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. 2003 Sep;58(9):745–751. doi: 10.1136/thorax.58.9.745

Nutritional enhancement of exercise performance in chronic obstructive pulmonary disease: a randomised controlled trial

M Steiner 1, R Barton 1, S Singh 1, M Morgan 1
PMCID: PMC1746806  PMID: 12947128

Abstract

Background: Pulmonary rehabilitation is effective in improving exercise performance and health status in chronic obstructive pulmonary disease (COPD). However, the role of nutritional support in the enhancement of the benefits of exercise training has not been explored. A double blind, randomised, controlled trial of carbohydrate supplementation was undertaken in patients attending outpatient pulmonary rehabilitation.

Methods: 85 patients with COPD were randomised to receive a 570 kcal carbohydrate rich supplement or a non-nutritive placebo daily for the duration of a 7 week outpatient pulmonary rehabilitation programme. Primary outcome measures were peak and submaximal exercise performance using the shuttle walk tests. Changes in health status, body composition, muscle strength, and dietary macronutrient intake were also measured.

Results: Patients in both the supplement and placebo groups increased shuttle walking performance and health status significantly. There was no statistically significant difference between treatment groups in these outcomes. Patients receiving placebo lost weight whereas supplemented patients gained weight. In well nourished patients (BMI >19 kg/m2) improvement in incremental shuttle performance was significantly greater in the supplemented group (mean difference between groups: 27 (95% CI 1 to 53) m, p<0.05). Increases in incremental shuttle performance correlated with increases in total carbohydrate intake.

Conclusions: When universally prescribed, carbohydrate supplementation does not enhance the rehabilitation of patients with COPD. This study suggests that exercise training results in negative energy balance that can be overcome by supplementation and that, in selected patients, this may improve the outcome of training. The finding of benefit in well nourished patients may suggest a role for nutritional supplementation beyond the treatment of weight loss in COPD.

