Am. J. Respir. Crit. Care Med., Volume 159, Number 3, March 1999, 881-885

Evidence of Skeletal Muscle Metabolic Reserve During Whole Body Exercise in Patients with Chronic Obstructive Pulmonary Disease

R. S. RICHARDSON, J. SHELDON, D. C. POOLE, S. R. HOPKINS, A. L. RIES, and P. D. WAGNER

Department of Medicine, University of California San Diego, La Jolla, California, and Department of Anatomy and Physiology, Kansas State University, Manhattan, Kansas

When freed from central cardiorespiratory limitations, healthy human skeletal muscle has exhibited a significant metabolic reserve. We studied the existence of this reserve in 10 severely compromised (FEV₁ = 0.97 ± SE 0.01) patients with chronic obstructive pulmonary disease (COPD). To manipulate O₂ supply and O₂ demand in locomotor and respiratory muscles, subjects performed both maximal conventional two-legged cycle ergometry (large muscle mass) and single-leg knee extensor exercise (KE, small muscle mass) while breathing room air (RA), 100% O₂, and 79% helium + 21% O₂ (HeO₂). With each gas mixture, peak ventilation, peak heart rate, and perceived breathlessness were lower in KE than cycle exercise (p < 0.05). Arterial O₂ saturation and maximal work capacity increased in both exercise modalities while subjects breathed 100% O₂ (work: +10% bike, +25% KE, p < 0.05). HeO₂ increased maximal work capacity on the cycle (+14%, p < 0.05) but had no effect on KE. HeO₂ resulted in the greatest maximum minute ventilation in both bike and KE (p < 0.05) but had no effect on arterial O₂ saturation. Thus, a skeletal muscle metabolic reserve in these patients with COPD is evidenced by: (1) greater muscle mass specific work in KE; (2) greater work rates with higher fraction of inspired oxygen (FI_O2); (3) an even greater effect of FI_O2 during KE (i.e., when the lungs are less challenged); and (4) the positive effect of HeO₂ on bicycle work rate. This skeletal muscle metabolic reserve suggests that reduced whole body exercise capacity in COPD is the result of central restraints rather than peripheral skeletal muscle dysfunction, while the beneficial effect of 100% O₂ (with no change in maximum ventilation) suggests that the respiratory system is not the sole constraint to oxygen consumption.

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