Exercise prescription in patients with chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and airflow limitation. Apart from the ventilatory limitations, patients with COPD present an impaired exercise capacity that limits their ability to perform the activities of daily living and impacts negatively on their quality of life. Limb muscle dysfunction is a systemic consequence of COPD associated with exercise intolerance, poor quality of life and increased mortality. This COPD-related syndrome is characterized by reduced muscle cross-sectional area, strength and endurance, and is highly prevalent among COPD patients. Thus, pulmonary rehabilitation (PR) is recommended in order to combat the negative consequences of COPD on patients’ exercise capacity and quality of life. Exercise training is regarded as the cornerstone of PR and can be implemented at any stage of the disease. To date, the combination of resistance and endurance training (i.e. concurrent training) has demonstrated to be the most beneficial exercise intervention in COPD. Concurrent training provides clinically and statistically significant benefits in exercise tolerance and quality of life to patients with COPD. In addition, there are other potential adjuncts to exercise training and strategies to enhance the implementation of PR programs in COPD patients.La enfermedad pulmonar obstructiva crónica (EPOC) se caracteriza por la persistencia de síntomas respiratorios y limitación al flujo de aire. Además de las limitaciones ventilatorias, los pacientes con EPOC presentan una reducida capacidad para realizar ejercicio que limita su habilidad para realizar actividades de la vida diaria e impacta negativamente sobre su calidad de vida. La disfunción muscular de las extremidades es un síntoma sistémico consecuencia de la EPOC y está asociada con la intolerancia al ejercicio, la reducción de la calidad de vida y el aumento de la mortalidad. Este síndrome relacionado con la EPOC se caracteriza por la reducción del área de sección transversal del músculo esquelético, la fuerza y la resistencia, y es altamente prevalente entre los pacientes con EPOC. Así, la rehabilitación pulmonar (RP) está recomendada para combatir las consecuencias negativas de la EPOC sobre la capacidad para realizar ejercicio y la calidad de vida de los pacientes. El entrenamiento con ejercicio es considerado una pieza clave de la RP y puede implementarse en cualquier estadio de la enfermedad. Hasta la fecha, la combinación de entrenamiento de resistencia y fuerza (entrenamiento concurrente) ha demostrado ser la intervención con ejercicio más beneficiosa para la EPOC. El entrenamiento concurrente proporciona beneficios clínica y estadísticamente significativos con respecto a la tolerancia al ejercicio y calidad de vida de los pacientes con EPOC. Además, existen otras terapias y estrategias que potencialmente pueden complementar al entrenamiento con ejercicio para la mejora de la implementación de los programas de RP en pacientes con EPOC

The Effect of the Stretch-Shortening Cycle in the Force–Velocity Relationship and Its Association With Physical Function in Older Adults With COPD

This study aimed to evaluate the effect of the stretch-shortening cycle (SSC) on different portions of the force–velocity (F–V) relationship in older adults with and without chronic obstructive pulmonary disease (COPD), and to assess its association with physical function. The participants were 26 older adults with COPD (79 ± 7 years old; FEV1 = 53 ± 36% of predicted) and 10 physically active non-COPD (77 ± 4 years old) older adults. The F–V relationship was evaluated in the leg press exercise during a purely concentric muscle action and compared with that following an eccentric muscle action at 10% intervals of maximal unloaded shortening velocity (V0). Vastus lateralis (VL) muscle thickness, pennation angle (PA), and fascicle length (FL) were assessed by ultrasound. Habitual gait speed was measured over a 4-m distance. COPD subjects exhibited lower physical function and concentric maximal muscle power (Pmax) values compared with the non-COPD group (both p < 0.05). The SSC increased force and power values among COPD participants at 0–100 and 1–100% of V0, respectively, while the same was observed among non-COPD participants only at 40–90 and 30–90% of V0, respectively (all p < 0.05). The SSC induced greater improvements in force, but not power, among COPD compared with non-COPD subjects between 50 and 70% of V0 (all p < 0.05). Thus, between-group differences in muscle power were not statistically significant after the inclusion of the SSC (p > 0.05). The SSC-induced potentiation at 50–100% of V0 was negatively associated with physical function (r = -0.40–0.50), while that observed at 80–100% of V0 was negatively associated with VL muscle thickness and PA (r = -0.43–0.52) (all p < 0.05). In conclusion, older adults with COPD showed a higher SSC-induced potentiation compared with non-COPD subjects, which eliminated between-group differences in muscle power when performing SSC muscle actions. The SSC-induced potentiation was associated with lower physical function, VL muscle thickness, and VL PA values. The SSC-induced potentiation may help as a compensatory mechanism in those older subjects with a decreased ability to produce force/power during purely concentric muscle actions

