Does peripheral arterial occlusive disease influence muscle strength and exercise capacity in COPD patients?

Abstract

BackgroundThe pathophysiology of chronic obstructive pulmonary disease (COPD) is complex and understanding of it has been changing in recent years, with regard to its multisystemic manifestations, especially peripheral dysfunction and its influence on intolerance to exercise.ObjectivesTo evaluate the relationship between peripheral arterial occlusive disease (PAOD) and peripheral muscle strength and exercise capacity in COPD patients.MethodsWe conducted a cross-sectional study of 35 patients with COPD who were evaluated with the Ankle-Brachial Index, handgrip strength test, 1 repetition maximum (1RM) of knee extensors and flexors, and distance covered in the incremental shuttle walking test (dISWT).ResultsCOPD patients with coexisting PAOD had lower dominant handgrip strength test results (33.00 vs. 26.66 kgf, p = 0.02) and worse performance in the dISWT (297.32 vs. 219.41 m, p = 0.02) when compared to the COPD patients without PAOD. Strong correlations were found between the result of the handgrip strength test and both the dISWT (r = 0.78; p < 0.001) and the 1RM/knee extension (r = 0.71; p = 0.03); and also between the dISWT and both the 1RM/knee extension (r = 0.72; p = 0.02) and the 1RM/knee flexion (r = 0.92; p < 0.001). The linear regression model showed that the dISWT variable alone explains 15.3% of the Ankle-Brachial Index result (p = 0.01).ConclusionCOPD patients with PAOD exhibit reduced muscle strength and lower exercise capacity than COPD patients without PAOD.

Handgrip Strength and Pulmonary Disease in the Elderly: What is the Link?

“…This result suggests that dysfunctions occur simultaneously in the heart and skeletal muscles in patients with COPD and LH and are not only due to pulmonary mechanics; therefore, low HGS may be a marker of cardiac function impairment in COPD. Accordingly, current studies report that patients with COPD have endothelial dysfunction that may manifest as loss of ability to dilate the brachial artery, probably due to LH and chest wall distension [60, 61]. These changes may negatively impact the HGS.…”

“…These changes may negatively impact the HGS. In fact, Miranda et al [61] recently showed that COPD patients with coexisting peripheral arterial occlusive disease (PAOD) presented lower HGS (33 vs. 26.7 kgf, P =0.02) compared with patients with COPD without PAOD.…”

Association between respiratory variables and exercise capacity in COPD patients

“…4,5 Exercise capacity is commonly assessed by maximal and submaximal tests, which reflect different pathophysiological alterations in COPD regarding aerobic, muscular strength, cardiovascular and respiratory fitness systems. [6][7][8] The submaximal exercise capacity can be assessed by the Six-Minute Walk Test (6MWT) and the maximal capacity through the Incremental Shuttle Walking Test (ISWT) and both allow assessing the impact of COPD on the quality of life and activities of daily living (ADLs). 6,7 The causes and mechanisms of exercise intolerance in these patients are still complex and involve respiratory function, gas exchange limitations and reduced peripheral skeletal muscle mass.…”