The impact of obesity on walking and cycling performance and response to pulmonary rehabilitation in COPD

Francesco Sava, Louis Laviolette, Sarah Bernard, Marie-Josée Breton, Jean Bourbeau, François Maltais, Francesco Sava, Louis Laviolette, Sarah Bernard, Marie-Josée Breton, Jean Bourbeau, François Maltais

Abstract

Background: We examined the influence of overweight and obesity on pulmonary function, exercise tolerance, quality of life and response to pulmonary rehabilitation in COPD.

Methods: 261 patients with COPD were divided into three groups: normal body mass index (BMI), overweight and obese. Baseline and post rehabilitation pulmonary function, 6-min walking test (6MWT), endurance time during a constant workrate exercise test (CET) and St. George's Respiratory Questionnaire (SGRQ) scores were compared between all three classes of BMI.

Results: At baseline, obese and overweight patients had less severe airflow obstruction compared to normal BMI patients. There was no baseline difference in CET performance or SGRQ scores across BMI classes and 6MWT was reduced in the presence of obesity (p < 0.01). Compared to baseline, post-rehabilitation 6MWT, CET performance and SGRQ scores improved significantly in each group (p < 0.01), but 6MWT was still significantly lower in the presence of obesity.

Conclusions: Walking, but not cycling performance was worse in obese patients. This difference was maintained post rehabilitation despite significant improvements. Weight excess may counterbalance the effect of a better preserved respiratory function in the performance of daily activities such as walking. However, obesity and overweight did not influence the magnitude of improvement after pulmonary rehabilitation.

Figures

Figure 1
Figure 1
GOLD stage distribution across body mass index (BMI).
Figure 2
Figure 2
6-minute walking distance and endurance time to constant workrate exercise according to the 3 body mass index (BMI) categories, at baseline and after pulmonary rehabilitation. Values are mean (SD). * = p < 0.01 baseline versus after rehabilitation within each BMI group, † = p < 0.01 obese versus normal BMI, ‡ = p < 0.01 obese versus overweight.
Figure 3
Figure 3
Dyspnea and leg fatigue Borg scores at the end of the 6-minute walking test (6MWT) and of constant workrate cycling exercise (CET) according to the 3 body mass index (BMI) categories, at baseline and after pulmonary rehabilitation. Values are mean (SD).). * = p < 0.01 obese versus normal BMI, † = p < 0.01, obese versus overweight, ‡ = p < 0.01 baseline versus after rehabilitation within each BMI group.
Figure 4
Figure 4
Changes in St. George's Respiratory Questionnaire (SGRQ) total score with pulmonary rehabilitation according to BMI categories. The horizontal dashed line represents the minimally important clinical difference (MCID) for this variable (∆ of 4 units). Values are mean (SD).

