Am. J. Respir. Crit. Care Med., Volume 161, Number 2, February 2000, 447-453

Quadriceps Fatigue after Cycle Exercise in Patients with Chronic Obstructive Pulmonary Disease

M. JEFFERY MADOR, THOMAS J. KUFEL, and LILIBETH PINEDA

The Division of Pulmonary and Critical Care Medicine, State University of New York at Buffalo, and the VA Western New York Healthcare System, Buffalo, New York

Patients with COPD have derangements in respiratory mechanics that may cause them to stop exercising before the exercising limb muscles reach their functional limits. However, because lung disease makes activity unpleasant, patients with chronic obstructive pulmonary disease (COPD) often adapt a sedentary lifestyle leading to progressive deconditioning. Deconditioning will lead to progressive deterioration in limb muscle function, which could adversely affect exercise capacity. The purpose of this study was to determine whether fatigue of the quadriceps muscle occurs after high intensity cycle exercise to the limits of tolerance in patients with moderate to severe COPD. Nineteen male patients with COPD (FEV₁ 1.54 ± 0.12 L; 42 ± 3% predicted) exercised at 60 to 70% of their predetermined maximal work capacity until exhaustion. The femoral nerve was supramaximally stimulated with a figure-of-eight magnetic coil, and quadriceps twitch force (TwQ) was measured before and at 10, 30, and 60 min postexercise. Patients exercised at 53.7 ± 4.1 watts for 10.4 ± 1.4 min. Peak O₂ was 1.24 ± 0.08 L/min (51.3 ± 3.6% predicted). TwQ fell significantly postexercise; 79.2 ± 5.4% of baseline value at 10 min postexercise (p < 0.005), 75.7 ± 4.8% at 30 min postexercise (p < 0.001), and 84.0 ± 5.0% at 60 min postexercise (p < 0.005). Acceptable M-waves from the quadriceps muscle (not obscured by stimulus artifact) were obtained in six subjects. M-wave amplitude was unchanged from baseline at all times postexercise indicating that the fall in TwQ was due to contractile fatigue and not to transmission failure. In conclusion, contractile fatigue of the quadriceps muscle occurs after high intensity cycle exercise to the limits of tolerance in patients with COPD.

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