The effect of the stretch-shortening cycle in the force–velocity relationship and its association with physical function in older adults with COPD

This study aimed to evaluate the effect of the stretch-shortening cycle (SSC) on different portions of the force–velocity (F–V) relationship in older adults with and without chronic obstructive pulmonary disease (COPD), and to assess its association with physical function. The participants were 26 older adults with COPD (79 ± 7 years old; FEV1 = 53 ± 36% of predicted) and 10 physically active non-COPD (77 ± 4 years old) older adults. The F–V relationship was evaluated in the leg press exercise during a purely concentric muscle action and compared with that following an eccentric muscle action at 10% intervals of maximal unloaded shortening velocity (V0). Vastus lateralis (VL) muscle thickness, pennation angle (PA), and fascicle length (FL) were assessed by ultrasound. Habitual gait speed was measured over a 4-m distance. COPD subjects exhibited lower physical function and concentric maximal muscle power (Pmax) values compared with the non-COPD group (both p 0.05). The SSC-induced potentiation at 50–100% of V0 was negatively associated with physical function (r = -0.40–0.50), while that observed at 80–100% of V0 was negatively associated with VL muscle thickness and PA (r = -0.43–0.52

Low relative mechanical power in older adults: An operational definition and algorithm for its application in the clinical setting

The assessment and treatment of low relative muscle power in older people has received little attention in the clinical setting when compared to sarcopenia. Our main goal was to assess the associations of low relative power and sarcopenia with other negative outcomes in older people. Methods: The participants were 1189 subjects (54% women; 65–101 years old) from the Toledo Study for Healthy Aging. Probable sarcopenia was defined as having low handgrip strength, while confirmed sarcopenia also included low appendicular skeletal muscle index (assessed by dual energy X-ray absorptiometry) (EWGSOP2’s definition). Low relative (i.e. normalized to body mass) muscle power was assessed with the 5-repetition sit-tostand power test (which uses an equation that converts sit-to-stand performance into mechanical power) and diagnosed in those subjects in the lowest sex-specific tertile. Low usual gait speed (UGS), frailty (according to Fried’s criteria and the Frailty Trait Scale), limitations in basic (BADL) and instrumental activities of daily living (IADL) and poor quality of life were also recorded. Results: Age-adjusted logistic regression analyses demonstrated that low relative muscle power was associated with low UGS (odds ratio (OR) = 1.9 and 2.5), frailty (OR = 3.9 and 4.7) and poor quality of life (OR = 1.8 and 1.9) in older men and women, respectively, and with limitations in BADL (OR = 1.6) and IADL (OR = 3.8) in older women (all p < 0.05). Confirmed sarcopenia was only associated with low UGS (OR = 2.5) and frailty (OR = 5.0) in older men, and with limitations in IADL in older women (OR = 4.3) (all p < 0.05). Conclusions: Low relative muscle power had a greater clinical relevance than low handgrip strength and confirmed sarcopenia among older people. An operational definition and algorithm for low relative muscle power case finding in daily clinical practice was presented

reliability and validity of a systematic procedure

This study compared the reliability and validity of different protocols evaluating the force-velocity (F-V) relationship and muscle power in older adults. Thirty-one older men and women (75.8 ± 4.7 years) underwent two F-V tests by collecting the mean and peak force and velocity data exerted against increasing loads until one repetition maximum (1RM) was achieved in the leg press exercise. Two attempts per load were performed, with a third attempt when F-V points deviated from the linear F-V regression equation. Then, the subjects performed 2 × 3 repetitions at 60 % 1RM to compare purely concentric and eccentric- concentric repetitions. The Short Physical Performance Battery was conducted to assess the validity of the different protocols. Significant differences were found in maximal power (Pmax) between mean and peak values and between protocols differing in the number of attempts per load (p < 0.01). Registering mean values, a third attempt, and multiple loads (>3), was significantly more reliable (Pmax: CV = 2.6 %; ICC = 0.99) than the other alternatives. Mean values were also observed to be more associated with physical function than peak values (R2 = 0.34 and 0.15, respectively; p < 0.05). No significant differences were observed between concentric and eccentric-concentric repetitions. Thus, collecting mean force and velocity values against multiple loads, while monitoring the linearity of the F-V relationship, seemed to be the more adequate procedure to assess the F-V profile and muscle power in older adults

