicine, Muscle and Respiratory System Research Unit (URMAR), Institute of Medical Research of Hospital del Mar (IMIM)-Hospital del Mar, Barcelona, Spain Department of Health Sciences (CEXS), Universitat Pompeu Fabra, Barcelona, Spain Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Joaquim Gea
- Department of Respiratory Medicine, Muscle and Respiratory System Research Unit (URMAR), Institute of Medical Research of Hospital del Mar (IMIM)-Hospital del Mar, Barcelona, Spain Department of Health Sciences (CEXS), Universitat Pompeu Fabra, Barcelona, Spain Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
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Katayama K, Itoh Y, Saito M, Koike T, Ishida K. Sympathetic vasomotor outflow and blood pressure increase during exercise with expiratory resistance. Physiol Rep 2015; 3:3/5/e12421. [PMID: 26019293 PMCID: PMC4463841 DOI: 10.14814/phy2.12421] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The purpose of the present study was to elucidate the effect of increasing expiratory muscle work on sympathetic vasoconstrictor outflow and arterial blood pressure (BP) during dynamic exercise. We hypothesized that expiratory muscle fatigue would elicit increases in sympathetic vasomotor outflow and BP during submaximal exercise. The subjects performed four submaximal exercise tests; two were maximal expiratory pressure (PEmax) tests and two were muscle sympathetic nerve activity (MSNA) tests. In each test, the subjects performed two 10-min exercises at 40% peak oxygen uptake using a cycle ergometer in a semirecumbent position [spontaneous breathing for 5 min and voluntary hyperpnoea with and without expiratory resistive breathing for 5 min (breathing frequency: 60 breaths/min, inspiratory and expiratory times were set at 0.5 sec)]. PEmax was estimated before and immediately after exercises. MSNA was recorded via microneurography of the right median nerve at the elbow. PEmax decreased following exercise with expiratory resistive breathing, while no change was found without resistance. A progressive increase in MSNA burst frequency (BF) appeared during exercise with expiratory resistance (MSNA BF, without resistance: +22 ± 5%, with resistance: +44 ± 8%, P < 0.05), accompanied by an augmentation of BP (mean BP, without resistance: +5 ± 2%, with resistance: +29 ± 5%, P < 0.05). These results suggest that an enhancement of expiratory muscle activity leads to increases in sympathetic vasomotor outflow and BP during dynamic leg exercise.
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Affiliation(s)
- Keisho Katayama
- Research Center of Health, Physical Fitness and Sports, Nagoya University, Nagoya, Japan Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Yuka Itoh
- Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Mitsuru Saito
- Faculty of Psychological and Physical Science, Aichigakuin University, Nisshin, Japan
| | - Teruhiko Koike
- Research Center of Health, Physical Fitness and Sports, Nagoya University, Nagoya, Japan Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Koji Ishida
- Research Center of Health, Physical Fitness and Sports, Nagoya University, Nagoya, Japan Graduate School of Medicine, Nagoya University, Nagoya, Japan
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Does expiratory muscle activity influence dynamic hyperinflation and exertional dyspnea in COPD? Respir Physiol Neurobiol 2014; 199:24-33. [DOI: 10.1016/j.resp.2014.04.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 04/15/2014] [Accepted: 04/18/2014] [Indexed: 11/24/2022]
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