References

    1. Schols AM, Slangen J, Volovics L, Wouters EF. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998;157:1791–1797.
    1. Bernard S, Leblanc P, Whittom F, Carrier G, Jobin J, Belleau R, Maltais F. Peripheral muscle weakness in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998;158:629–634.
    1. Ramachandran K, McCusker C, Connors M, Zuwallack R, Lahiri B. The influence of obesity on pulmonary rehabilitation outcomes in patients with COPD. Chron Respir Dis. 2008;5:205–209. doi: 10.1177/1479972308096711.
    1. Celli BR, Cote CG, Marin JM, Casanova C, Montes de OM, Mendez RA, Pinto PV, Cabral HJ. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004;350:1005–1012. doi: 10.1056/NEJMoa021322.
    1. Lazarus R, Sparrow D, Weiss ST. Effects of obesity and fat distribution on ventilatory function: the normative aging study. Chest. 1997;111:891–898. doi: 10.1378/chest.111.4.891.
    1. Salvadori A, Fanari P, Mazza P, Agosti R, Longhini E. Work capacity and cardiopulmonary adaptation of the obese subject during exercise testing. Chest. 1992;101:674–679. doi: 10.1378/chest.101.3.674.
    1. Swinburn CR, Cooper BG, Mould H, Corris PA, Gibson GJ. Adverse effect of additional weight on exercise against gravity in patients with chronic obstructive airways disease. Thorax. 1989;44:716–720. doi: 10.1136/thx.44.9.716.
    1. Jia H, Lubetkin EI. The impact of obesity on health-related quality-of-life in the general adult US population. J Public Health (Oxf) 2005;27:156–164. doi: 10.1093/pubmed/fdi025.
    1. Han TS, Tijhuis MA, Lean ME, Seidell JC. Quality of life in relation to overweight and body fat distribution. Am J Public Health. 1998;88:1814–1820. doi: 10.2105/AJPH.88.12.1814.
    1. Al SS, Ottenbacher KJ, Markides KS, Kuo YF, Eschbach K, Goodwin JS. The effect of obesity on disability vs mortality in older Americans. Arch Intern Med. 2007;167:774–780. doi: 10.1001/archinte.167.8.774.
    1. Ora J, Laveneziana P, Ofir D, Deesomchok A, Webb KA, O'Donnell DE. Combined Effects of Obesity and COPD on Dyspnea and Exercise Tolerance. Am J Respir Crit Care Med. 2009;180(10):964–71.
    1. Laviolette L, Sava F, O'Donnell DE, Webb KA, Hamilton AL, Kesten S, Maltais F. Effect of obesity on constant workrate exercise in hyperinflated men with COPD. BMC Pulm Med. 2010;10:33. doi: 10.1186/1471-2466-10-33.
    1. Lacasse Y, Martin S, Lasserson TJ, Goldstein RS. Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease. A Cochrane systematic review. Eura Medicophys. 2007;43:475–485.
    1. Landbo C, Prescott E, Lange P, Vestbo J, Almdal TP. Prognostic value of nutritional status in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999;160:1856–1861.
    1. Maltais F, Bourbeau J, Shapiro S, Lacasse Y, Perrault H, Baltzan M, Hernandez P, Rouleau M, Julien M, Parenteau S, Paradis B, Levy RD, Camp P, Lecours R, Audet R, Hutton B, Penrod JR, Picard D, Bernard S. Effects of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med. 2008;149:869–878.
    1. Laviolette L, Bourbeau J, Bernard S, Lacasse Y, Pepin V, Breton MJ, Baltzan M, Rouleau M, Maltais F. Assessing the impact of pulmonary rehabilitation on functional status in COPD. Thorax. 2008;63:115–121. doi: 10.1136/thx.2006.076844.
    1. Fletcher CM, Elmes PC, Fairbairn AS, Wood CH. The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population. Br Med J. 1959;2:257–266. doi: 10.1136/bmj.2.5147.257.
    1. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report. National Institutes of Health. Obes Res. 1998;6(Suppl 2):51S–209S.
    1. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J. Standardisation of spirometry. Eur Respir J. 2005;26:319–338. doi: 10.1183/09031936.05.00034805.
    1. Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC. Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl. 1993;16:5–40.
    1. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van WC, Zielinski J. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176:532–555. doi: 10.1164/rccm.200703-456SO.
    1. Guyatt GH, Pugsley SO, Sullivan MJ, Thompson PJ, Berman L, Jones NL, Fallen EL, Taylor DW. Effect of encouragement on walking test performance. Thorax. 1984;39:818–822. doi: 10.1136/thx.39.11.818.
    1. ATS Statement: Guidelines for the Six-Minute Walk Test. Am J Respir Crit Care Med. 2002;166:111–117.
    1. Redelmeier DA, Bayoumi AM, Goldstein RS, Guyatt GH. Interpreting small differences in functional status: the Six Minute Walk test in chronic lung disease patients. Am J Respir Crit Care Med. 1997;155:1278–1282.
    1. Chuang ML, Lin IF, Wasserman K. The body weight-walking distance product as related to lung function, anaerobic threshold and peak VO2 in COPD patients. Respir Med. 2001;95:618–626. doi: 10.1053/rmed.2001.1115.
    1. Bourbeau J, Maltais F, Rouleau M, Guimont C. French-Canadian version of the Chronic Respiratory and St George's Respiratory questionnaires: an assessment of their psychometric properties in patients with chronic obstructive pulmonary disease. Can Respir J. 2004;11:480–486.
    1. Jones PW, Quirk FH, Baveystock CM, Littlejohns P. A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire. Am Rev Respir Dis. 1992;145:1321–1327.
