Frequency and impact on clinical outcomes of sarcopenia in patients with idiopathic pulmonary fibrosis

Abstract

Objectives Sarcopenia is a syndrome characterized by reduced muscle mass and function. It is well-recognized as a complication in chronic diseases such as chronic obstructive pulmonary disease. However, little is known about sarcopenia in patients with idiopathic pulmonary fibrosis (IPF). This study aimed to investigate the clinical characteristics of sarcopenia and the association between quality of life and sarcopenia in patients with IPF. Methods In this pilot cross-sectional study, 56 Japanese outpatients with IPF (49 men) were enrolled prospectively. Sarcopenia was diagnosed according to the criteria of the Asian Working Group for Sarcopenia 2019. Its associations with clinical parameters including age, pulmonary functions, physical performance, and patient-reported outcomes (PROs) were examined. Results The frequency of sarcopenia was 39.3% ( n = 22) in this cohort. There were significant differences in St George’s Respiratory Questionnaire ( p = .005), modified Medical Research Council score ( p = .004), and Hospital and Anxiety Depression Scale depression score ( p = .030) between the sarcopenic and non-sarcopenic groups. On multivariate regression analysis, 6-min walk distance (6MWD) was an independent factor associated with sarcopenia (odds ratio 1.241, 95% confidence interval 1.016–1.515, p = .034). Conclusion Sarcopenia was associated with PROs and physical performance in patients with IPF.

A Systematic Review of the Prognostic Significance of the Body Mass Index in Idiopathic Pulmonary Fibrosis

“…This might lead to increased exercise tolerance and cardiorespiratory fitness through increased oxygen consumption via increased muscle diffusion, mitochondrial respiration capacity, and skeletal muscle strength, as already proposed in patients with heart failure [ 73 , 74 ]. This hypothesis is further supported by the results of studies reporting that lower skeletal muscle mass and strength are significantly associated with advanced disease and mortality in patients with IPF [ 75 , 76 , 77 ]. Furthermore, one study in our systematic review reported a significant and positive association between BMI and the cross-sectional area of elector spine muscles, an imaging parameter used to investigate sarcopenia and cachexia.…”

Peak Quadriceps Muscle Torque and Electromyographic Output in Patients With Chronic Respiratory Disorders: Effects of Pulmonary Rehabilitation

“…Once consented, all patients underwent a standard 8-week outpatient PR program conducted by the members of the Department of physical therapy. 16 Patients are initially evaluated by a dedicated physical therapist and are requested to be seen ideally twice weekly thereafter to partake of the program that involves upper and lower body strength and endurance training. Many patients, however, are indigent, having limited financial resources and able to come at best once a week or every other week, mainly because of transportation issues, illness, or hospitalization.…”

“…The numbers in each category were too small to achieve significant associations with pulmonary function, so larger studies are needed to demonstrate a relation as studies suggest that sarcopenia may be more severe and extensive in CAL than in ILD and have a greater effect on outcome. 13 , 14 , 15 , 16 This study was also affected by the COVID-19 pandemic during which our center experienced closures of most outpatient services including physical rehabilitation. For pragmatic reasons, most PR programs hold sessions only 2 or 3 times weekly, 20 but most programs instruct patients to exercise at home in between sessions, as we do.…”

“… 6 , 15 Patients with idiopathic pulmonary fibrosis (an advanced form of interstitial lung disease) also exhibit sarcopenia with differences in indices of QOL, physical activities, psychological state, and depression compared with non-sarcopenic groups. 16 More important, recovery of quadriceps muscle strength and endurance underlie much of the increase in exercise tolerance after multidisciplinary pulmonary rehabilitation (PR) for CAL. 15 , 17 , 18 , 19 , 20 PR programs significantly benefit QOL and exercise tolerance in patients with chronic lung disease.…”

“…The purpose of this study was to assess the relation of the peak quadriceps electromyographic (EMG) output to the torque produced during a train of 5 knee extensions over the course of an 8-week PR program in patients with chronic respiratory disorders, including restrictive diseases. Given that PR is known to improve QOL, 15 , 16 we also wished to assess if Eq/Tq correlated with quality-of-life as measured by the validated St. George's Respiratory Questionnaire (SGRQ), 32 the total score of which has been used as an independent predictor of mortality also in patients with idiopathic pulmonary fibrosis. 33 …”