This study evaluated the effects of body weight and lean mass abnormalities on health-related quality of life (HRQL) in obstructive airways disease.Body weight, lean mass (using dual-energy X-ray absorptiometry), and HRQL (using the St George's Respiratory Questionnaire (SGRQ)) were measured in 50 patients. Low lean mass was defined as a lean mass index (lean mass/height 2 ) below the fifth percentile of a control population. Dyspnoea was measured by the baseline dyspnoea index.The mean (SD) age was 69±9 yrs; the forced expiratory volume in one second (FEV1) was 39±19% of predicted. Patients had 2.4±4.1 kg less lean mass than predicted. Increased dyspnoea was the most influential predictor of poor HRQL. Compared to normal-weight patients, those who were underweight had significantly greater impairment in activity, impact, and total SGRQ scores, while those who were overweight had greater impairment in impact and total SGRQ scores. Low lean mass was associated with greater impairment in symptoms, activity and impact subscores and the total SGRQ score. When dyspnoea was added to the model as a covariate, neither weight nor lean mass remained significantly related to HRQL.Thus, although body weight and lean mass abnormalities influence health-related quality of life, their effects appear to be mediated through increased levels of dyspnoea. Eur Respir J 1997; 10: 1576-1580 A significantly reduced body weight, which is common in individuals with advanced chronic obstructive pulmonary disease (COPD) [1,2], is related to decreased exercise performance [3,4] and increased mortality [5,6]. In addition, analyses using bioimpedance techniques have demonstrated reductions in fat-free mass in normal-weight and underweight patients [7]. Decreased fat-free mass may be a predictor of poor exercise performance independently of body weight [3].Although the effect of nutritional status on exercise performance is established, little attention has been given to its effect on health-related quality of life (HRQL). To evaluate this, we measured two nutritional parameters, body weight and total body lean mass determined by dual-energy X-ray absorptiometry, in 50 patients with symptomatic obstructive lung disease. These two variables were then compared with HRQL measured by the St George's Respiratory Questionnaire (SGRQ). MethodsThe study was approved by the Medical Center's Institutional Review Board and informed consent was obtained from all subjects before participation in the study. All testing was performed in the Osteoporosis Center, which is in close proximity to the University of Connecticut Health Center.Adults with obstructive lung disease who were symptomatic with dyspnoea despite medical therapy, were recruited for the study. All had moderate-to-severe airways obstruction following bronchodilator inhalation and were clinically stable at the time of the study. Most had previously completed an out-patient pulmonary rehabilitation programme and many were in a postrehabilitation exercise maintenance programme. Patient...

Although obesity is increasing in prevalence, relatively little attention has been given to its impact on outcomes in patients with chronic obstructive pulmonary disease (COPD) completing pulmonary rehabilitation. We conducted a retrospective chart review of 114 patients with COPD who completed outpatient pulmonary rehabilitation at our center. Body habitus categories were determined based on body mass index (BMI). Underweight patients (BMI < 21 kg/m 2 ) were excluded from the analysis. Normal weight and overweight patients were classified as nonobese. Obese patients (BMI >30 kg/m 2 ) were compared with non-obese patients in the following areas: forced expiratory volume in 1 s (FEV 1 ) percent predicted, the 6-min walk distance (6MWD), health status, the number of unsupported arm lifts per minute, and functional performance. Health status was determined using the Self-Reported Chronic Respiratory Questionnaire (CRQ-SR), which has dimensions of dyspnea, fatigue, emotion, and mastery. Functional performance was determined using the Pulmonary Functional Status Scale Daily Activities subscore. Compared with non-obese patients, obese patients had a higher FEV 1 percent-predicted (44 ± 15% vs 52 ± 16%; P = 0.01), yet had lower 6MWD (269 ± 11 vs 203 ± 13; P = 0.0002), lower functional status, and greater fatigue at initial evaluation. However, the two groups had similar walk-work, which adjusts for differences in weight. Despite the baseline differences, both groups improved similarly following pulmonary rehabilitation (change in 6MWD was 52 ± 7 m in the non-obese patients versus 47 ± 9 in the obese patients; P = 0.65). Our study suggests that obese COPD patients are referred to pulmonary rehabilitation at an earlier spirometric stage of their disease, but have a poorer exercise performance, a greater degree of functional impairment and greater fatigue levels. This is probably, largely because of the effect of an increased weight burden. However, obesity did not seem to adversely affect the pulmonary rehabilitation outcomes.

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Metabolic function was measured by open-circuit spirometry for 310 competitive oarsmen during and following a 6-min maximal rowing ergometer exercise. Aerobic and anaerobic energy contributions to exercise were estimated by calculating exercise O2 cost and O2 debt.O2 debt was measured for 30 min of recovery using oxygen consumption (Vo2) during light rowing as the base line. Venous blood lactates were analyzed at rest and at 5 and 30 min of recovery. Maximal ventilation volumes ranged from 175 to 22l 1/min while Vo2 max values averaged 5,950 ml/min and 67.6 ml/kg min. Maximal venous blood lactates ranged from 126 to 240 mg/100 ml. Average O2 debt equaled 13.4 liters. The total energy cost for simulated rowing was calculated at 221.5 kcal assuming 5 kcal/l O2 with aerobic metabolism contributing 70% to the total energy released and anaerobiosis providing the remaining 30%. Vo2 values for each minute of exercise reflect a severe steady state since oarsmen work at 96-98% of maximal aerobic capacity. O2 debt and lactate measurements attest to the severity of exercise and dominance of anaerobic metabolism during early stages of work.