Additional Effects of Nutritional Antioxidant Supplementation on Peripheral Muscle during Pulmonary Rehabilitation in COPD Patients: A Randomized Controlled Trial

Fares Gouzi, Jonathan Maury, Nelly Héraud, Nicolas Molinari, Héléna Bertet, Bronia Ayoub, Marine Blaquière, François Bughin, Philippe De Rigal, Magali Poulain, Joël Pincemail, Jean-Paul Cristol, Dalila Laoudj-Chenivesse, Jacques Mercier, Christian Préfaut, Pascal Pomiès, Maurice Hayot, Fares Gouzi, Jonathan Maury, Nelly Héraud, Nicolas Molinari, Héléna Bertet, Bronia Ayoub, Marine Blaquière, François Bughin, Philippe De Rigal, Magali Poulain, Joël Pincemail, Jean-Paul Cristol, Dalila Laoudj-Chenivesse, Jacques Mercier, Christian Préfaut, Pascal Pomiès, Maurice Hayot

Abstract

Background: Skeletal muscle dysfunction in patients with chronic obstructive pulmonary disease (COPD) is not fully reversed by exercise training. Antioxidants are critical for muscle homeostasis and adaptation to training. However, COPD patients experience antioxidant deficits that worsen after training and might impact their muscle response to training. Nutritional antioxidant supplementation in combination with pulmonary rehabilitation (PR) would further improve muscle function, oxidative stress, and PR outcomes in COPD patients.

Methods: Sixty-four COPD patients admitted to inpatient PR were randomized to receive 28 days of oral antioxidant supplementation targeting the previously observed deficits (PR antioxidant group; α-tocopherol: 30 mg/day, ascorbate: 180 mg/day, zinc gluconate: 15 mg/day, selenomethionine: 50 μg/day) or placebo (PR placebo group). PR consisted of 24 sessions of moderate-intensity exercise training. Changes in muscle endurance (primary outcome), oxidative stress, and PR outcomes were assessed.

Results: Eighty-one percent of the patients (FEV1 = 58.9 ± 20.0%pred) showed at least one nutritional antioxidant deficit. Training improved muscle endurance in the PR placebo group (+37.4 ± 45.1%, p < 0.001), without additional increase in the PR antioxidant group (-6.6 ± 11.3%; p = 0.56). Nevertheless, supplementation increased the α-tocopherol/γ-tocopherol ratio and selenium (+58 ± 20%, p < 0.001, and +16 ± 5%, p < 0.01, respectively), muscle strength (+11 ± 3%, p < 0.001), and serum total proteins (+7 ± 2%, p < 0.001), and it tended to increase the type I fiber proportion (+32 ± 17%, p = 0.07). The prevalence of muscle weakness decreased in the PR antioxidant group only, from 30.0 to 10.7% (p < 0.05).

Conclusions: While the primary outcome was not significantly improved, COPD patients demonstrate significant improvements of secondary outcomes (muscle strength and other training-refractory outcomes), suggesting a potential "add-on" effect of the nutritional antioxidant supplementation (vitamins C and E, zinc, and selenium) during PR. This trial is registered with NCT01942889.

Figures

Figure 1
Figure 1
CONSORT diagram of the COPD patient recruitment.
Figure 2
Figure 2
Box-and-whisker plots for relative change (%) in functional parameters: (a) quadriceps maximal voluntary contraction (QMVC) and (b) quadriceps type I oxidative fiber proportion. ∗p < 0.05, ∗∗p < 0.01, and ∗∗∗p < 0.001. #Group effect adjusted on the corticosteroid treatment. ##Group effect adjusted on the baseline value and interaction term.
Figure 3
Figure 3
Linear regression analysis. The change (in %) in quadriceps maximal voluntary contraction (QMVC) was independently correlated with the change in the α-tocopherol/γ-tocopherol ratio (r = 0.39, p < 0.05) in all COPD patients (a), and the change (in %) in quadriceps maximal voluntary contraction (QMVC) was independently correlated with the change in selenium (r = −0.64, p < 0.001) in all COPD patients (b).

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