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Am. J. Respir. Crit. Care Med., Volume 159, Number 6, June 1999, 1726-1734

Effects of Endurance Training on Skeletal Muscle Bioenergetics in Chronic Obstructive Pulmonary Disease

ERNEST SALA, JOSEP ROCA, RAMÓN M. MARRADES, JULI ALONSO, JOSÉ M. GONZALEZ de SUSO, ANGEL MORENO, JOAN ALBERT BARBERÁ, JOSEP NADAL, LLUIS de JOVER, ROBERT RODRIGUEZ-ROISIN, and PETER D. WAGNER

Servie de Pneumologia i Al·lèrgia Respiratòria, Departament de Medicina, IDIBAPS (Institut d'Investigacions Biomèdiques Pi i Sunyer), Hospital Clínic, Unitat de Medicina Preventiva i Salut Pública, Facultat de Medicina, Universitat de Barcelona, Centre Diagnòstic Pedralbes, Barcelona; Centre d'Alt Rendiment, Sant Cugat del Vallès, Spain; and Department of Medicine, Section of Physiology, University of California San Diego, La Jolla, California

Physiologic adaptations after an 8-wk endurance training program were examined in 13 patients with chronic obstructive pulmonary disease (COPD) (age, 64 ± 4 [SD] yr; FEV1, 43 ± 9% pred; PaO2, 72 ± 8 mm Hg; and PaCO2, 36 ± 2 mm Hg) and in eight healthy sedentary control subjects (61 ± 4 yr). Both pre- and post-training studies included: (1) whole-body oxygen consumption (V O2) and one-leg O2 uptake (V O2leg) during exercise; and (2) intracellular pH (pHi) and inorganic phosphate to phosphocreatine ratio ([Pi]/[PCr]) during exercise; and half-time of [PCr] recovery. After training, the two groups increased peak V O2 (p < 0.05 each) and showed a similar fall in submaximal femoral venous lactate levels (p < 0.05 each). However, control subjects increased peak V E (p < 0.01) and raised peak O2 delivery (p = 0.05), not shown in patients with COPD. Both groups increased post-training O2 extraction ratio (p < 0.05). The most consistent finding, however, was in patients with COPD, who had a substantial improvement in cellular bioenergetics: (1) half-time of [PCr] recovery fell from 50 ± 8 to 34 ± 7 s (p = 0.02); and (2) at a given submaximal work rate, [Pi]/[PCr] ratio decreased and pHi increased (p < 0.05 each). We conclude that beneficial effects of training in patients with COPD essentially occurred at muscle level during submaximal exercise.




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