Peripheral muscle weakness contributes to exercise limitation in COPD

Peripheral muscle weakness contributes to exercise limitation in COPD

R Gosselink, T Troosters and M Decramer
Respiratory Division, University Hospitals, Katholieke Universiteit Leuven, Belgium.

Recently, it was suggested that fatigue of peripheral muscles could contribute to exercise limitation in patients with chronic obstructive pulmonary disease (COPD). In order to quantify the role of peripheral muscle force, we restudied potential determinants of exercise capacity (6-min walking distance [6 MWD] and maximal oxygen consumption [V02max]) in 41 consecutive COPD patients (FEV1, 43 +/- 19% of predicted, TLCO, 56 +/- 25% of predicted) admitted to our pulmonary rehabilitation program. VO2max (incremental cycle ergometer test), 6 MWD (best of three), lung function (FEV1, FVC, TLC, FRC), diffusing capacity (TLCO), isometric quadriceps force (QF), hand grip force (HF), and maximal inspiratory (PImax) and expiratory (PEmax) pressures were measured. Patients had a poor 6 MWD (372 +/- 136 m) and VO2max (1.35 +/- 0.60 L, 71%), reduced respiratory (PImax 65 +/- 27%) and peripheral muscle force (QF 74 +/- 27%, HF 82 +/- 23%). In single regression analysis, significant correlations (r) were found for VO2max and TLCO (0.68), FEV1 (0.64), QF (0.55), HF (0.53), and body weight (0.49). Walking distance was significantly correlated with QF (0.63), HF (0.61), PImax (0.49), and TLCO (0.38). In stepwise multiple regression analysis, the variables significantly contributing to 6 MWD were QF and Plmax. For VO2max, variables significantly contributing were TLCO, QF, and FEV1. We conclude that lung function and peripheral muscle force are important determinants of exercise capacity in COPD.

This article has been cited by other articles:

C. J. Jolley and J. Moxham
A physiological model of patient-reported breathlessness during daily activities in COPD
Eur. Respir. Rev., June 1, 2009; 18(112): 66 - 79.
[Abstract] [Full Text] [PDF]

D. Langer, E. Hendriks, C. Burtin, V. Probst, C. van der Schans, W. Paterson, M. Verhoef-de Wijk, R. Straver, M. Klaassen, T. Troosters, et al.
A clinical practice guideline for physiotherapists treating patients with chronic obstructive pulmonary disease based on a systematic review of available evidence
Clinical Rehabilitation, May 1, 2009; 23(5): 445 - 462.
[Abstract] [PDF]

W. Janssens, A. Lehouck, C. Carremans, R. Bouillon, C. Mathieu, and M. Decramer
Vitamin D Beyond Bones in Chronic Obstructive Pulmonary Disease: Time to Act
Am. J. Respir. Crit. Care Med., April 15, 2009; 179(8): 630 - 636.
[Abstract] [Full Text] [PDF]

T. Troosters, D. Langer, B. Vrijsen, J. Segers, K. Wouters, W. Janssens, R. Gosselink, M. Decramer, and L. Dupont
Skeletal muscle weakness, exercise tolerance and physical activity in adults with cystic fibrosis
Eur. Respir. J., January 1, 2009; 33(1): 99 - 106.
[Abstract] [Full Text] [PDF]

E Barreiro, R Rabinovich, J Marin-Corral, J A Barbera, J Gea, and J Roca
Chronic endurance exercise induces quadriceps nitrosative stress in patients with severe COPD
Thorax, January 1, 2009; 64(1): 13 - 19.
[Abstract] [Full Text] [PDF]

C. Vassaux, L. Torre-Bouscoulet, S. Zeineldine, F. Cortopassi, H. Paz-Diaz, B. R. Celli, and V. M. Pinto-Plata
Effects of hyperinflation on the oxygen pulse as a marker of cardiac performance in COPD
Eur. Respir. J., November 1, 2008; 32(5): 1275 - 1282.
[Abstract] [Full Text] [PDF]

