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Reduced Mechanical Efficiency in Chronic Obstructive Pulmonary Disease but Normal Peak O₂ with Small Muscle Mass Exercise

Department of Medicine, University of California San Diego, La Jolla, California

Correspondence and requests for reprints should be addressed to Russell S. Richardson, Ph.D., Department of Medicine, 0623, University of California San Diego, La Jolla, CA 92093-0623. E-mail: rrichardson{at}ucsd.edu

We studied six patients with chronic obstructive pulmonary disease (COPD) (FEV₁ = 1.1 ± 0.2 L, 32% of predicted) and six age- and activity level–matched control subjects while performing both maximal bicycle exercise and single leg knee-extensor exercise. Arterial and femoral venous blood sampling, thermodilution blood flow measurements, and needle biopsies allowed the assessment of muscle oxygen supply, utilization, and structure. Maximal work rates and single leg O₂max (control subjects = 0.63 ± 0.1; patients with COPD = 0.37 ± 0.1 L/minute) were significantly greater in the control group during bicycle exercise. During knee-extensor exercise this difference in O₂max disappeared, whereas maximal work capacity was reduced (flywheel resistance: control subjects = 923 ± 198; patients with COPD = 612 ± 81 g) revealing a significantly reduced mechanical efficiency (work per unit oxygen consumed) with COPD. The patients had an elevated number of less efficient type II muscle fibers, whereas muscle fiber cross-sectional areas, capillarity, and mitochondrial volume density were not different between the groups. Therefore, although metabolic capacity per se is unchanged, fiber type differences associated with COPD may account for the reduced muscular mechanical efficiency that becomes clearly apparent during knee-extensor exercise, when muscle function is no longer overshadowed by the decrement in lung function.

Key Words: lung disease • oxygen consumption • blood flow • fiber type • quadriceps

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