The Influence of 6 Months of Oral Anabolic Steroids on Body Mass and Respiratory Muscles in Undernourished COPD Patients

Ferreira, Ivone; Verreschi, Ieda Therezinha do Nascimento; Nery, Luíz Eduardo; Goldstein, Roger; Zamel, Noé; Brooks, Dina; Jardim, José Roberto

doi:10.1378/chest.114.1.19

Cited by 214 publications

(141 citation statements)

References 29 publications

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“…Men with COPD have been shown to have low testosterone levels which may further contribute to low muscle mass and muscle weakness. A few clinical studies of testosterone analogs in COPD have been published and have generally shown modest improvements in muscle mass, but have not shown unequivocal improvements in muscle strength [1][2][3]. Cellular studies have demonstrated androgen-mediated hypertropic responses to testosterone replacement [4], and myocardial hypertrophy associated with testosterone replacement has been quite reproducible in animals [5], our study is perhaps the first study to evaluate this effect in humans.…”

Section: Introductionmentioning

confidence: 76%

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Effect of Testosterone and Resistance Training on Cardiac Mass and Contractility in Men with COPD

Budoff¹,

Mao²,

Rambod³

et al. 2011

J Allergy Ther

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Introduction: Testosterone therapy and resistance training have been demonstrated to improve muscle mass and strength in patients with testosterone deficiency. However the effects on cardiac mass and contractility of these interventions have not been identified in prospective placebo-controlled trials. The hypothesis of this trial was that resistance training and testosterone replacement would improve cardiac mass and contractility in male COPD patients with low testosterone levels. Methods:We conducted a 10 week trial in a 2 by 2 factorial design, randomizing 53 patients to replacement doses of testosterone enanthate (100 mg weekly) or placebo, as well as to a program of lower extremity resistance training or no exercise. We performed rest and exercise cardiac computed tomography (CCT) studies before and after 10 weeks of therapy to evaluate right and left heart function. Patients were injected with 40-50 ml of non-ionic, iodinated contrast and cine CCT images were obtained at rest. Patients were exercised to 60% of their maximal work rate on a semi-supine ergometer, then re-injected with another bolus of 40-50 ml of contrast and re-imaged. We evaluated cardiac output and left ventricular (LV) and right ventricular (RV) mass, LV and RV stroke volume, ejection fractions and end-diastolic volumes at rest and exercise, before and after therapy.Results: 42 men with COPD (mean FEV 1 =40%pred. pre-bronchodilator) and low testosterone levels (mean=320ng/dl) completed the 10 week protocol. Factorial analysis demonstrated that testosterone, but not resistance training increased LV and RV mass (by 4.9% and 8.3%, respectively). Resistance training, but not testosterone, was associated with increased LV ejection fraction at rest and during exercise (by 5.5% and 4.4%, respectively). In the entire study group, increases in both left and right ventricular mass were correlated with increases in lean body mass (assessed by DEXA) (r=0.49 and r=0.65, respectively). Conclusions:In men with COPD, testosterone replacement and strength training are associated with distinct alterations in cardiac structure and function. Specifically, resistance training improved ejection fraction, while testosterone increased lean body mass and LV mass.

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Section: Introductionmentioning

confidence: 76%

“…To determine whether testosterone and resistance training exerted independent and significant effects on cardiac mass and contractility variables, data from all subjects were entered into a linear regression model of the form: ∆y = a 1 [testosterone] + a 2 …”

Section: Factorial Analysismentioning

confidence: 99%

Effect of Testosterone and Resistance Training on Cardiac Mass and Contractility in Men with COPD

Budoff¹,

Mao²,

Rambod³

et al. 2011

J Allergy Ther

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“…Sridhar et al, (27) por exemplo, fizeram suplementação em um grupo de pacientes com DPOC em programa de reabilitação pulmonar com aumento do aporte nutricional por quatro meses, porém, não obtiveram melhora significativa nas medidas antropométricas, na função pulmonar, na força muscular respiratória e no consumo máximo de oxigê-nio. A administração de anabólico-esteróides (28) aos pacientes desnutridos (com o intuito de aumentar a massa magra), também tem sido objeto de estudo. Contudo, a capacidade ao exercício não se alterou.…”

Section: Discussionunclassified

Efeitos da suplementação oral de L-carnitina associada ao treinamento físico na tolerância ao exercício de pacientes com doença pulmonar obstrutiva crônica

Silva

Lorenzo²,

Jamami

et al. 2003

J. Pneumologia

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INTRODUÇÃO: Pacientes portadores de doença pulmonar obstrutiva crônica apresentam redução da tolerância ao exercício físico, principalmente devido à limitação ventilatória. A L-carnitina tem sido utilizada com o objetivo de melhorar a capacidade aeróbia de pacientes com doenças crônicas, porém não existem estudos em pacientes portadores de doença pulmonar obstrutiva crônica. OBJETIVO: Avaliar a influência da suplementação de L-carnitina, associada ao treinamento físico por seis semanas, três vezes por semana em pacientes portadores de doença pulmonar obstrutiva crônica. MÉTODO: A amostra foi constituída de 30 pacientes portadores de doença pulmonar obstrutiva crônica (69 ± 7 anos) com volume expiratório forçado no primeiro segundo < 65% do previsto, dividida em três grupos de 10 pacientes: grupo 1 com treinamento físico e suplementação com 2g/dia de L-carnitina, grupo 2 que recebeu treinamento físico e placebo e grupo 3 que não foi submetido a treinamento físico e recebeu 2g/dia de L-carnitina. Os pacientes foram submetidos a avaliação espirométrica, a teste de caminhada de seis minutos e à mensuração dos níveis plasmáticos de carnitina livre no inicio e no final do estudo. RESULTADOS: Foi constatado aumento significativo (p < 0,05) da distância percorrida no teste de caminhada de seis minutos somente nos pacientes dos dois primeiros grupos (de 421 ± 100 para 508 ± 80,7 e de 496 ± 78,7 para 526 ± 64,3 respectivamente). Além disso, com intensidade de exercício semelhante, a subida da freqüência cardíaca foi menor no grupo 1 quando comparado com o grupo 2. As variáveis espirométricas, a saturação da oxihemoglobina e a dispnéia não se alteraram em nenhum dos grupos estudados. Os valores de L-carnitina livre no plasma aumentaram somente nos pacientes do terceiro grupo (59,2 ± 13,8 para 102,3 ± 15,32mmol/L). CONCLUSÃO: A L-carnitina associada ao treinamento físico pode proporcionar maior tolerância ao exercício em pacientes com doença pulmonar obstrutiva crônica.

