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Muscle Strength and Exercise Kinetics in COPD Patients With a Normal Fat-Free Mass Index Are Comparable to Control Subjects^*

^* From the Pulmonary Department (Dr. Heijdra), University Medical Center St. Radboud, Nijmegen, the Netherlands; and Pulmonary and Critical Care Division (Drs. Pinto-Plata, Frants, Kenney, and Celli, and Mr. Rassulo), St. Elizabeth’s Medical Center, Tufts University School of Medicine, Boston, MA.

Correspondence to: Bartolome Celli, MD, FCCP, St. Elizabeth’s Medical Center, 736 Cambridge St, Boston, MA 02135; e-mail: bcelli{at}cchcs.org

Study objective: This study was designed to investigate the extent of clinical muscle dysfunction in stable patients with COPD who were attending an out-patient pulmonary clinic compared with that of age-matched control subjects without COPD.

Design and subjects: Respiratory muscle and hand grip strength, steady-state O₂ kinetics, and body composition were measured in 32 patients with COPD (19 women) [mean (± SD) FEV₁, 38 ± 11% predicted] and 36 age-matched control subjects (13 women).

Results: Measurements of handgrip force (mean, 97 ± 32% vs 106 ± 26% predicted, respectively), maximal expiratory pressure (mean, 57 ± 33% vs 61 ± 22% predicted, respectively), steady-state O₂ kinetics (mean , 72 ± 34 s vs 78 ± 37 s, respectively) and steady-state CO₂ kinetics (mean , 77 ± 38 s vs 65 ± 32 s, respectively) at submaximal exercise were similar in patients and control subjects. All the subjects, except for one female COPD patient, had a normal fat-free mass index (FFMI), although on average the FFMI was lower in male patients (19.8 ± 2.8) than in male control subjects (23.0 ± 2.8; p < 0.01).

Conclusions: In patients with COPD who were attending a regular outpatient pulmonary clinic, there was no evidence of reduced upper extremity and expiratory muscle strength or prolonged O₂ and CO₂ kinetics during isowork submaximal cardiopulmonary exercise compared to healthy, age-matched control subjects. Also, a normal body composition was found in nearly all COPD patients. This argues against the existence of a clinically significant systemic myopathy in most stable patients with severe COPD and normal FFMI.

Key Words: COPD • exercise kinetics • muscle strength • nutrition

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