Relative sit-to-stand power cut-off points and their association with negatives outcomes in older adults

The purposes of this study were: (i) to evaluate the association of sit-to-stand (STS) power and body composition parameters [body mass index (BMI) and legs skeletal muscle index (SMI)] with age; (ii) to provide cut-off points for low relative STS power (STSrel), (iii) to provide normative data for well-functioning older adults and (iv) to assess the association of low STSrel with negative outcomes. Cross-sectional design (1369 older adults). STS power parameters assessed by validated equations, BMI and Legs SMI assessed by dual-energy X-ray absorptiometry were recorded. Sex- and age-adjusted segmented and logistic regression analyses and receiver operator characteristic curves were used. Among men, STSrel showed a negative association with age up to the age of 85 years (− 1.2 to − 1.4%year−1; p < 0.05). In women, a negative association with age was observed throughout the old adult life (− 1.2 to − 2.0%year−1; p < 0.001). Cut-off values for low STSrel were 2.5 W kg−1 in men and 1.9 W kg−1 in women. Low STSrel was associated with frailty (OR [95% CI] = 5.6 [3.1, 10.1]) and low habitual gait speed (HGS) (OR [95% CI] = 2.7 [1.8, 3.9]) in men while low STSrel was associated with frailty (OR [95% CI] = 6.9 [4.5, 10.5]) low HGS (OR [95% CI] = 2.9 [2.0, 4.1]), disability in activities of daily living (OR [95% CI] = 2.1 [1.4, 3.2]), and low quality of life (OR [95%CI] = 1.7 [1.2, 2.4]) in women. STSrel declined with increasing age in both men and women. Due to the adverse outcomes related to STSrel, the reported cut-off points can be used as a clinical tool to identify low STSrel among older adults

Relative sit‑to‑stand power cut‑of points and their association with negatives outcomes in older adults

The purposes of this study were: (i) to evaluate the association of sit-to-stand (STS) power and body composition parameters [body mass index (BMI) and legs skeletal muscle index (SMI)] with age; (ii) to provide cut-of points for low relative STS power (STSrel), (iii) to provide normative data for well functioning older adults and (iv) to assess the association of low STSrel with negative outcomes. Cross-sectional design (1369 older adults). STS power parameters assessed by validated equations, BMI and Legs SMI assessed by dual-energy X-ray absorptiometry were recorded. Sex- and age adjusted segmented and logistic regression analyses and receiver operator characteristic curves were used. Among men, STSrel showed a negative association with age up to the age of 85 years (− 1.2 to − 1.4%year−1; p < 0.05). In women, a negative association with age was observed throughout the old adult life (− 1.2 to − 2.0%year−1; p < 0.001). Cut-of values for low STSrel were 2.5W ­kg−1 in men and 1.9W ­kg−1 in women. Low STSrel was associated with frailty (OR [95% CI] = 5.6 [3.1, 10.1]) and low habitual gait speed (HGS) (OR [95% CI] = 2.7 [1.8, 3.9]) in men while low STSrel was associated with frailty (OR [95% CI] = 6.9 [4.5, 10.5]) low HGS (OR [95% CI] = 2.9 [2.0, 4.1]), disability in activities of daily living (OR [95% CI] = 2.1 [1.4, 3.2]), and low quality of life (OR [95%CI] = 1.7 [1.2, 2.4]) in women. STSrel declined with increasing age in both men and women. Due to the adverse outcomes related to STSrel, the reported cut-of points can be used as a clinical tool to identify low STSrel among older adults

Sex Differences in the Association between Serum Levels of Testosterone and Frailty in an Elderly Population: The Toledo Study for Healthy Aging

