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Original Research: COPD |

Is Quadriceps Endurance Reduced in COPD?Quadriceps Endurance Is Reduced in COPD: A Systematic Review

Rachael A. Evans, MBChB, PhD; Eric Kaplovitch, MD; Marla K. Beauchamp, PhD; Thomas E. Dolmage, MSc; Roger S. Goldstein, MBChB, FCCP; Clare L. Gillies, PhD; Dina Brooks, PhD; Sunita Mathur, PhD
Author and Funding Information

From the Department of Respiratory Medicine (Drs Evans, Kaplovitch, Beauchamp, Goldstein, Brooks, and Mathur and Mr Dolmage), West Park Healthcare Centre, Toronto, ON, Canada; the Department of Medicine (Drs Evans, Kaplovitch, and Goldstein) and the Department of Physical Therapy (Drs Beauchamp, Goldstein, Brooks, and Mathur), University of Toronto, Toronto, ON, Canada; the Department of Physical Medicine and Rehabilitation (Dr Beauchamp), Harvard Medical School, Spaulding Rehabilitation Hospital, Cambridge, MA; and the Department of Infection, Immunity and Inflammation (Dr Evans) and the Department of Health Sciences (Dr Gillies), University of Leicester, Leicester, England.

CORRESPONDENCE TO: Rachael Evans, MBChB, PhD, Department of Respiratory Medicine, Glenfield Hospital, Leicester, LE3 9QP, England; e-mail: rachael.evans@uhl-tr.nhs.uk


FUNDING/SUPPORT: Dr Evans was supported with a National Institute for Health Research clinical lectureship.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(3):673-684. doi:10.1378/chest.14-1079
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BACKGROUND:  Although the aerobic profile of the quadriceps muscle is reduced in COPD, there is conflicting evidence regarding whether this leads to reduced quadriceps muscle endurance. We, therefore, performed a systematic review of studies comparing quadriceps endurance in individuals with COPD with that in healthy control subjects.

METHODS:  Relevant studies were identified by searching six electronic databases (1946-2011). Full-text articles were obtained after two researchers independently reviewed the abstracts. The results were combined in a random effects meta-analysis, and metaregression models were fitted to assess the influence of the type of measurement.

RESULTS:  Data were extracted from 21 studies involving 728 individuals with COPD and 440 healthy control subjects. Quadriceps endurance was reduced in those with COPD compared with healthy control subjects (standardized mean difference, 1.16 [95% CI, 1.02-1.30]; P < .001) with a 44.5 s (4.5-84.5 s; P = .029) reduction in COPD (large effect size) when measured using a nonvolitional technique. The relationship between quadriceps endurance in those with COPD and control subjects did not differ when comparing nonvolitional and volitional techniques (P = .22) or when high- or low-intensity tasks (P = .44) were undertaken.

CONCLUSIONS:  Quadriceps endurance is reduced in individuals with COPD compared with healthy control subjects, independent of the type of task performed.

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