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Published ahead of print on April 24, 2003, doi:10.1164/rccm.200208-856OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 4, August 2003, 425-430

A more recent version of this article appeared on August 15, 2003
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Submitted on August 14, 2002
Accepted on April 21, 2003

CONTRACTILE LEG FATIGUE AFTER CYCLE EXERCISE: A FACTOR LIMITING EXERCISE IN PATIENTS WITH COPD

Didier Saey1, Richard Debigare1, Pierre LeBlanc1, M. Jeffery Mador2, Claude H Cote3, Jean Jobin1, and Francois Maltais1*

1 Institut Universitaire de Cardiologie et de Pneumologie, Universite Laval, Centre de Recherche, Hopital Laval, Quebec City, Quebec, Canada, 2 Pulmonary, Critical Care and Sleep Medicine, State University of New York at Buffalo and the Buffalo VA Medical Center, Buffalo, NY, USA, 3 Universite Laval, Centre de Recherche du CHUQ pavillion CHUL, Quebec City, Quebec, Canada

* To whom correspondence should be addressed. E-mail: francois.maltais{at}med.ulaval.ca.

We evaluated if contractile fatigue of the quadriceps occurs after cycling exercise in COPD patients and if it could contribute to exercise limitation. Eighteen COPD patients performed two constant-workrate cycling exercises up to exhaustion. These tests were preceded by nebulization of placebo or 500mg of ipratropium bromide. Muscle fatigue was defined as a post-exercise reduction in quadriceps twitch force >15% of the resting value. There was an increase in endurance time post ipratropium compared to placebo nebulization (440 ± 244 seconds vs. 322 ± 188 seconds, p = 0.06). Nine patients developed contractile fatigue after placebo exercise. In these patients, ipratropium did not increase endurance time (394 ± 220 seconds with placebo vs 400 ± 119 seconds with ipratropium) despite an 11% improvement in FEV1. In the 9 patients who did not fatigue after placebo exercise, endurance time increased from 249 ± 124 seconds with placebo to 479 ± 298 seconds with ipratropium, p < 0.05. There was a significant correlation between the improvement in endurance time with ipratropium and quadriceps twitch force at 10-min post placebo exercise(r = 0.59, p = 0.01). The occurrence of contractile fatigue during exercise may explain why bronchodilation fails to improve exercise tolerance in some COPD patients.
Key words: COPD, muscle, fatigue, exertion




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