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“…Dans deux autres études, l'androgénothérapie a été combinée à l'exercice physique [25,70] (Tableau 1). Dix patients BPCO stade II-III de sexe masculin dénutris (IMC < 20), ambulatoires, ont reçu une injection intramusculaire de 250 mg de testosté-rone, suivie par un apport quotidien oral de 12 mg de stanozolol [70].…”

Section: Androgénothérapie Associée à L'exercice Physiqueunclassified

“…Dix patients BPCO stade II-III de sexe masculin dénutris (IMC < 20), ambulatoires, ont reçu une injection intramusculaire de 250 mg de testosté-rone, suivie par un apport quotidien oral de 12 mg de stanozolol [70]. Le groupe témoin était constitué de sept patients aux caractéristiques identiques et recevait un placebo.…”

Section: Androgénothérapie Associée à L'exercice Physiqueunclassified

Réhabilitation respiratoire dans la broncho-pneumopathie chronique obstructive (BPCO) : l’androgénothérapie, pourquoi ? Pour qui ? Comment ?

Thibault

Samaras

et al. 2016

Nutrition Clinique et Métabolisme

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Résumé L'insuffisance respiratoire chronique obstructive secondaire à la broncho-pneumopathie chronique obstructive (BPCO) combine les effets délétères de l'hypoxie chronique, l'inflammation chronique, l'insulinorésistance, l'augmentation de la dépense énergétique, la fonte musculaire, et le déconditionnement à l'exercice. Comme pour d'autres maladies chroniques, la perte de masse non grasse diminue la survie. Préserver la masse et la fonction musculaires en maintenant le métabolisme mitochondrial oxydatif est un point clé de la prise en charge du patient BPCO. Du fait du vieillissement de la population, de l'augmentation de prévalence de la BPCO et du progrès médical, les années futures vont connaître l'augmentation de la prévalence de la dénutrition chez les patients BPCO. L'androgénopénie, ou l'hypogonadisme, définie par une testostéronémie libre inférieure à 50 pg/mL, est observée chez 40 % des patients BPCO. Comme les androgènes stimulent l'anabolisme musculaire, l'androgénopénie s'associe à une fonte musculaire. Des études, dont une récente méta-analyse, indiquent que l'androgénothérapie pouvait augmenter l'indice de masse corporelle et la masse non grasse, ainsi que la qualité de vie des patients BPCO, mais, seule, était insuffisante pour améliorer la fonction respiratoire. Deux essais randomisés multicentriques ont démontré que l'association androgénothérapie-exercice physique-compléments nutritionnels oraux contenant des acides gras poly-insaturés oméga-3, pendant au moins trois mois, diminuait la morbi-mortalité. Ce traitement multimodal est optimisé dans le cadre de la réhabilitation respiratoire, qui est le traitement de référence de la dénutrition du patient BPCO. © 2016 Elsevier Masson SAS. Tous droits réservés.Mots clés : Dénutrition ; Insuffisance respiratoire ; Activité physique ; Compléments nutritionnels oraux ; Nutrition AbstractChronic obstructive pulmonary disease (COPD) combines the deleterious effects of chronic hypoxia, chronic inflammation, insulin-resistance, increased energy expenditure, muscle wasting, and exercise deconditioning. As for other chronic disorders, loss of fat-free mass decreased survival. The preservation of muscle mass and function, through the protection of the mitochondrial oxidative metabolism, is an important challenge in the management of COPD patients. As the prevalence of the disease is increasing and the medical advances make COPD patients live longer, the prevalence of COPD-associated nutritional disorders is expected to augmentation in future decades. Androgenopenia, or hypogonadism, defined by free testosterone plasma concentrations below 50 pg/mL, is observed in 40% of COPD patients. Due to the stimulating effects of androgens on muscle anabolism, androgenopenia favors loss of muscle mass. Studies, including one recent meta-analysis, indicate that androgen substitution * Auteur correspondant. R. Thibault et al. / Nutrition clinique et métabolisme 30 (2016) 74-82 75 could improve body mass index and fat-free mass as well as quality of life in COPD pa...

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The Influence of 6 Months of Oral Anabolic Steroids on Body Mass and Respiratory Muscles in Undernourished COPD Patients

Cited by 214 publications

References 29 publications

Effect of Testosterone and Resistance Training on Cardiac Mass and Contractility in Men with COPD

Effect of Testosterone and Resistance Training on Cardiac Mass and Contractility in Men with COPD

Efeitos da suplementação oral de L-carnitina associada ao treinamento físico na tolerância ao exercício de pacientes com doença pulmonar obstrutiva crônica

Réhabilitation respiratoire dans la broncho-pneumopathie chronique obstructive (BPCO) : l’androgénothérapie, pourquoi ? Pour qui ? Comment ?

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