A E Holland, C J Hill, M Conron, P Munro, and C F McDonald
Short term improvement in exercise capacity and symptoms following exercise training in interstitial lung disease
Thorax, June 1, 2008; 63(6): 549 - 554.
[Abstract] [Full Text] [PDF]

D. C. Todd, R. A. McIvor, S. O. Pugsley, and G. Cox
Approach to chronic obstructive pulmonary disease in primary care
Can Fam Physician, May 1, 2008; 54(5): 706 - 711.
[Abstract] [Full Text] [PDF]

M. D. Eisner, C. Iribarren, E. H. Yelin, S. Sidney, P. P. Katz, L. Ackerson, P. Lathon, I. Tolstykh, T. Omachi, N. Byl, et al.
Pulmonary Function and the Risk of Functional Limitation in Chronic Obstructive Pulmonary Disease
Am. J. Epidemiol., May 1, 2008; 167(9): 1090 - 1101.
[Abstract] [Full Text] [PDF]

E. G. Collins, W. E. Langbein, L. Fehr, S. O'Connell, C. Jelinek, E. Hagarty, L. Edwards, D. Reda, M. J. Tobin, and F. Laghi
Can Ventilation-Feedback Training Augment Exercise Tolerance in Patients with Chronic Obstructive Pulmonary Disease?
Am. J. Respir. Crit. Care Med., April 15, 2008; 177(8): 844 - 852.
[Abstract] [Full Text] [PDF]

H. Watz, B. Waschki, C. Boehme, M. Claussen, T. Meyer, and H. Magnussen
Extrapulmonary Effects of Chronic Obstructive Pulmonary Disease on Physical Activity: A Cross-sectional Study
Am. J. Respir. Crit. Care Med., April 1, 2008; 177(7): 743 - 751.
[Abstract] [Full Text] [PDF]

C. G. Cote, C. Casanova, J. M. Marin, M. V. Lopez, V. Pinto-Plata, M. M. de Oca, L. J. Dordelly, H. Nekach, and B. R. Celli
Validation and comparison of reference equations for the 6-min walk distance test
Eur. Respir. J., March 1, 2008; 31(3): 571 - 578.
[Abstract] [Full Text] [PDF]

M. Cazzola, W. MacNee, F. J. Martinez, K. F. Rabe, L. G. Franciosi, P. J. Barnes, V. Brusasco, P. S. Burge, P. M. A. Calverley, B. R. Celli, et al.
Outcomes for COPD pharmacological trials: from lung function to biomarkers
Eur. Respir. J., February 1, 2008; 31(2): 416 - 469.
[Abstract] [Full Text] [PDF]

N. S Hopkinson, K. W. Li, A. Kehoe, S. E Humphries, M. Roughton, J. Moxham, H. Montgomery, and M. I Polkey
Vitamin D receptor genotypes influence quadriceps strength in chronic obstructive pulmonary disease
Am. J. Clinical Nutrition, February 1, 2008; 87(2): 385 - 390.
[Abstract] [Full Text] [PDF]

E Barreiro, A M W J Schols, M I Polkey, J B Galdiz, H R Gosker, E B Swallow, C Coronell, J Gea, and on behalf of the ENIGMA in COPD project
Cytokine profile in quadriceps muscles of patients with severe COPD
Thorax, February 1, 2008; 63(2): 100 - 107.
[Abstract] [Full Text] [PDF]

M. I. Lewis, M. Fournier, T. W. Storer, S. Bhasin, J. Porszasz, S.-G. Ren, X. Da, and R. Casaburi
Skeletal muscle adaptations to testosterone and resistance training in men with COPD
J Appl Physiol, October 1, 2007; 103(4): 1299 - 1310.
[Abstract] [Full Text] [PDF]

S. Radom-Aizik, N. Kaminski, S. Hayek, H. Halkin, D. M. Cooper, and I. Ben-Dov
Effects of exercise training on quadriceps muscle gene expression in chronic obstructive pulmonary disease
J Appl Physiol, May 1, 2007; 102(5): 1976 - 1984.
[Abstract] [Full Text] [PDF]

