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Original Research: PULMONARY REHABILITATION |

Effect of Pulmonary Rehabilitation on Peripheral Muscle Fiber Remodeling in Patients With COPD in GOLD Stages II to IVPeripheral Muscle Regeneration in COPD

Ioannis Vogiatzis, PhD; Gerasimos Terzis, PhD; Grigoris Stratakos, MD, FCCP; Evgenia Cherouveim, MSc; Dimitris Athanasopoulos, PhD; Stauroula Spetsioti, MSc; Ioannis Nasis, MSc; Panagiota Manta, MD; Charis Roussos, MD, PhD, FCCP; Spyros Zakynthinos, MD, PhD
Author and Funding Information

From the Department of Critical Care Medicine (Drs Vogiatzis, Stratakos, Athanasopoulos, Roussos, and Zakynthinos; Ms Spetsioti; and Mr Nasis), Pulmonary Rehabilitation Center, Evangelismos Hospital; the Department of Physical Education and Sport Sciences (Drs Vogiatzis, Terzis, and Athanasopoulos; Mss Cherouveim and Spetsioti; and Mr Nasis); and 1st Department of Neurology (Drs Terzis and Manta), Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece.

Correspondence to: Ioannis Vogiatzis, PhD, Thorax Foundation, 3 Ploutarhou Str., 106 75 Kolonaki, Athens, Greece; e-mail: gianvog@phed.uoa.gr


Funding/Support: This study was funded by the Thorax Foundation.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(3):744-752. doi:10.1378/chest.10-3058
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Background:  In most patients with COPD, rehabilitative exercise training partially reverses the morphologic and structural abnormalities of peripheral muscle fibers. However, whether the degree of improvement in muscle fiber morphology and typology with exercise training varies depending on disease severity remains unknown.

Methods:  Forty-six clinically stable patients with COPD classified by GOLD (Global Initiative for Obstructive Lung Disease) as stage II (n = 14), III (n = 18), and IV (n = 14) completed a 10-week comprehensive pulmonary rehabilitation program consisting of high-intensity exercise three times weekly.

Results:  At baseline, muscle fiber mean cross-sectional area and capillary density did not significantly differ between patients with COPD and healthy control subjects, whereas muscle fiber type I and II proportion was respectively lower (P < .001) and higher (P < .002) in patients with GOLD stage IV compared with healthy subjects and patients with GOLD stages II and III. Exercise training improved, to a comparable degree, functional capacity and the St. George Respiratory Questionnaire health-related quality of life score across all three GOLD stages. Vastus lateralis muscle fiber mean cross-sectional area was increased (P < .001) in all patient groups (stage II: from 4,507 ± 280 μm2 to 5,091 ± 271 μm2 [14% ± 3%]; stage III: from 3,753 ± 258 μm2 to 4,212 ± 268 μm2 [14% ± 3%]; stage IV: from 3,961 ± 266 μm2 to 4,551 ± 262 μm2 [17% ± 5%]), whereas all groups exhibited a comparable reduction (P < .001) in type IIb fiber proportion (stage II: by 6% ± 2%; stage III: by 6% ± 1%; stage IV: by 7% ± 1%) and an increase (P < .001) in capillary to fiber ratio (stage II: from 1.48 ± 0.10 to 1.81 ± 0.10 [23% ± 5%]; stage III: from 1.29 ± 0.06 to 1.56 ± 0.09 [21% ± 5%]; stage IV: from 1.43 ± 0.10 to 1.71 ± 0.13 [18 ± 3%]). The magnitude of changes in the aforementioned variables did not differ across GOLD stages.

Conclusions:  Functional capacity and morphologic and typologic adaptations to rehabilitation in peripheral muscle fibers were similar across GOLD stages II to IV. Pulmonary rehabilitation should be implemented in patients at all COPD stages.

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