BACKGROUND: Age-associated decline in testosterone levels represent one of the potential mechanisms involved in the development of frailty. Although this association has been widely reported in older men, very few data are available in women. We studied the association between testosterone and frailty in women and assessed sex differences in this relationship. METHODS: We used cross-sectional data from the Toledo Study for Healthy Aging, a population-based cohort study of Spanish elderly. Frailty was defined according to Fried's approach. Multivariate odds-ratios (OR) and 95% confidence intervals (CI) associated with total (TT) and free testosterone (FT) levels were estimated using polytomous logistic regression. RESULTS: In women, there was a U-shaped relationship between FT levels and frailty (p for FT(2) = 0.03). In addition, very low levels of FT were observed in women with ≥ 4 frailty criteria (age-adjusted geometric means = 0.13 versus 0.37 in subjects with <4 components, p = 0.010). The association of FT with frailty appeared confined to obese women (p-value for interaction = 0.05).In men, the risk of frailty levels linearly decreased with testosterone (adjusted OR for frailty = 2.9 (95%CI, 1.6-5.1) and 1.6 (95%CI, 1.0-2.5), for 1 SD decrease in TT and FT, respectively). TT and FT showed association with most of frailty criteria. No interaction was found with BMI. CONCLUSION: There is a relationship between circulating levels of FT and frailty in older women. This relation seems to be modulated by BMI. The relevance and the nature of the association of FT levels and frailty are sex-specific, suggesting that different biological mechanisms may be involved

Deterioro cognitivo en ancianos: contribución de la reserva funcional en el desarrollo cognitivo, y efecto modulador de la función cognitiva sobre la interacción índice de masa corporal-fractura de cadera

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina. Departamento de Medicina Preventiva y Salud Pública. Fecha de lectura: 24 de Abril de 200

Exercise prescription in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and airflow limitation. Apart from the ventilatory limitations, patients with COPD present an impaired exercise capacity that limits their ability to perform the activities of daily living and impact negatively on their quality of life. Limb muscle dysfunction is a systemic consequence of COPD associated with exercise intolerance, poor quality of life and increased mortality. This COPD-related syndrome is characterized by reduced muscle cross-sectional area, strength and endurance, and is highly prevalent among COPD patients. Thus, pulmonary rehabilitation (PR) is recommended in order to combat the negative consequences of COPD on patients’ exercise capacity and quality of life. Exercise training is regarded as the cornerstone of PR and can be implemented at any stage of the disease. To date, the combination of resistance and endurance training (i.e. concurrent training) has demonstrated to be the most beneficial exercise intervention in COPD. Concurrent training provides clinically and statistically significant benefits in exercise tolerance and quality of life to patients with COPD. In addition, there are other potential adjuncts to exercise training and strategies to enhance the implementation of PR programs in COPD patients.La enfermedad pulmonar obstructiva crónica (EPOC) se caracteriza por la persistencia de síntomas respiratorios y limitación al flujo de aire. Además de las limitaciones ventilatorias, los pacientes con EPOC presentan una reducida capacidad para realizar ejercicio que limita su capacidad para realizar actividades de la vida diaria e impacta negativamente sobre su calidad de vida. La disfunción muscular de las extremidades es un síntoma sistémico consecuencia de la EPOC y está asociada con la intolerancia al ejercicio, la reducción de la calidad de vida y el aumento de la mortalidad. Este síndrome relacionado con la EPOC se caracteriza por la reducción del área de sección transversal del músculo esquelético, la fuerza y la resistencia, y es altamente prevalente entre los pacientes con EPOC. Así, la rehabilitación pulmonar (RP) está recomendada para combatir las consecuencias negativas de la EPOC sobre la capacidad para realizar ejercicio y la calidad de vida de los pacientes. El entrenamiento con ejercicio es considerado una pieza clave de la RP y puede implementarse en cualquier estadio de la enfermedad. Hasta la fecha, la combinación de entrenamiento de resistencia y fuerza (entrenamiento concurrente) ha demostrado ser la intervención con ejercicio más beneficiosa para la EPOC. El entrenamiento concurrente proporciona beneficios clínica y estadísticamente significativos con respecto a la tolerancia al ejercicio y calidad de vida de los pacientes con EPOC. Además, existen otras terapias y estrategias que potencialmente pueden complementar al entrenamiento con ejercicio para la mejora de la implementación de los programas de RP en pacientes con EPOC