A. L. Ries, G. S. Bauldoff, B. W. Carlin, R. Casaburi, C. F. Emery, D. A. Mahler, B. Make, C. L. Rochester, R. ZuWallack, and C. Herrerias
Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines
Chest, May 1, 2007; 131(5_suppl): 4S - 42S.
[Abstract] [Full Text] [PDF]

M. C Steiner
Sarcopaenia in chronic obstructive pulmonary disease
Thorax, February 1, 2007; 62(2): 101 - 103.
[Full Text] [PDF]

E. B Swallow, D. Reyes, N. S Hopkinson, W. D-C Man, R. Porcher, E. J Cetti, A. J Moore, J. Moxham, and M. I Polkey
Quadriceps strength predicts mortality in patients with moderate to severe chronic obstructive pulmonary disease
Thorax, February 1, 2007; 62(2): 115 - 120.
[Abstract] [Full Text] [PDF]

R. Casaburi
Impacting patient-centred outcomes in COPD: deconditioning
Eur. Respir. Rev., December 1, 2006; 15(99): 42 - 46.
[Abstract] [Full Text] [PDF]

P. M. A. Calverley
Exercise and dyspnoea in COPD
Eur. Respir. Rev., December 1, 2006; 15(100): 72 - 79.
[Abstract] [Full Text] [PDF]

L. Nici, C. Donner, E. Wouters, R. Zuwallack, N. Ambrosino, J. Bourbeau, M. Carone, B. Celli, M. Engelen, B. Fahy, et al.
American thoracic society/european respiratory society statement on pulmonary rehabilitation.
Am. J. Respir. Crit. Care Med., June 15, 2006; 173(12): 1390 - 1413.
[Full Text] [PDF]

I. Vivodtzev, J.-L. Pepin, G. Vottero, V. Mayer, B. Porsin, P. Levy, and B. Wuyam
Improvement in Quadriceps Strength and Dyspnea in Daily Tasks After 1 Month of Electrical Stimulation in Severely Deconditioned and Malnourished COPD
Chest, June 1, 2006; 129(6): 1540 - 1548.
[Abstract] [Full Text] [PDF]

V. Z. Dourado, L. C. d. O. Antunes, S. E. Tanni, S. A. R. de Paiva, C. R. Padovani, and I. Godoy
Relationship of Upper-Limb and Thoracic Muscle Strength to 6-min Walk Distance in COPD Patients
Chest, March 1, 2006; 129(3): 551 - 557.
[Abstract] [Full Text] [PDF]

N. S. Hill
Pulmonary rehabilitation.
Proceedings of the ATS, January 1, 2006; 3(1): 66 - 74.
[Abstract] [Full Text] [PDF]

I. Vogiatzis, G. Terzis, S. Nanas, G. Stratakos, D. C. M. Simoes, O. Georgiadou, S. Zakynthinos, and C. Roussos
Skeletal Muscle Adaptations to Interval Training in Patients With Advanced COPD
Chest, December 1, 2005; 128(6): 3838 - 3845.
[Abstract] [Full Text] [PDF]

S. I. Rennard and J. A. Stoner
Challenges and Opportunities for Combination Therapy in Chronic Obstructive Pulmonary Disease
Proceedings of the ATS, November 1, 2005; 2(4): 391 - 393.
[Abstract] [Full Text] [PDF]

M. Van Vliet, M. A. Spruit, G. Verleden, A. Kasran, E. Van Herck, F. Pitta, R. Bouillon, and M. Decramer
Hypogonadism, Quadriceps Weakness, and Exercise Intolerance in Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., November 1, 2005; 172(9): 1105 - 1111.
[Abstract] [Full Text] [PDF]

C. G. Cote and B. R. Celli
Pulmonary rehabilitation and the BODE index in COPD
Eur. Respir. J., October 1, 2005; 26(4): 630 - 636.
[Abstract] [Full Text] [PDF]

