This Article Full Text Full Text (PDF) Online Supplement Online Supplement All Versions of this Article: 200302-162OCv1 168/5/562    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Man, W. D.-C. Articles by Moxham, J. Search for Related Content PubMed PubMed Citation Articles by Man, W. D.-C. Articles by Moxham, J.

Symptoms and Quadriceps Fatigability after Walking and Cycling in Chronic Obstructive Pulmonary Disease

Respiratory Muscle Laboratory and Department of Physiotherapy, Guy's King's and St Thomas' School of Medicine, King's College Hospital; and Royal Brompton Hospital, London, United Kingdom

Correspondence and requests for reprints should be addressed to William Man, BSc, MBBS, MRCP, Respiratory Muscle Laboratory, Guy's King's and St Thomas' School of Medicine, King's College Hospital, Bessemer Road, London SE5 9PJ UK. E-mail: William.man{at}kcl.ac.uk

Patients with chronic obstructive pulmonary disease (COPD) may stop cycling due to leg effort rather than breathlessness. However, cycling is not relevant to many patients, although walking may be more familiar. A total of 84 patients with COPD were asked to name the predominant symptom limiting incremental shuttle walking, endurance shuttle walking, incremental cycle ergometry, and endurance cycle ergometry, performed to exhaustion on four separate days. Furthermore, quadriceps fatigability was evaluated in 12 patients by measuring unpotentiated and potentiated twitch quadriceps tensions before and 30 minutes after incremental walking and cycling. Breathlessness alone was a more commonly cited limiting symptom after incremental walking compared with incremental cycling (81 vs. 34%; p < 0.001) and after endurance walking compared with endurance cycling (75 vs. 29%; p < 0.001). In addition, there was no significant change in mean pre- and postwalking twitch quadriceps tensions. However, cycling produced a significant reduction (unpotentiated 7.42 ± 2.22 vs. 6.48 ± 2.09 kg [p < 0.001]; potentiated 10.19 ± 3.99 vs. 8.45 ± 3.18 kg [p < 0.001]). Pre- to postexercise changes were significantly greater during cycling compared with walking (unpotentiated p = 0.01; potentiated p = 0.003). Leg effort is an infrequent symptom after walking in COPD, and low frequency fatigue of the quadriceps is an infrequent feature of incremental walking.

Key Words: magnetic stimulation • rehabilitation • dyspnea

This article has been cited by other articles:

				C. Brouillard, V. Pepin, J. Milot, Y. Lacasse, and F. Maltais Endurance shuttle walking test: responsiveness to salmeterol in COPD Eur. Respir. J., March 1, 2008; 31(3): 579 - 584. [Abstract] [Full Text] [PDF]

				S. Jenkins Which is the best exercise test to assess therapeutic intervention in COPD? Chronic Respiratory Disease, February 1, 2008; 5(1): 3 - 5. [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]

				M. J. Mador Exercise Training in Patients With COPD: One Leg Is Better Than Two? Chest, February 1, 2008; 133(2): 337 - 339. [Full Text] [PDF]

				A. von Leupoldt, S. Balewski, S. Petersen, K. Taube, S. Schubert-Heukeshoven, H. Magnussen, and B. Dahme Verbal Descriptors of Dyspnea in Patients With COPD at Different Intensity Levels of Dyspnea Chest, July 1, 2007; 132(1): 141 - 147. [Abstract] [Full Text] [PDF]

				P. Palange and S. A. Ward From the authors Eur. Respir. J., May 1, 2007; 29(5): 1066 - 1067. [Full Text] [PDF]

				J. E. Cotes and J. W. Reed Recommendations on the use of exercise testing in clinical practice Eur. Respir. J., May 1, 2007; 29(5): 1064 - 1066. [Full Text] [PDF]

				M D L Morgan and S J Singh Assessing the exercise response to a bronchodilator in COPD: time to get off your bike? Thorax, April 1, 2007; 62(4): 281 - 283. [Full Text] [PDF]

				V. Pepin, J. Brodeur, Y. Lacasse, J. Milot, P. LeBlanc, F. Whittom, and F. Maltais Six-minute walking versus shuttle walking: responsiveness to bronchodilation in chronic obstructive pulmonary disease Thorax, April 1, 2007; 62(4): 291 - 298. [Abstract] [Full Text] [PDF]

				P. Palange, S. A. Ward, K-H. Carlsen, R. Casaburi, C. G. Gallagher, R. Gosselink, D. E. O'Donnell, L. Puente-Maestu, A. M. Schols, S. Singh, et al. Recommendations on the use of exercise testing in clinical practice Eur. Respir. J., January 1, 2007; 29(1): 185 - 209. [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]

				M. I. Polkey and N. S. Hopkinson Bronchoscopic lung volume reduction Eur. Respir. Rev., December 1, 2006; 15(100): 99 - 103. [Abstract] [Full Text] [PDF]

				D. A. Mahler Mechanisms and Measurement of Dyspnea in Chronic Obstructive Pulmonary Disease Proceedings of the ATS, May 1, 2006; 3(3): 234 - 238. [Abstract] [Full Text] [PDF]

				P. M. A. Calverley Dynamic Hyperinflation: Is It Worth Measuring? Proceedings of the ATS, May 1, 2006; 3(3): 239 - 244. [Abstract] [Full Text] [PDF]

				V. Pepin, D. Saey, F. Whittom, P. LeBlanc, and F. Maltais Walking versus Cycling: Sensitivity to Bronchodilation in Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., December 15, 2005; 172(12): 1517 - 1522. [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]

				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]

				N. S. Hopkinson, T. P. Toma, D. M. Hansell, P. Goldstraw, J. Moxham, D. M. Geddes, and M. I. Polkey Effect of Bronchoscopic Lung Volume Reduction on Dynamic Hyperinflation and Exercise in Emphysema Am. J. Respir. Crit. Care Med., March 1, 2005; 171(5): 453 - 460. [Abstract] [Full Text] [PDF]

				P. M. A. Calverley and N. G. Koulouris Flow limitation and dynamic hyperinflation: key concepts in modern respiratory physiology Eur. Respir. J., January 1, 2005; 25(1): 186 - 199. [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]

				N.S. Hopkinson, W.D-C. Man, M.J. Dayer, E.T. Ross, A.H. Nickol, N. Hart, J. Moxham, and M.I. Polkey Acute effect of oral steroids on muscle function in chronic obstructive pulmonary disease Eur. Respir. J., July 1, 2004; 24(1): 137 - 142. [Abstract] [Full Text] [PDF]

				W D C Man, N Mustfa, D Nikoletou, S Kaul, N Hart, G F Rafferty, N Donaldson, M I Polkey, and J Moxham Effect of salmeterol on respiratory muscle activity during exercise in poorly reversible COPD Thorax, June 1, 2004; 59(6): 471 - 476. [Abstract] [Full Text] [PDF]

				M. J. Tobin Sleep-Disordered Breathing, Control of Breathing, Respiratory Muscles, Pulmonary Function Testing in AJRCCM 2003 Am. J. Respir. Crit. Care Med., January 15, 2004; 169(2): 254 - 264. [Full Text] [PDF]

				M. J. Tobin Chronic Obstructive Pulmonary Disease, Pollution, Pulmonary Vascular Disease, Transplantation, Pleural Disease, and Lung Cancer in AJRCCM 2003 Am. J. Respir. Crit. Care Med., January 15, 2004; 169(2): 301 - 313. [Full Text] [PDF]