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Distribution of Muscle Mass and Maximal Exercise Performance in Patients With COPD^*

^* From the Second Department of Internal Medicine (Drs. Yoshikawa, Yoneda, Takenaka, Fukuoka, Okamoto, and Narita) and Department of Surgery III (Dr. Nezu), Nara Medical University, Nara, Japan.

Correspondence to: Masanori Yoshikawa, MD, Second Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan 634-8522

Study objective: To investigate the distribution of reduction in lean body mass (LBM) and whether LBM in legs (LBMlegs) can be a determinant of maximal exercise performance in COPD patients.

Methods: Thirty-eight male outpatients with COPD (mean ± SD FEV₁, 47.4 ± 24.0% of predicted) who underwent complete pulmonary function testing were classified into two groups according to FEV₁ expressed as a percentage of predicted value. Group A comprised 21 patients with mild-to-moderate airflow limitation (FEV₁ 35% predicted), and group B comprised 17 patients with severe airflow limitation (FEV₁ < 35% predicted). LBM, which represents skeletal muscle mass, was measured by dual energy x-ray absorptiometry (DXA) and was assessed separately in arms, legs, and trunk. Maximal oxygen uptake (O₂max) was measured during maximal exercise on a cycle ergometer.

Results: LBM in each region was expressed as a percentage of ideal body weight (IBW). LBM in arms (LBMarms)/IBW, LBMlegs/IBW, and LBM in trunk (LBMtrunk)/IBW were significantly depleted in group B compared with group A (p < 0.01). LBMlegs expressed as a percentage of total LBM (LBMlegs/total LBM) was significantly lower in group B (p < 0.05), although there was no significant difference in LBMarms/total LBM and LBMtrunk/total LBM between the two groups. O₂max correlated significantly with LBMlegs/IBW in group A, but not in group B. By stepwise regression analysis, LBMlegs/IBW appeared to be a significant predictor of O₂max in group A, while not in group B.

Conclusion: LBMlegs was a significant predictor of maximal exercise performance in patients with mild-to-moderate airflow limitation, but not in patients with severe airflow limitation who had disproportional reduction in LBMlegs.

Key Words: body composition analysis • COPD • distribution of peripheral muscle mass • dual energy x-ray absorptiometry • maximal exercise performance

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