K Hill and P R Eastwood
Respiratory muscle training: the con argument
Chronic Respiratory Disease, October 1, 2005; 2(4): 223 - 224.
[PDF]

W D-C Man, N S Hopkinson, F Harraf, D Nikoletou, M I Polkey, and J Moxham
Abdominal muscle and quadriceps strength in chronic obstructive pulmonary disease
Thorax, September 1, 2005; 60(9): 718 - 722.
[Abstract] [Full Text] [PDF]

C. Ai-Ping, K.-H. Lee, and T.-K. Lim
In-Hospital and 5-Year Mortality of Patients Treated in the ICU for Acute Exacerbation of COPD: A Retrospective Study
Chest, August 1, 2005; 128(2): 518 - 524.
[Abstract] [Full Text] [PDF]

M. A Spruit
Enhanced physiotherapy management of acute exacerbations of chronic obstructive pulmonary disease
Chronic Respiratory Disease, July 1, 2005; 2(3): 117 - 119.
[PDF]

J P Fuld, L P Kilduff, J A Neder, Y Pitsiladis, M E J Lean, S A Ward, and M M Cotton
Creatine supplementation during pulmonary rehabilitation in chronic obstructive pulmonary disease
Thorax, July 1, 2005; 60(7): 531 - 537.
[Abstract] [Full Text] [PDF]

T. Troosters, R. Casaburi, R. Gosselink, and M. Decramer
Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., July 1, 2005; 172(1): 19 - 38.
[Full Text] [PDF]

J. P Mattson and J. C Martin
Emphysema-induced reductions in locomotory skeletal muscle contractile function
Exp Physiol, July 1, 2005; 90(4): 519 - 525.
[Abstract] [Full Text] [PDF]

O. Nishiyama, H. Taniguchi, Y. Kondoh, T. Kimura, T. Ogawa, F. Watanabe, and S. Arizono
Quadriceps Weakness Is Related to Exercise Capacity in Idiopathic Pulmonary Fibrosis
Chest, June 1, 2005; 127(6): 2028 - 2033.
[Abstract] [Full Text] [PDF]

M A Spruit, M J Thomeer, R Gosselink, T Troosters, A Kasran, A J T Debrock, M G Demedts, and M Decramer
Skeletal muscle weakness in patients with sarcoidosis and its relationship with exercise intolerance and reduced health status
Thorax, January 1, 2005; 60(1): 32 - 38.
[Abstract] [Full Text] [PDF]

C. Opasich, S. De Feo, G. D. Pinna, G. Furgi, R. Pedretti, D. Scrutinio, and R. Tramarin
Distance Walked in the 6-Minute Test Soon After Cardiac Surgery: Toward an Efficient Use in the Individual Patient
Chest, December 1, 2004; 126(6): 1796 - 1801.
[Abstract] [Full Text] [PDF]

W.D-C. Man, J. Moxham, and M.I. Polkey
Magnetic stimulation for the measurement of respiratory and skeletal muscle function
Eur. Respir. J., November 1, 2004; 24(5): 846 - 860.
[Abstract] [Full Text] [PDF]

R. Casaburi, S. Bhasin, L. Cosentino, J. Porszasz, A. Somfay, M. I. Lewis, M. Fournier, and T. W. Storer
Effects of Testosterone and Resistance Training in Men with Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., October 15, 2004; 170(8): 870 - 878.
[Abstract] [Full Text] [PDF]

B Polla, G D'Antona, R Bottinelli, and C Reggiani
Respiratory muscle fibres: specialisation and plasticity
Thorax, September 1, 2004; 59(9): 808 - 817.
[Abstract] [Full Text] [PDF]

N. S. Hopkinson, A. H. Nickol, J. Payne, E. Hawe, W. D.-C. Man, J. Moxham, H. Montgomery, and M. I. Polkey
Angiotensin Converting Enzyme Genotype and Strength in Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., August 15, 2004; 170(4): 395 - 399.
[Abstract] [Full Text] [PDF]