    1. Jones PW. St. George's Respiratory Questionnaire: MCID. COPD. 2005;2:75–79. doi: 10.1081/COPD-200050513.
    1. Ries AL. Minimally clinically important difference for the UCSD Shortness of Breath Questionnaire, Borg Scale, and Visual Analog Scale. COPD. 2005;2:105–110. doi: 10.1081/COPD-200050655.
    1. Bernard S, Whittom F, Leblanc P, Jobin J, Belleau R, Berube C, Carrier G, Maltais F. Aerobic and strength training in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999;159:896–901.
    1. Tjepkema M. Nutrition: Findings from the Canadian Community Health Survey. Statistics Canada Catalog. 2005.
    1. Eisner MD, Blanc PD, Sidney S, Yelin EH, Lathon PV, Katz PP, Tolstykh I, Ackerson L, Iribarren C. Body composition and functional limitation in COPD. Respir Res. 2007;8:7. doi: 10.1186/1465-9921-8-7.
    1. Steuten LM, Creutzberg EC, Vrijhoef HJ, Wouters EF. COPD as a multicomponent disease: inventory of dyspnoea, underweight, obesity and fat free mass depletion in primary care. Prim Care Respir J. 2006;15:84–91. doi: 10.1016/j.pcrj.2005.09.001.
    1. Schols AM. Nutritional and metabolic modulation in chronic obstructive pulmonary disease management. Eur Respir J Suppl. 2003;46:81s–86s. doi: 10.1183/09031936.03.00004611.
    1. Vestbo J, Prescott E, Almdal T, Dahl M, Nordestgaard BG, Andersen T, Sorensen TI, Lange P. Body mass, fat-free body mass, and prognosis in patients with chronic obstructive pulmonary disease from a random population sample: findings from the Copenhagen City Heart Study. Am J Respir Crit Care Med. 2006;173:79–83. doi: 10.1164/rccm.200505-969OC.
    1. Sin DD, Jones RL, Man SF. Obesity is a risk factor for dyspnea but not for airflow obstruction. Arch Intern Med. 2002;162:1477–1481. doi: 10.1001/archinte.162.13.1477.
    1. Celli BR, Thomas NE, Anderson JA, Ferguson GT, Jenkins CR, Jones PW, Vestbo J, Knobil K, Yates JC, Calverley PM. Effect of pharmacotherapy on rate of decline of lung function in chronic obstructive pulmonary disease: results from the TORCH study. Am J Respir Crit Care Med. 2008;178:332–338. doi: 10.1164/rccm.200712-1869OC.
    1. Ofir D, Laveneziana P, Webb KA, O'Donnell DE. Ventilatory and perceptual responses to cycle exercise in obese women. J Appl Physiol. 2007;102:2217–2226. doi: 10.1152/japplphysiol.00898.2006.
    1. Cote CG, Celli BR. Pulmonary rehabilitation and the BODE index in COPD. Eur Respir J. 2005;26:630–636. doi: 10.1183/09031936.05.00045505.
    1. Garrow JS, Summerbell CD. Meta-analysis: effect of exercise, with or without dieting, on the body composition of overweight subjects. Eur J Clin Nutr. 1995;49:1–10.
    1. Crisafulli E, Costi S, Luppi F, Cirelli G, Cilione C, Coletti O, Fabbri LM, Clini EM. Role of comorbidities in a cohort of patients with COPD undergoing pulmonary rehabilitation. Thorax. 2008;63:487–492. doi: 10.1136/thx.2007.086371.
    1. Crisafulli E, Gorgone P, Vagaggini B, Pagani M, Rossi G, Costa F, Guarriello V, Paggiaro P, Chetta A, de BF, Olivieri D, Fabbri LM, Clini EM. Efficacy of standard rehabilitation in COPD outpatients with co-morbidities. Eur Respir J. 2010;36(5):1042–8. doi: 10.1183/09031936.00203809.
    1. Riario-Sforza GG, Incorvaia C, Paterniti F, Pessina L, Caligiuri R, Pravettoni C, Di MF, Centanni S. Effects of pulmonary rehabilitation on exercise capacity in patients with COPD: a number needed to treat study. Int J Chron Obstruct Pulmon Dis. 2009;4:315–319.
    1. Leung RW, Alison JA, McKeough ZJ, Peters MJ. Ground walk training improves functional exercise capacity more than cycle training in people with chronic obstructive pulmonary disease (COPD): a randomised trial. J Physiother. 2010;56:105–112.
    1. Engelen MP, Schols AM, Does JD, Wouters EF. Skeletal muscle weakness is associated with wasting of extremity fat-free mass but not with airflow obstruction in patients with chronic obstructive pulmonary disease. Am J Clin Nutr. 2000;71:733–738.
    1. Baarends EM, Schols AM, Mostert R, Wouters EF. Peak exercise response in relation to tissue depletion in patients with chronic obstructive pulmonary disease. Eur Respir J. 1997;10:2807–2813. doi: 10.1183/09031936.97.10122807.
    1. Marquis K, Debigare R, Lacasse Y, Leblanc P, Jobin J, Carrier G, Maltais F. 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. doi: 10.1164/rccm.2107031.
    1. Schols AM, Broekhuizen R, Weling-Scheepers CA, Wouters EF. Body composition and mortality in chronic obstructive pulmonary disease. Am J Clin Nutr. 2005;82:53–59.
    1. Schols AM, Soeters PB, Mostert R, Pluymers RJ, Wouters EF. Physiologic effects of nutritional support and anabolic steroids in patients with chronic obstructive pulmonary disease. A placebo-controlled randomized trial. Am J Respir Crit Care Med. 1995;152:1268–1274.
    1. Takigawa N, Tada A, Soda R, Takahashi S, Kawata N, Shibayama T, Matsumoto H, Hamada N, Hirano A, Kimura G, Okada C, Endo S, Yamashita M, Date H, Takahashi K. Comprehensive pulmonary rehabilitation according to severity of COPD. Respir Med. 2007;101:326–332. doi: 10.1016/j.rmed.2006.03.044.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere