Non-invasive mechanical ventilation improves walking distance but not quadriceps strength in chronic respiratory failure

Schönhofer, Bernd; Zimmermann, C.; Abramek, Piotr; Suchi, Stefan; Köhler, Dieter; Polkey, Michael I.

doi:10.1016/s0954-6111(03)00037-4

Cited by 30 publications

(28 citation statements)

References 24 publications

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“…Quadriceps strength was measured as the twitch tension elicited by magnetic stimulation of the femoral nerve and the maximum voluntary contraction force in patients with chronic respiratory failure due to COPD and restrictive thoracic disease before and after 2-month NPPV. After NPPV there was significant clinical, arterial blood gas and walking distance improvement, but there was no improvement in quadriceps strength [66].…”

Section: Night-time Nppv and Day-time Exercisementioning

confidence: 88%

“…Indeed the hypothesis that the observed increased exercise performance with nocturnal NPPV may be associated with increased quadriceps strength was not confirmed [66]. Quadriceps strength was measured as the twitch tension elicited by magnetic stimulation of the femoral nerve and the maximum voluntary contraction force in patients with chronic respiratory failure due to COPD and restrictive thoracic disease before and after 2-month NPPV.…”

Section: Night-time Nppv and Day-time Exercisementioning

confidence: 99%

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New strategies to improve exercise tolerance in chronic obstructive pulmonary disease

Ambrosino¹,

Strambi²

2004

Eur Respir J

137

106

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Breathlessness is the most common symptom limiting exercise in patients with chronic obstructive pulmonary disease (COPD). Exercise training can improve both exercise tolerance and health status in these patients, intensity being of key importance. Nevertheless, in these patients extreme breathlessness and/or peripheral muscle fatigue may prevent patients from higher levels of intensity. In this review article the literature concerning the different ways to optimise exercise tolerance in patients with COPD, with the objective of enhancing the tolerance to higher exercise training intensity, is summarised.Continuous positive airway pressure and different modalities of noninvasive positive pressure ventilation (NPPV) may reduce breathlessness and increase exercise tolerance in these patients. Respiratory muscle unloading and reduction in intrinsic positive end-expiratory pressure have been considered among mechanisms underlying these effects. Nevertheless, the role of NPPV in pulmonary rehabilitation, if any, is still controversial. The addition of nocturnal domiciliary NPPV during a daily exercise programme in patients with severe COPD resulted in an improvement in exercise tolerance and quality of life.In patients with severe COPD application of electrical stimulation combined with active limb mobilisation significantly improved muscle strength, and interval training has been shown capable of inducing physiological training effects.Oxygen supplementation in patients who do not desaturate during exercise seems to be the most promising treatment, since it allows for higher exercise intensities and, therefore, superior training efficacy.In conclusion, further studies are needed to define the appropriate patients in order to generalise such interventions. The modalities discussed should be used as adjuncts to a well designed comprehensive respiratory rehabilitation programme.

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Section: Night-time Nppv and Day-time Exercisementioning

confidence: 88%

Section: Night-time Nppv and Day-time Exercisementioning

confidence: 99%

New strategies to improve exercise tolerance in chronic obstructive pulmonary disease

Ambrosino¹,

Strambi²

2004

Eur Respir J

137

106

View full text Add to dashboard Cite

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“…Most of the evidence favoring 6-MWD in the evaluation of treatment effects [9,10,11,12] and prediction of survival has been obtained in COPD [8, 13, 14], consistent with the fact that COPD exhibits multiple systemic manifestations beyond the respiratory impairment itself [14,15,16,17,18], e.g. reductions in body mass index (BMI) and fat-free mass [4, 18], which affect 6-MWD [19].…”

Section: Introductionmentioning

confidence: 99%

Predictive Significance of the Six-Minute Walk Distance for Long-Term Survival in Chronic Hypercapnic Respiratory Failure