N. J. M. Cano, C. Pichard, H. Roth, I. Court-Fortune, L. Cynober, M. Gerard-Boncompain, A. Cuvelier, J.-P. Laaban, J.-C. Melchior, J.-C. Raphael, et al.
C-Reactive Protein and Body Mass Index Predict Outcome in End-Stage Respiratory Failure
Chest, August 1, 2004; 126(2): 540 - 546.
[Abstract] [Full Text] [PDF]

J Allaire, F Maltais, J-F Doyon, M Noel, P LeBlanc, G Carrier, C Simard, and J Jobin
Peripheral muscle endurance and the oxidative profile of the quadriceps in patients with COPD
Thorax, August 1, 2004; 59(8): 673 - 678.
[Abstract] [Full Text] [PDF]

C. Coronell, M. Orozco-Levi, R. Mendez, A. Ramirez-Sarmiento, J.B. Galdiz, and J. Gea
Relevance of assessing quadriceps endurance in patients with COPD
Eur. Respir. J., July 1, 2004; 24(1): 129 - 136.
[Abstract] [Full Text] [PDF]

M. J. Mador, E. Bozkanat, A. Aggarwal, M. Shaffer, and T. J. Kufel
Endurance and Strength Training in Patients With COPD
Chest, June 1, 2004; 125(6): 2036 - 2045.
[Abstract] [Full Text] [PDF]

T Troosters
Endurance versus strength training in chronic obstructive pulmonary disease 2) Resistance training
Chronic Respiratory Disease, January 1, 2004; 1(1): 40 - 41.
[PDF]

K. E. Sietsema and F. X. McCormack
Lymphangioleiomyomatosis: Insights about, and from, a Rare Disease
Am. J. Respir. Crit. Care Med., December 15, 2003; 168(12): 1405 - 1406.
[Full Text] [PDF]

R.T. Jagoe and M.P.K.J. Engelen
Muscle wasting and changes in muscle protein metabolism in chronic obstructive pulmonary disease
Eur. Respir. J., November 2, 2003; 22(46_suppl): 52s - 63s.
[Abstract] [Full Text] [PDF]

A.A. Ionescu and E. Schoon
Osteoporosis in chronic obstructive pulmonary disease
Eur. Respir. J., November 2, 2003; 22(46_suppl): 64s - 75s.
[Abstract] [Full Text] [PDF]

E. Monninkhof, P. van der Valk, J. van der Palen, C. van Herwaarden, and G. Zielhuis
Effects of a comprehensive self-management programme in patients with chronic obstructive pulmonary disease
Eur. Respir. J., November 1, 2003; 22(5): 815 - 820.
[Abstract] [Full Text] [PDF]

M A Spruit, R Gosselink, T Troosters, A Kasran, G Gayan-Ramirez, P Bogaerts, R Bouillon, and M Decramer
Muscle force during an acute exacerbation in hospitalised patients with COPD and its relationship with CXCL8 and IGF-I
Thorax, September 1, 2003; 58(9): 752 - 756.
[Abstract] [Full Text] [PDF]

W. D.-C. Man, M. G. G. Soliman, J. Gearing, S. G. Radford, G. F. Rafferty, B. J. Gray, M. I. Polkey, and J. Moxham
Symptoms and Quadriceps Fatigability after Walking and Cycling in Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., September 1, 2003; 168(5): 562 - 567.
[Abstract] [Full Text] [PDF]

R. Casaburi
Limitation to Exercise Tolerance in Chronic Obstructive Pulmonary Disease: Look to the Muscles of Ambulation
Am. J. Respir. Crit. Care Med., August 15, 2003; 168(4): 409 - 410.
[Full Text] [PDF]

K. H. Groenewegen, A. M.W.J. Schols, and E. F.M. Wouters
Mortality and Mortality-Related Factors After Hospitalization for Acute Exacerbation of COPD
Chest, August 1, 2003; 124(2): 459 - 467.
[Abstract] [Full Text] [PDF]

