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Published ahead of print on June 26, 2003, doi:10.1164/rccm.200302-162OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 5, September 2003, 562-567

A more recent version of this article appeared on September 1, 2003
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Submitted on February 6, 2003
Accepted on June 24, 2003

Symptoms and Quadriceps Fatiguability Following Walking and Cycling in COPD

William D-C Man1*, Mohamed G. G. Soliman2, Johanne Gearing2, Sheena G Radford1, Gerrard F Rafferty1, Barry J Gray1, Michael I Polkey3, and John Moxham1

1 Respiratory Muscle Laboratory, Guy's King's and St Thomas' School of Medicine, King's College Hospital, London, United Kingdom, 2 Physiotherapy, King's College Hospital, London, United Kingdom, 3 Respiratory Muscle Laboratory, Royal Brompton Hospital, London, United Kingdom

* To whom correspondence should be addressed. E-mail: william.man{at}kcl.ac.uk.

Patients with chronic obstructive pulmonary disease may stop cycling due to leg effort rather than breathlessness. However cycling is not relevant to many patients, whilst walking may be more familiar. 84 patients with chronic obstructive pulmonary disease 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 following incremental walking compared with incremental cycling (81% versus 34%; p<0.001), and following endurance walking compared with endurance cycling (75% versus 29%; p<0.001). In addition, there was no significant change in mean pre- and post- walking twitch quadriceps tensions. However cycling produced a significant reduction (unpotentiated 7.42±2.22 versus 6.48±2.09 kilograms [p<0.001]; potentiated 10.19±3.99 versus 8.45±3.18 kilograms [p<0.001]). Pre- to post- exercise changes were significantly greater during cycling compared with walking (unpotentiated p=0.01; potentiated p=0.003). Leg effort is an infrequent symptom following walking in chronic obstructive pulmonary disease, and low frequency fatigue of the quadriceps is an infrequent feature of incremental walking.
Key words: magnetic stimulation, exercise, peripheral muscle




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