Is Quadriceps Endurance Reduced in COPD?: A Systematic Review

doi:10.1378/chest.14-1079

Chest

Volume 147, Issue 3, March 2015, Pages 673-684

https://doi.org/10.1378/chest.14-1079 Get rights and content

BACKGROUND

Although the aerobic profile of the quadriceps muscle is reduced in COPD, there is conflicting evidence regarding whether this leads to reduced quadriceps muscle endurance. We, therefore, performed a systematic review of studies comparing quadriceps endurance in individuals with COPD with that in healthy control subjects.

METHODS

Relevant studies were identified by searching six electronic databases (1946-2011). Full-text articles were obtained after two researchers independently reviewed the abstracts. The results were combined in a random effects meta-analysis, and metaregression models were fitted to assess the influence of the type of measurement.

RESULTS

Data were extracted from 21 studies involving 728 individuals with COPD and 440 healthy control subjects. Quadriceps endurance was reduced in those with COPD compared with healthy control subjects (standardized mean difference, 1.16 [95% CI, 1.02-1.30];P< .001) with a 44.5 s (4.5-84.5 s;P= .029) reduction in COPD (large effect size) when measured using a nonvolitional technique. The relationship between quadriceps endurance in those with COPD and control subjects did not differ when comparing nonvolitional and volitional techniques (P= .22) or when high-or low-intensity tasks (P= .44) were undertaken.

CONCLUSIONS

Quadriceps endurance is reduced in individuals with COPD compared with healthy control subjects, independent of the type of task performed.

Section snippets

Study Design

We performed a systematic review of studies comparing quadriceps endurance in individuals with COPD with healthy control subjects; our study was consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.²⁰ This study is a systematic review so no ethical approval was sought.

Eligibility Criteria

We included studies involving individuals with COPD and any measurement of quadriceps/knee extensor endurance. Eligibility required a comparison with a healthy control group. All

Identification of Studies

Figure 2 summarizes the process of identifying eligible studies. Of 349 studies, knee extensor/quadriceps muscle endurance was compared between individuals with COPD and healthy control subjects in 25. Two studies (French and Chinese) required translation (the latter was included in the final meta-analysis). Four studies (n = 88 individuals with COPD [15%] and n = 79 healthy control subjects [22%]) were excluded because of missing data, which was unavailable from the authors.24, 25, 26, 27 Data

Discussion

This systematic review and meta-analysis confirms a reduction in quadriceps muscle endurance in individuals with COPD compared with healthy control subjects (large effect size), irrespective of the type of measurement protocol used. To our knowledge, this is the first synthesis of measurements of quadriceps endurance in COPD, and it highlights the many different approaches that have been reported to examine localized muscle function in this population.

Impairment of any of the steps involved in

Conclusions

We have shown, in a large number of individuals with COPD, that quadriceps endurance is reduced compared with healthy control subjects, independent of type of task and measurement technique. In addition to the cellular changes that have been observed in muscle oxidative capacity, neuromotor changes that may contribute to the early onset of muscle fatigue should be further examined in this population. Our findings have implications for the development of pharmacologic and nonpharmacologic

Acknowledgments

Author contributions: R. A. E. is the guarantor of the paper, taking responsibility for the integrity of the work as a whole, from inception to the published article. R. A. E., R. S. G., D. B., and S. M. contributed to the study design; R. A. E. contributed to the identification of the eligible full-text studies and review of the quality assessment; E. K. contributed to the literature search; R. A. E. and E. K. contributed to the review of the abstracts for eligibility; E. K. and M. K. B.

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This provides a strong rationale for an in-depth assessment of quadriceps endurance in patients with COPD. Isokinetic, isometric, and isotonic approaches are available to volitionally assess quadriceps endurance in patients with COPD,2,7,13 amongst which isokinetic testing is most common.13 Advantages of isokinetic methods are the dynamic evaluation of muscle function while controlling for angular velocities, amplitude, and duration of movement, and its high reliability.14,15
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Pre PR, 27% of the patients performed the isokinetic test incorrectly. In male and female patients with a correct pre and post PR isokinetic test, peak torque (Δ=10±13 Nm or 9% and Δ=7±9 Nm or 10%, respectively) and total work (Δ=263±270 J or 14% and Δ=198±190 J or 15%, respectively) improved significantly. There was no change in work fatigue index following PR. Using distribution-based calculations, MID estimates for peak torque and total work ranged between 6–7 Nm and 97–135 J in males and between 4–5 Nm and 62–99 J in females.
Based on the current test criteria, three in four patients with COPD performed the isokinetic quadriceps test correctly during baseline PR assessment. Furthermore, peak torque and total work, but not work fatigue index, were responsive to PR and sex-specific MIDs were established.
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View all citing articles on Scopus

FUNDING/SUPPORT: Dr Evans was supported with a National Institute for Health Research clinical lectureship.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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Chest

Original Research: COPDIs Quadriceps Endurance Reduced in COPD?: A Systematic Review

BACKGROUND

METHODS

RESULTS

CONCLUSIONS

Section snippets

Study Design

Eligibility Criteria

Identification of Studies

Discussion

Conclusions

Acknowledgments

Respir Med

Chest

Chest

Cell

COPD as a systemic disease

COPD

ATS/ERS Ad Hoc Committee on Limb Muscle Dysfunction in COPD. 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

Systemic manifestations and comorbidities of COPD

Eur Respir J

Ultrasound measurement of rectus femoris cross-sectional area and the relationship with quadriceps strength in COPD

Thorax

Quadriceps strength predicts mortality in patients with moderate to severe chronic obstructive pulmonary disease

Thorax

Outpatient pulmonary rehabilitation following acute exacerbations of COPD

Thorax

Muscle weakness is related to utilization of health care resources in COPD patients

Eur Respir J

Histochemical and morphological characteristics of the vastus lateralis muscle in patients with chronic obstructive pulmonary disease

Med Sci Sports Exerc

Muscle fibre type shifting in the vastus lateralis of patients with COPD is associated with disease severity: a systematic review and meta-analysis

Thorax

Oxidative enzyme activities of the vastus lateralis muscle and the functional status in patients with COPD

Thorax

Relationship between ventilatory constraint and muscle fatigue during exercise in COPD

Eur Respir J

Adenine nucleotide loss in the skeletal muscles during exercise in chronic obstructive pulmonary disease

Thorax

Ventilatory limitations in chronic obstructive pulmonary disease

Med Sci Sports Exerc

Limitation of lower limb VO(2) during cycling exercise in COPD patients

J Appl Physiol (1985)

Muscle fatigue: what, why and how it influences muscle function

J Physiol

Muscle fatigue and the mechanisms of task failure

Exerc Sport Sci Rev

Maximal force and endurance to fatigue of respiratory and skeletal muscles in chronic hypoxemic patients: the effects of oxygen breathing

Muscle Nerve

PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

BMJ

Selective glycogen depletion in skeletal muscle fibres of man following sustained contractions

J Physiol

The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions

J Epidemiol Community Health

Skeletal muscle strength and endurance in patients with mild COPD and the effects of weight training

Eur Respir J

Skeletal muscle contractility is preserved in COPD patients with normal fat-free mass

Acta Physiol Scand

Quadriceps fatigability after single muscle exercise in patients with chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Original Research: COPD
Is Quadriceps Endurance Reduced in COPD?: A Systematic Review