W D-C Man, M G G Soliman, D Nikoletou, M L Harris, G F Rafferty, N Mustfa, M I Polkey, and J Moxham
Non-volitional assessment of skeletal muscle strength in patients with chronic obstructive pulmonary disease
Thorax, August 1, 2003; 58(8): 665 - 669.
[Abstract] [Full Text] [PDF]

D. Y. Sue
Peripheral Muscle Dysfunction in Patients With COPD: Comparing Apples to Apples?
Chest, July 1, 2003; 124(1): 1 - 4.
[Full Text] [PDF]

Y. F. Heijdra, V. Pinto-Plata, R. Frants, J. Rassulo, L. Kenney, and B. R. Celli
Muscle Strength and Exercise Kinetics in COPD Patients With a Normal Fat-Free Mass Index Are Comparable to Control Subjects
Chest, July 1, 2003; 124(1): 75 - 82.
[Abstract] [Full Text] [PDF]

E. Zanotti, G. Felicetti, M. Maini, and C. Fracchia
Peripheral Muscle Strength Training in Bed-Bound Patients With COPD Receiving Mechanical Ventilation: Effect of Electrical Stimulation
Chest, July 1, 2003; 124(1): 292 - 296.
[Abstract] [Full Text] [PDF]

M. J. Mador, O. Deniz, A. Aggarwal, and T. J. Kufel
Quadriceps Fatigability after Single Muscle Exercise in Patients with Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., July 1, 2003; 168(1): 102 - 108.
[Abstract] [Full Text] [PDF]

A. Couillard, F. Maltais, D. Saey, R. Debigare, A. Michaud, C. Koechlin, P. LeBlanc, and C. Prefaut
Exercise-induced Quadriceps Oxidative Stress and Peripheral Muscle Dysfunction in Patients with Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., June 15, 2003; 167(12): 1664 - 1669.
[Abstract] [Full Text] [PDF]

D. J. Bihari, F. S.S. Leijten, M. A. Spruit, B. Nemery, M. Decramer, M. S. Herridge, and the Toronto ARDS Outcomes Group
Survivors of the Acute Respiratory Distress Syndrome
N. Engl. J. Med., May 22, 2003; 348(21): 2149 - 2150.
[Full Text] [PDF]

H. R. Gosker, N. H. M. K. Lencer, F. M. E. Franssen, G. J. van der Vusse, E. F. M. Wouters, and A. M. W. J. Schols
Striking Similarities in Systemic Factors Contributing to Decreased Exercise Capacity in Patients With Severe Chronic Heart Failure or COPD
Chest, May 1, 2003; 123(5): 1416 - 1424.
[Abstract] [Full Text] [PDF]

M. J. Mador, E. Bozkanat, and T. J. Kufel
Quadriceps Fatigue After Cycle Exercise in Patients With COPD Compared With Healthy Control Subjects
Chest, April 1, 2003; 123(4): 1104 - 1111.
[Abstract] [Full Text] [PDF]

ATS/ACCP Statement on Cardiopulmonary Exercise Testing
Am. J. Respir. Crit. Care Med., January 15, 2003; 167(2): 211 - 277.
[Full Text] [PDF]

K. Marquis, R. Debigare, Y. Lacasse, P. LeBlanc, J. Jobin, G. Carrier, and F. Maltais
Midthigh Muscle Cross-Sectional Area Is a Better Predictor of Mortality than Body Mass Index in Patients with Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., September 15, 2002; 166(6): 809 - 813.
[Abstract] [Full Text]

T. Troosters, J. Vilaro, R. Rabinovich, A. Casas, J.A. Barbera, R. Rodriguez-Roisin, and J. Roca
Physiological responses to the 6-min walk test in patients with chronic obstructive pulmonary disease
Eur. Respir. J., September 1, 2002; 20(3): 564 - 569.
[Abstract] [Full Text] [PDF]