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Selected References

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  1. Baarends E. M., Schols A. M., Pannemans D. L., Westerterp K. R., Wouters E. F. Total free living energy expenditure in patients with severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1997 Feb;155(2):549–554. doi: 10.1164/ajrccm.155.2.9032193. [DOI] [PubMed] [Google Scholar]
  2. Coudray-Lucas C., Lasnier E., Renaud F., Ziegler F., Settembre P., Cynober L. A., Ekindjian O. G. Is alpha-ketoisocaproyl-glutamine a suitable glutamine precursor to sustain fibroblast growth? Clin Nutr. 1999 Feb;18(1):29–33. doi: 10.1016/s0261-5614(99)80046-6. [DOI] [PubMed] [Google Scholar]
  3. Coyle E. F., Coggan A. R., Hemmert M. K., Ivy J. L. Muscle glycogen utilization during prolonged strenuous exercise when fed carbohydrate. J Appl Physiol (1985) 1986 Jul;61(1):165–172. doi: 10.1152/jappl.1986.61.1.165. [DOI] [PubMed] [Google Scholar]
  4. Creutzberg E. C., Schols A. M., Weling-Scheepers C. A., Buurman W. A., Wouters E. F. Characterization of nonresponse to high caloric oral nutritional therapy in depleted patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2000 Mar;161(3 Pt 1):745–752. doi: 10.1164/ajrccm.161.3.9808075. [DOI] [PubMed] [Google Scholar]
  5. Efthimiou J., Mounsey P. J., Benson D. N., Madgwick R., Coles S. J., Benson M. K. Effect of carbohydrate rich versus fat rich loads on gas exchange and walking performance in patients with chronic obstructive lung disease. Thorax. 1992 Jun;47(6):451–456. doi: 10.1136/thx.47.6.451. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Ferreira I. M., Brooks D., Lacasse Y., Goldstein R. S. Nutritional support for individuals with COPD: a meta-analysis. Chest. 2000 Mar;117(3):672–678. doi: 10.1378/chest.117.3.672. [DOI] [PubMed] [Google Scholar]
  7. Ginsberg R. J., Rubinstein L. V. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg. 1995 Sep;60(3):615–623. doi: 10.1016/0003-4975(95)00537-u. [DOI] [PubMed] [Google Scholar]
  8. Griffiths T. L., Burr M. L., Campbell I. A., Lewis-Jenkins V., Mullins J., Shiels K., Turner-Lawlor P. J., Payne N., Newcombe R. G., Ionescu A. A. Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial. Lancet. 2000 Jan 29;355(9201):362–368. doi: 10.1016/s0140-6736(99)07042-7. [DOI] [PubMed] [Google Scholar]
  9. Guyatt G. H., Berman L. B., Townsend M., Pugsley S. O., Chambers L. W. A measure of quality of life for clinical trials in chronic lung disease. Thorax. 1987 Oct;42(10):773–778. doi: 10.1136/thx.42.10.773. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Helge J. W., Richter E. A., Kiens B. Interaction of training and diet on metabolism and endurance during exercise in man. J Physiol. 1996 Apr 1;492(Pt 1):293–306. doi: 10.1113/jphysiol.1996.sp021309. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hurley B. F., Nemeth P. M., Martin W. H., 3rd, Hagberg J. M., Dalsky G. P., Holloszy J. O. Muscle triglyceride utilization during exercise: effect of training. J Appl Physiol (1985) 1986 Feb;60(2):562–567. doi: 10.1152/jappl.1986.60.2.562. [DOI] [PubMed] [Google Scholar]
  12. Jakobsson P., Jorfeldt L. Long-term oxygen therapy may improve skeletal muscle metabolism in advanced chronic obstructive pulmonary disease patients with chronic hypoxaemia. Respir Med. 1995 Aug;89(7):471–476. doi: 10.1016/0954-6111(95)90122-1. [DOI] [PubMed] [Google Scholar]
  13. Juniper E. F., Guyatt G. H., Willan A., Griffith L. E. Determining a minimal important change in a disease-specific Quality of Life Questionnaire. J Clin Epidemiol. 1994 Jan;47(1):81–87. doi: 10.1016/0895-4356(94)90036-1. [DOI] [PubMed] [Google Scholar]
  14. Koike Teruaki, Yamato Yasushi, Yoshiya Katsuo, Shimoyama Takehiko, Suzuki Ryuta. Intentional limited pulmonary resection for peripheral T1 N0 M0 small-sized lung cancer. J Thorac Cardiovasc Surg. 2003 Apr;125(4):924–928. doi: 10.1067/mtc.2003.156. [DOI] [PubMed] [Google Scholar]
  15. Lacasse Y., Brosseau L., Milne S., Martin S., Wong E., Guyatt G. H., Goldstein R. S. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2002;(3):CD003793–CD003793. doi: 10.1002/14651858.CD003793. [DOI] [PubMed] [Google Scholar]
  16. Lewis M. I., Belman M. J., Dorr-Uyemura L. Nutritional supplementation in ambulatory patients with chronic obstructive pulmonary disease. Am Rev Respir Dis. 1987 May;135(5):1062–1068. doi: 10.1164/arrd.1987.135.5.1062. [DOI] [PubMed] [Google Scholar]
  17. Murray C. J., Lopez A. D. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet. 1997 May 24;349(9064):1498–1504. doi: 10.1016/S0140-6736(96)07492-2. [DOI] [PubMed] [Google Scholar]
  18. Palange P., Forte S., Felli A., Galassetti P., Serra P., Carlone S. Nutritional state and exercise tolerance in patients with COPD. Chest. 1995 May;107(5):1206–1212. doi: 10.1378/chest.107.5.1206. [DOI] [PubMed] [Google Scholar]
  19. Revill S. M., Morgan M. D., Singh S. J., Williams J., Hardman A. E. The endurance shuttle walk: a new field test for the assessment of endurance capacity in chronic obstructive pulmonary disease. Thorax. 1999 Mar;54(3):213–222. doi: 10.1136/thx.54.3.213. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Schols A. M., Buurman W. A., Staal van den Brekel A. J., Dentener M. A., Wouters E. F. Evidence for a relation between metabolic derangements and increased levels of inflammatory mediators in a subgroup of patients with chronic obstructive pulmonary disease. Thorax. 1996 Aug;51(8):819–824. doi: 10.1136/thx.51.8.819. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Schols A. M., Creutzberg E. C., Buurman W. A., Campfield L. A., Saris W. H., Wouters E. F. Plasma leptin is related to proinflammatory status and dietary intake in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999 Oct;160(4):1220–1226. doi: 10.1164/ajrccm.160.4.9811033. [DOI] [PubMed] [Google Scholar]
  22. Schols A. M., Soeters P. B., Mostert R., Pluymers R. J., Wouters E. F. 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 Oct;152(4 Pt 1):1268–1274. doi: 10.1164/ajrccm.152.4.7551381. [DOI] [PubMed] [Google Scholar]
  23. Singh S. J., Morgan M. D., Hardman A. E., Rowe C., Bardsley P. A. Comparison of oxygen uptake during a conventional treadmill test and the shuttle walking test in chronic airflow limitation. Eur Respir J. 1994 Nov;7(11):2016–2020. [PubMed] [Google Scholar]
  24. Singh S. J., Morgan M. D., Scott S., Walters D., Hardman A. E. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax. 1992 Dec;47(12):1019–1024. doi: 10.1136/thx.47.12.1019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Steiner M. C., Barton R. L., Singh S. J., Morgan M. D. L. Bedside methods versus dual energy X-ray absorptiometry for body composition measurement in COPD. Eur Respir J. 2002 Apr;19(4):626–631. doi: 10.1183/09031936.02.00279602. [DOI] [PubMed] [Google Scholar]
  26. Vermeeren M. A., Wouters E. F., Nelissen L. H., van Lier A., Hofman Z., Schols A. M. Acute effects of different nutritional supplements on symptoms and functional capacity in patients with chronic obstructive pulmonary disease. Am J Clin Nutr. 2001 Feb;73(2):295–301. doi: 10.1093/ajcn/73.2.295. [DOI] [PubMed] [Google Scholar]
  27. Willett W. C., Dietz W. H., Colditz G. A. Guidelines for healthy weight. N Engl J Med. 1999 Aug 5;341(6):427–434. doi: 10.1056/NEJM199908053410607. [DOI] [PubMed] [Google Scholar]
  28. Williams J. E., Singh S. J., Sewell L., Guyatt G. H., Morgan M. D. Development of a self-reported Chronic Respiratory Questionnaire (CRQ-SR). Thorax. 2001 Dec;56(12):954–959. doi: 10.1136/thorax.56.12.954. [DOI] [PMC free article] [PubMed] [Google Scholar]

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