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Effects of Low-Load/High-Repetition Resistance Training on Exercise Capacity, Health Status, and Limb Muscle Adaptation in Patients With Severe COPD

A Randomized Controlled Trial
Published:December 11, 2020DOI:https://doi.org/10.1016/j.chest.2020.12.005

      Background

      Training volume is paramount in the magnitude of physiological adaptations following resistance training. However, patients with severe COPD are limited by dyspnea during traditional two-limb low-load/high-repetition resistance training (LLHR-RT), resulting in suboptimal training volumes. During a single exercise session, single-limb LLHR-RT decreases the ventilatory load and enables higher localized training volumes compared with two-limb LLHR-RT.

      Research Question

      Does single-limb LLHR-RT lead to more profound effects compared with two-limb LLHR-RT on exercise capacity (6-min walk distance [6MWD]), health status, muscle function, and limb adaptations in patients with severe COPD?

      Study Design and Methods

      Thirty-three patients (mean age 66 ± 7 years; FEV1 39 ± 10% predicted) were randomized to 8 weeks of single- or two-limb LLHR-RT. Exercise capacity (6MWD), health status, and muscle function were compared between groups. Quadriceps muscle biopsy specimens were collected to examine physiological responses.

      Results

      Single-limb LLHR-RT did not further enhance 6MWD compared with two-limb LLHR-RT (difference, 14 [–12 to 39 m]. However, 73% in the single-limb group exceeded the known minimal clinically important difference of 30 m compared with 25% in the two-limb group (P = .02). Health status and muscle function improved to a similar extent in both groups. During training, single-limb LLHR-RT resulted in a clinically relevant reduction in dyspnea during training compared with two-limb LLHR-RT (–1.75; P = .01), but training volume was not significantly increased (23%; P = .179). Quadriceps muscle citrate synthase activity (19%; P = .03), hydroxyacyl-coenzyme A dehydrogenase protein levels (32%; P < .01), and capillary-to-fiber ratio (41%; P < .01) were increased compared with baseline after pooling muscle biopsy data from all participants.

      Interpretation

      Single-limb LLHR-RT did not further increase mean 6MWD compared with two-limb LLHR-RT, but it reduced exertional dyspnea and enabled more people to reach clinically relevant improvements in 6MWD. Independent of execution strategy, LLHR-RT improved exercise capacity, health status, muscle endurance, and enabled several physiological muscle adaptations, reducing the negative consequences of limb muscle dysfunction in COPD.

      Clinical Trial Registration

      Key Words

      Abbreviations:

      6MWD (6-min walk distance), CAT (COPD Assessment Test), CS (citrate synthase), HADH (hydroxyacyl-coenzyme A dehydrogenase), LLHR-RT (low-load/high-repetition resistance training), MCID (minimally clinically important difference), TfAM (mitochondrial transcription factor)
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      References