Budweiser¹,

Heidtkamp²,

Jörres³

et al. 2007

Respiration

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Background: The 6-min walk distance (6-MWD) is a global marker of functional capacity and prognosis in chronic obstructive pulmonary disease (COPD), but less explored in other chronic respiratory diseases. Objective: To study the role of 6-MWD in chronic hypercapnic respiratory failure (CHRF). Methods: In 424 stable patients with CHRF and non-invasive ventilation (NIV) comprising COPD (n = 197), restrictive diseases (RD; n = 112) and obesity-hypoventilation-syndrome (OHS; n = 115), the prognostic value of 6-MWD for long-term survival was assessed in relation to that of body mass index (BMI), lung function, respiratory muscle function and laboratory parameters. Results: 6-MWD was reduced in patients with COPD (median 280 m; quartiles 204/350 m) and RD (290 m; 204/362 m) compared to OHS (360 m; 275/440 m; p < 0.001 each). Overall mortality during 24.9 (13.1/40.5) months was 22.9%. In the 424 patients with CHRF, 6-MWD independently predicted mortality in addition to BMI, leukocytes and forced expiratory volume in 1 s (p < 0.05 each). In COPD, 6-MWD was strongly associated with mortality using the median [p < 0.001, hazard ratio (HR) = 3.75, 95% confidence interval (CI): 2.24–6.38] or quartiles as cutoff levels. In contrast, 6-MWD was only significantly associated with impaired survival in RD patients when it was reduced to 204 m or less (1st quartile; p = 0.003, HR = 3.31, 95% CI: 1.73–14.10), while in OHS 6-MWD had not any prognostic value. Conclusions: In patients with CHRF and NIV, 6-MWD was predictive for long-term survival particularly in COPD. In RD only severely reduced 6-MWD predicted mortality, while in OHS 6-MWD was relatively high and had no prognostic value. These results support a disease-specific use of 6-MWD in the routine assessment of patients with CHRF.

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“…Studies investigating the impact of NIV on endurance in patients with COPD delivered conflicting results [3, 25, 26]. Recently we could show that NIV improves respiratory and peripheral muscle function in patients with thoracorestrictive disease [8, 27] as well as mobility in patients with COPD [1]. …”

Section: Discussionmentioning

confidence: 99%

Exercise Endurance before and after Long-Term Noninvasive Ventilation in Patients with Chronic Respiratory Failure

Schönhofer

Dellweg²,

Suchi³

et al. 2007

Respiration

Self Cite

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Background: Noninvasive mechanical ventilation (NIV) is known to reduce hypoventilation and improves respiratory and peripheral muscle endurance in patients with chronic respiratory failure (CRF) due to thoracic restriction. Objectives: To compare the effect of short-term NIV on endurance in patients with CRF due to thoracorestriction and chronic obstructive pulmonary disease (COPD) and to evaluate differences in spiroergometric data during exercise testing. Methods: Thirty-five patients with CRF due to COPD and 24 patients with CRF due to thoracorestriction entered the trial. Constant work rate exercise testing at 75% of the maximal workload, pulmonary function and arterial blood gas testing were performed before and after 3 months of NIV. Measurements were compared between and within groups. Results: The non-COPD group increased their exercise time significantly from 4.7 ± 1.81 to 6.59 ± 3.15 min (p = 0.0032). There was no change in the COPD group (4.57 ± 2.19 min before and 5.39 ± 3.09 min after NIV, p = 0.09). CO₂ levels at rest fell in both groups (COPD 52.30 ± 7.77 to 46.06 ± 4.61 mm Hg and non-COPD 47.82 ± 5.19 to 43.79 ± 4.15 mm Hg). While COPD patients increased their minute ventilation (13.47 ± 2.73 to 14.88 ± 2.67 l/min), non-COPD patients decreased their oxygen uptake from 6.27 ± 1.61 to 5.54 ± 1.35 ml/kg. Conclusions: NIV improved endurance only in the non-COPD group. This and the reduction in CO₂ are achieved by lowering energetic requirements. COPD patients though decreased their resting CO₂ by increased minute ventilation.

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Non-invasive mechanical ventilation improves walking distance but not quadriceps strength in chronic respiratory failure

Abstract: The strength of quadriceps does not change after 2 months of effective NMV in patients with CRF despite a marked increase in endurance time. Factors other than quadriceps strength account for the improved performance.

Cited by 30 publications

References 24 publications

New strategies to improve exercise tolerance in chronic obstructive pulmonary disease

New strategies to improve exercise tolerance in chronic obstructive pulmonary disease

Predictive Significance of the Six-Minute Walk Distance for Long-Term Survival in Chronic Hypercapnic Respiratory Failure

Exercise Endurance before and after Long-Term Noninvasive Ventilation in Patients with Chronic Respiratory Failure

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