F. Lotters, B. van Tol, G. Kwakkel, and R. Gosselink
Effects of controlled inspiratory muscle training in patients with COPD: a meta-analysis
Eur. Respir. J., September 1, 2002; 20(3): 570 - 577.
[Abstract] [Full Text] [PDF]

F. Ortega, J. Toral, P. Cejudo, R. Villagomez, H. Sanchez, J. Castillo, and T. Montemayor
Comparison of Effects of Strength and Endurance Training in Patients with Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., September 1, 2002; 166(5): 669 - 674.
[Abstract] [Full Text] [PDF]

T. Troosters, R. Gosselink, M. Decramer, T. M Steffen, T. A Hacker, and L. Mollinger
Six-Minute Walk Test: A Valuable Test, When Properly Standardized
Physical Therapy, August 1, 2002; 82(8): 826 - 828.
[Full Text]

H. R Gosker, M. P. Engelen, H. van Mameren, P. J van Dijk, G. J van der Vusse, E. F. Wouters, and A. M. Schols
Muscle fiber type IIX atrophy is involved in the loss of fat-free mass in chronic obstructive pulmonary disease
Am. J. Clinical Nutrition, July 1, 2002; 76(1): 113 - 119.
[Abstract] [Full Text] [PDF]

M.A. Spruit, R. Gosselink, T. Troosters, K. De Paepe, and M. Decramer
Resistance versus endurance training in patients with COPD and peripheral muscle weakness
Eur. Respir. J., June 1, 2002; 19(6): 1072 - 1078.
[Abstract] [Full Text] [PDF]

J A Neder, D Sword, S A Ward, E Mackay, L M Cochrane, and C J Clark
Home based neuromuscular electrical stimulation as a new rehabilitative strategy for severely disabled patients with chronic obstructive pulmonary disease (COPD)
Thorax, April 1, 2002; 57(4): 333 - 337.
[Abstract] [Full Text] [PDF]

A. Somfay, J. Porszasz, S.-M. Lee, and R. Casaburi
Effect of Hyperoxia on Gas Exchange and Lactate Kinetics Following Exercise Onset in Nonhypoxemic COPD Patients
Chest, February 1, 2002; 121(2): 393 - 400.
[Abstract] [Full Text] [PDF]

P W Jones
Health status measurement in chronic obstructive pulmonary disease
Thorax, November 1, 2001; 56(11): 880 - 887.
[Abstract] [Full Text] [PDF]

D. E. O'DONNELL, S. M. REVILL, and K. A. WEBB
Dynamic Hyperinflation and Exercise Intolerance in Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., September 1, 2001; 164(5): 770 - 777.
[Abstract] [Full Text] [PDF]

O. Diaz, C. Villafranca, H. Ghezzo, G. Borzone, A. Leiva, J. Milic-Emili, and C. Lisboa
Breathing pattern and gas exchange at peak exercise in COPD patients with and without tidal flow limitation at rest
Eur. Respir. J., June 1, 2001; 17(6): 1120 - 1127.
[Abstract] [Full Text] [PDF]

J.G. Gea, M. Pasto, M.A. Carmona, M. Orozco-Levi, J. Palomeque, and J. Broquetas
Metabolic characteristics of the deltoid muscle in patients with chronic obstructive pulmonary disease
Eur. Respir. J., May 1, 2001; 17(5): 939 - 945.
[Abstract] [Full Text] [PDF]

L. J. DOWSON, C. NEWALL, P. J. GUEST, S. L. HILL, and R. A. STOCKLEY
Exercise Capacity Predicts Health Status in {alpha}1-Antitrypsin Deficiency
Am. J. Respir. Crit. Care Med., March 15, 2001; 163(4): 936 - 941.
[Abstract] [Full Text]

A.M.W.J. Schols, G. Wesseling, A.D.M. Kester, G. de Vries, R. Mostert, J. Slangen, and E.F.M. Wouters
Dose dependent increased mortality risk in COPD patients treated with oral glucocorticoids
Eur. Respir. J., March 1, 2001; 17(3): 337 - 342.
[Abstract] [Full Text] [PDF]

