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30-11-2010 | Respiratory | Article

Supplements and exercise benefit malnourished COPD patients

Abstract

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MedWire News: Malnourished chronic obstructive pulmonary disease (COPD) patients benefit from nutritional supplementation combined with low-intensity exercise, results from a Japanese study show.

Takanobu Shioya (Akita University Graduate School of Health Sciences) and team found that nutritional supplementation plus low-intensity exercise significantly improved weight, energy intake, exercise capacity, and health-related quality of life (QoL), while significantly reducing levels of major inflammatory markers in malnourished COPD patients.

The findings, published in the journal Respiratory Medicine, come from a study of 32 patients with clinically stable moderate-to-severe COPD. All of the patients were considered to be malnourished, defined as a body mass index (BMI) of less than 19 kg/m2.

The participants were randomly assigned to an intervention (n=17) or control group (n=15).

Patients in the intervention group received a nutritional support drink twice a day for 12 weeks and participated in a home-based, low-intensity exercise program consisting of breathing exercises, upper and lower limb exercises, respiratory muscle stretching calisthenics, and inspiratory and expiratory muscle training. The overall training intensity was set at 40-50% of the maximum oxygen consumption.

Patients in the control group attended monthly 45-minute lectures on respiratory disease, control of dyspnea, medication, nutrition, stress management, and relaxation techniques.

The researchers found that patients in the intervention group showed a significant improvement in body weight and fat free mass index (FFMI), from respective means of 46.5 kg and 14.0 kg/m2 at baseline to 47.9 kg and 14.3 kg/m2 at 12 weeks. In contrast, there was no significant weight gain among controls, and their mean FFMI fell slightly.

Dietary energy intake (percentage of predicted) in the intervention group also increased significantly, from 81.2% at baseline to 91.1% at 12 weeks, while resting energy expenditure fell from 1418 to 1355 kcal. In contrast, controls experienced, respectively, a fall and rise in these measures.

Patients in the intervention group also experienced significant improvements in quadriceps muscle force (5.0 kg), 6-minute walking distance (24 m), and total scores on the Chronic Respiratory Disease Questionnaire (3 points). In contrast, these measures worsened among patients in the control group.

Furthermore, intervention patients had significantly lower levels of the inflammatory markers high-sensitivity C-reactive protein (1.23 vs 2.02 mg/l), interleukin (IL)-6 (2.04 vs 3.63 pg/ml), IL-8 (2.20 vs 4.26 pg/ml), and tumor necrosis factor-α (2.29 vs 4.20 pg/ml) after 12 weeks than controls.

Shioya and team conclude: "Our data suggest a potential role for the combination of nutritional support and low-intensity exercise, and that this combination may improve the outcomes of exercise tolerance and health-related QoL in patients with malnourished COPD.

"Thus a combination of nutritional support and low-intensity exercise may provide a new therapeutic approach for pulmonary cachexia."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Mark Cowen

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