        • Mostert R.
        • Goris A.
        • Weling-Scheepers C.
        • Wouters E.F.
        • Schols A.M.
        Tissue depletion and health related quality of life in patients with chronic obstructive pulmonary disease.
        RespirMed. 2000; 94: 859-867
        • Decramer M.
        • Gosselink R.
        • Troosters T.
        • Verschueren M.
        • Evers G.
        Muscle weakness is related to utilization of health care resources in COPD patients.
        Eur Respir J. 1997; 10: 417-423
        • Gosselink R.
        • Troosters T.
        • Decramer M.
        Peripheral muscle weakness contributes to exercise limitation in COPD.
        Am J Respir Crit Care Med. 1996; 153: 976-980
        • Coronell C.
        • Orozco-Levi M.
        • Mendez R.
        • Ramirez-Sarmiento A.
        • Galdiz J.B.
        • Gea J.
        Relevance of assessing quadriceps endurance in patients with COPD.
        Eur Respir J. 2004; 24: 129-136
        • Marquis K.
        • Debigaré R.
        • Lacasse Y.
        • et al.
        Midthigh muscle cross-sectional area is a better predictor of mortality than body mass index in patients with chronic obstructive pulmonary disease.
        Am J Respir Crit Care Med. 2002; 166: 809-813
        • Swallow E.B.
        • Reyes D.
        • Hopkinson N.S.
        • et al.
        Quadriceps strength predicts mortality in patients with moderate to severe chronic obstructive pulmonary disease.
        Thorax. 2007; 62: 115-120
        • Maltais F.
        • Decramer M.
        • Casaburi R.
        • et al.
        An official American Thoracic Society/European Respiratory Society statement: update on limb muscle dysfunction in chronic obstructive pulmonary disease.
        Am J Respir Crit Care Med. 2014; 189: e15-e62
        • De Brandt J.
        • Spruit M.A.
        • Derave W.
        • Hansen D.
        • Vanfleteren L.E.
        • Burtin C.
        Changes in structural and metabolic muscle characteristics following exercise-based interventions in patients with COPD: a systematic review.
        Expert Rev Respir Med. 2016; 10: 521-545
        • Spruit M.A.
        • Singh S.J.
        • Garvey C.
        • et al.
        An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation.
        Am J Respir Crit Care Med. 2013; 188: e13-e64
        • Evans R.A.
        • Kaplovitch E.
        • Beauchamp M.K.
        • et al.
        Is quadriceps endurance reduced in COPD?: a systematic review.
        Chest. 2015; 147: 673-684
        • van't Hul A.
        • Harlaar J.
        • Gosselink R.
        • Hollander P.
        • Postmus P.
        • Kwakkel G.
        Quadriceps muscle endurance in patients with chronic obstructive pulmonary disease.
        Muscle Nerve. 2004; 29: 267-274
        • Nyberg A.
        • Saey D.
        • Maltais F.
        Why and how limb muscle mass and function should be measured in patients with chronic obstructive pulmonary disease.
        Ann Am Thorac Soc. 2015; 12: 1269-1277
        • Nyberg A.
        • Tornberg A.
        • Wadell K.
        Correlation between limb muscle endurance, strength, and functional capacity in people with chronic obstructive pulmonary disease.
        Physiother Can. 2016; 68: 46-53
        • American College of Sports Medicine
        American College of Sports Medicine position stand. Progression models in resistance training for healthy adults.
        Med Sci Sports Exerc. 2009; 41: 687-708
        • Liao W.H.
        • Chen J.W.
        • Chen X.
        • et al.
        Impact of resistance training in subjects with COPD: a systematic review and meta-analysis.
        Respir Care. 2015; 60: 1130-1145
        • Mador M.J.
        Exercise training in patients with COPD: one leg is better than two?.
        Chest. 2008; 133: 337-339
        • Richardson R.S.
        • Sheldon J.
        • Poole D.C.
        • Hopkins S.R.
        • Ries A.L.
        • Wagner P.D.
        Evidence of skeletal muscle metabolic reserve during whole body exercise in patients with chronic obstructive pulmonary disease.
        Am J Respir Crit Care Med. 1999; 159: 881-885
        • Dolmage T.E.
        • Goldstein R.S.
        Effects of one-legged exercise training of patients with COPD.
        Chest. 2008; 133: 370-376
        • Dolmage T.E.
        • Goldstein R.S.
        Response to one-legged cycling in patients with COPD.
        Chest. 2006; 129: 325-332
        • Bjorgen S.
        • Hoff J.
        • Husby V.S.
        • et al.
        Aerobic high intensity one and two legs interval cycling in chronic obstructive pulmonary disease: the sum of the parts is greater than the whole.
        Eur J Appl Physiol. 2009; 106: 501-507
        • Nyberg A.
        • Saey D.
        • Martin M.
        • Maltais F.
        Acute effects of low load/high-repetition single-limb resistance training in COPD.
        Med Sci Sports Exerc. 2016; 48: 2353-2361
        • Nyberg A.
        • Saey D.
        • Martin M.
        • Maltais F.
        Cardiorespiratory and muscle oxygenation responses to low-load/high-repetition resistance exercises in COPD and healthy controls.
        J Appl Physiol (1985). 2018; 124: 877-887
        • Nyberg A.
        • Lindstrom B.
        • Rickenlund A.
        • Wadell K.
        Low-load/high-repetition elastic band resistance training in patients with COPD: a randomized, controlled, multicenter trial.
        Clin Respir J. 2015; 9: 278-288
        • Moher D.
        • Hopewell S.
        • Schulz K.F.
        • et al.
        CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials.
        J Clin Epidemiol. 2010; 63: e1-e37
      1. National Institutes of Health Clinical Center. Low load, high-repetitive elastic band resistance training in COPD. NCT02283580. ClinicalTrials.gov. National Institutes of Health; 2014. Updated March 7, 2018. https://clinicaltrials.gov/ct2/show/NCT02283580

        • Nyberg A.
        • Saey D.
        • Martin M.
        • Maltais F.
        Muscular and functional effects of partitioning exercising muscle mass in patients with chronic obstructive pulmonary disease—a study protocol for a randomized controlled trial.
        Trials. 2015; 16: 194
        • Voorrips L.E.
        • Ravelli A.C.
        • Dongelmans P.C.
        • Deurenberg P.
        • Van Staveren W.A.
        A physical activity questionnaire for the elderly.
        Med Sci Sports Exerc. 1991; 23: 974-979
        • Wise R.A.
        • Brown C.D.
        Minimal Clinically important differences in the six-minute walk test and the incremental shuttle walking test.
        COPD. 2005; 2: 125-129
        • Takahashi T.
        • Jenkins S.C.
        • Strauss G.R.
        • Watson C.P.
        • Lake F.R.
        A new unsupported upper limb exercise test for patients with chronic obstructive pulmonary disease.
        J Cardiopulm Rehabil. 2003; 23: 430-437
        • Alma H.
        • de Jong C.
        • Tsiligianni I.
        • Sanderman R.
        • Kocks J.
        • van der Molen T.
        Clinically relevant differences in COPD health status: systematic review and triangulation.
        Eur Respir J. 2018; 52
        • Doucet M.
        • Dube A.
        • Joanisse D.R.
        • et al.
        Atrophy and hypertrophy signalling of the quadriceps and diaphragm in COPD.
        Thorax. 2010; 65: 963-970
        • Nyberg A.
        • Lindstrom B.
        • Wadell K.
        A cohort study to evaluate the feasibility of low load/high repetition elastic band resistance training for people with chronic obstructive pulmonary disease.
        Novel Physiotherapies. 2014; 4
        • Puhan M.A.
        • Siebeling L.
        • Frei A.
        • Zoller M.
        • Bischoff-Ferrari H.
        • Ter Riet G.
        No association of 25-hydroxyvitamin D with exacerbations in primary care patients with COPD.
        Chest. 2014; 145: 37-43
        • Li P.
        • Stuart E.A.
        Best (but oft-forgotten) practices: missing data methods in randomized controlled nutrition trials.
        Am J Clin Nutr. 2019; 109: 504-508
        • Meijer K.
        • Annegarn J.
        • Lima Passos V.
        • et al.
        Characteristics of daily arm activities in patients with COPD.
        Eur Respir J. 2014; 43: 1631-1641
        • Borde R.
        • Hortobagyi T.
        • Granacher U.
        Dose-response relationships of resistance training in healthy old adults: a systematic review and meta-analysis.
        Sports Med. 2015; 45: 1693-1720
        • Grgic J.
        • Schoenfeld B.J.
        • Davies T.B.
        • Lazinica B.
        • Krieger J.W.
        • Pedisic Z.
        Effect of resistance training frequency on gains in muscular strength: a systematic review and meta-analysis.
        Sports Med. 2018; 48: 1207-1220
        • Ribeiro F.
        • Lepine P.A.
        • Garceau-Bolduc C.
        • et al.
        Test-retest reliability of lower limb isokinetic endurance in COPD: a comparison of angular velocities.
        Int J Chron Obstruct Pulmon Dis. 2015; 10: 1163-1172
        • Shingai K.
        • Kanezaki M.
        Effect of dyspnea induced by breath-holding on maximal muscular strength of patients with COPD.
        J Phys Ther Sci. 2014; 26: 255-258
        • Laviolette L.
        • Laveneziana P.
        Dyspnoea: a multidimensional and multidisciplinary approach.
        Eur Respir J. 2014; 43: 1750-1762
        • Larsen S.
        • Nielsen J.
        • Hansen C.N.
        • et al.
        Biomarkers of mitochondrial content in skeletal muscle of healthy young human subjects.
        J Physiol. 2012; 590: 3349-3360
        • Maltais F.
        • LeBlanc P.
        • Simard C.
        • et al.
        Skeletal muscle adaptation to endurance training in patients with chronic obstructive pulmonary disease.
        Am J Respir Crit Care Med. 1996; 154: 442-447
        • Bronstad E.
        • Rognmo O.
        • Tjonna A.E.
        • et al.
        High-intensity knee extensor training restores skeletal muscle function in COPD patients.
        Eur Respir J. 2012; 40: 1130-1136
        • Iepsen U.W.
        • Munch G.D.
        • Rugbjerg M.
        • et al.
        Effect of endurance versus resistance training on quadriceps muscle dysfunction in COPD: a pilot study.
        Int J Chron Obstruct Pulmon Dis. 2016; 11: 2659-2669
        • Wood J.
        • Freemantle N.
        • King M.
        • Nazareth I.
        Trap of trends to statistical significance: likelihood of near significant P value becoming more significant with extra data.
        BMJ. 2014; 348: g2215