Effects of Whole-Body Exercise Training on Body Composition and Functional Capacity in Normal-Weight Patients With COPD

Skeletal muscle wasting is related to muscle dysfunction, exercise intolerance, and increased mortality risk in patients with COPD. The aims of this study were to investigate the effects of whole-body exercise training on body composition in normal-weight patients with COPD, and to study the relationship between changes in body composition and functional capacity. Fifty patients with COPD (FEV1, 39% of predicted [SD, 16]) admitted to the pulmonary rehabilitation center at Hornerheide, and 36 healthy age-matched control subjects (for baseline comparison) were included. Patients participated in a standardized inpatient exercise training program consisting of daily submaximal cycle ergometry, treadmill walking, weight training, and gymnastics during 8 weeks. Fat-free mass (FFM) was measured by bioelectrical impedance analysis. None of the patients met the criteria for nutritional supplementation (body mass index ≤ 21, or FFM index ≤ 15 kg/m2 in women and ≤ 16 kg/m2 in men). Exercise capacity was measured using incremental cycle ergometry. Isokinetic quadriceps strength was measured with a Biodex dynamometer (Biodex Medical Corporation; Shirley, NY). At baseline, patients were characterized by a significantly lower FFM than the control subjects. Age and FFM were independent predictors of skeletal muscle function and exercise capacity in patients. After rehabilitation, weight (72.4 ± 9.8 to 73.0 ± 9.4 kg, p < 0.05) significantly increased, as a result of increased FFM (52.4 ± 7.3 to 53.4 ± 7.7 kg, p < 0.05), while fat mass (20.0 ± 6.1 to 19.6 ± 5.7 kg) tended to decrease. Peak work rate (63 ± 29 to 84 ± 42 W, p < 0.001), maximal oxygen consumption ( V˙O2max) [1,028 ± 307 to 1,229 ± 421 mL/min, p < 0.001], and isokinetic quadriceps strength (82.5 ± 36.4 to 90.3 ± 34.9 Newton-meters, p < 0.05) all improved. Changes in FFM were proportionally smaller than functional improvements, and were related to changes in V˙O2max (r = 0.361, p < 0.05), but not to other changes in functional capacity. Intensive exercise training per se is able to induce an anabolic response in normal-weight patients with COPD classified into Global Initiative for Chronic Obstructive Lung Disease stages III-IV. Improvements in exercise performance and muscle function are proportionally larger than increases in FFM.