M. Yoshikawa, T. Yoneda, H. Takenaka, A. Fukuoka, Y. Okamoto, N. Narita, and K. Nezu
Distribution of Muscle Mass and Maximal Exercise Performance in Patients With COPD
Chest, January 1, 2001; 119(1): 93 - 98.
[Abstract] [Full Text] [PDF]

M C Steiner and M D L Morgan
Enhancing physical performance in chronic obstructive pulmonary disease
Thorax, January 1, 2001; 56(1): 73 - 77.
[Full Text]

D. Murciano, A. Ferretti, J. Boczkowski, C. Sleiman, M. Fournier, and J. Milic-Emili
Flow Limitation and Dynamic Hyperinflation During Exercise in COPD Patients After Single Lung Transplantation
Chest, November 1, 2000; 118(5): 1248 - 1254.
[Abstract] [Full Text] [PDF]

V. Noonan and E. Dean
Submaximal Exercise Testing: Clinical Application and Interpretation
Physical Therapy, August 1, 2000; 80(8): 782 - 807.
[Abstract] [Full Text] [PDF]

L. M A Heunks and P N R. Dekhuijzen
Respiratory muscle function and free radicals: from cell to COPD
Thorax, August 1, 2000; 55(8): 704 - 716.
[Full Text]

M. T. E. Hernandez, T. M. Rubio, F. O. Ruiz, H. S. Riera, R. S. Gil, and J. C. Gomez
Results of a Home-Based Training Program for Patients With COPD
Chest, July 1, 2000; 118(1): 106 - 114.
[Abstract] [Full Text] [PDF]

L. M. A. Heunks, A. Bast, C. L. A. van Herwaarden, G. R. M. M. Haenen, and P. N. R. Dekhuijzen
Effects of emphysema and training on glutathione oxidation in the hamster diaphragm
J Appl Physiol, June 1, 2000; 88(6): 2054 - 2061.
[Abstract] [Full Text] [PDF]

H. R Gosker, E. F. Wouters, G. J van der Vusse, and A. M. Schols
Skeletal muscle dysfunction in chronic obstructive pulmonary disease and chronic heart failure: underlying mechanisms and therapy perspectives
Am. J. Clinical Nutrition, May 1, 2000; 71(5): 1033 - 1047.
[Abstract] [Full Text] [PDF]

R. Casaburi
Skeletal Muscle Function in COPD
Chest, May 1, 2000; 117(5_suppl_1): 267S - 271S.
[Abstract] [Full Text] [PDF]

M. P. Engelen, A. M. Schols, J. D Does, and E. F. Wouters
Skeletal muscle weakness is associated with wasting of extremity fat-free mass but not with airflow obstruction in patients with chronic obstructive pulmonary disease
Am. J. Clinical Nutrition, March 1, 2000; 71(3): 733 - 738.
[Abstract] [Full Text] [PDF]

M. JEFFERY MADOR, T. J. KUFEL, and L. PINEDA
Quadriceps Fatigue after Cycle Exercise in Patients with Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., February 1, 2000; 161(2): 447 - 453.
[Abstract] [Full Text]

A. Baydur
Improvements in Lung and Respiratory Muscle Function Following Lung Volume Reduction Surgery : Smaller May Be Better, But How Long Does It Last?
Chest, December 1, 1999; 116(6): 1507 - 1509.
[Full Text] [PDF]

L. M. A. Heunks, J. Vina, C. L. A. van Herwaarden, H. T. M. Folgering, A. Gimeno, and P. N. R. Dekhuijzen
Xanthine oxidase is involved in exercise-induced oxidative stress in chronic obstructive pulmonary disease
Am J Physiol Regulatory Integrative Comp Physiol, December 1, 1999; 277(6): R1697 - R1704.
[Abstract] [Full Text] [PDF]