Skip to main content
PMC home page
Thorax logoLink to Thorax
. 2005 May 27;60(9):718–722. doi: 10.1136/thx.2005.040709

Abdominal muscle and quadriceps strength in chronic obstructive pulmonary disease

W Man 1, N Hopkinson 1, F Harraf 1, D Nikoletou 1, M Polkey 1, J Moxham 1
PMCID: PMC1747513  PMID: 15923239

Abstract

Background: Quadriceps muscle weakness is common in chronic obstructive pulmonary disease (COPD) but is not observed in a small hand muscle (adductor pollicis). Although this could be explained by reduced activity in the quadriceps, the observation could also be explained by anatomical location of the muscle or fibre type composition. However, the abdominal muscles are of a similar anatomical and fibre type distribution to the quadriceps, although they remain active in COPD. Cough gastric pressure is a recently described technique that assesses abdominal muscle (and hence expiratory muscle) strength more accurately than traditional techniques. A study was undertaken to test the hypothesis that more severe weakness exists in the quadriceps than in the abdominal muscles of patients with COPD compared with healthy elderly controls.

Methods: Maximum cough gastric pressure and quadriceps isometric strength were measured in 43 patients with stable COPD and 25 healthy elderly volunteers matched for anthropometric variables.

Results: Despite a significant reduction in mean quadriceps strength (29.9 kg v 41.2 kg; 95% CI –17.9 to –4.6; p = 0.001), cough gastric pressure was preserved in patients with COPD (227.3 cm H2O v 204.8 cm H2O; 95% CI –5.4 to 50.6; p = 0.11).

Conclusions: Abdominal muscle strength is preserved in stable COPD outpatients in the presence of quadriceps weakness. This suggests that anatomical location and fibre type cannot explain quadriceps weakness in COPD. By inference, we conclude that disuse and consequent deconditioning are important factors in the development of quadriceps muscle weakness in COPD patients, or that activity protects the abdominal muscles from possible systemic myopathic processes.

Full Text

The Full Text of this article is available as a PDF (82.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aujesky Drahomir, Auble Thomas E., Yealy Donald M., Stone Roslyn A., Obrosky D. Scott, Meehan Thomas P., Graff Louis G., Fine Jonathan M., Fine Michael J. Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia. Am J Med. 2005 Apr;118(4):384–392. doi: 10.1016/j.amjmed.2005.01.006. [DOI] [PubMed] [Google Scholar]
  2. 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 Aug;158(2):629–634. doi: 10.1164/ajrccm.158.2.9711023. [DOI] [PubMed] [Google Scholar]
  3. Byrd R. B., Hyatt R. E. Maximal respiratory pressures in chronic obstructive lung disease. Am Rev Respir Dis. 1968 Nov;98(5):848–856. doi: 10.1164/arrd.1968.98.5.848. [DOI] [PubMed] [Google Scholar]
  4. Couillard A., Koechlin C., Cristol J. P., Varray A., Prefaut C. Evidence of local exercise-induced systemic oxidative stress in chronic obstructive pulmonary disease patients. Eur Respir J. 2002 Nov;20(5):1123–1129. doi: 10.1183/09031936.02.00014302. [DOI] [PubMed] [Google Scholar]
  5. 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]
  6. Debigaré Richard, Marquis Karine, Côté Claude H., Tremblay Roland R., Michaud Annie, LeBlanc Pierre, Maltais François. Catabolic/anabolic balance and muscle wasting in patients with COPD. Chest. 2003 Jul;124(1):83–89. doi: 10.1378/chest.124.1.83. [DOI] [PubMed] [Google Scholar]
  7. Dekhuijzen P. N., Decramer M. Steroid-induced myopathy and its significance to respiratory disease: a known disease rediscovered. Eur Respir J. 1992 Sep;5(8):997–1003. [PubMed] [Google Scholar]
  8. Deurenberg P., van der Kooij K., Evers P., Hulshof T. Assessment of body composition by bioelectrical impedance in a population aged greater than 60 y. Am J Clin Nutr. 1990 Jan;51(1):3–6. doi: 10.1093/ajcn/51.1.3. [DOI] [PubMed] [Google Scholar]
  9. Eid A. A., Ionescu A. A., Nixon L. S., Lewis-Jenkins V., Matthews S. B., Griffiths T. L., Shale D. J. Inflammatory response and body composition in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001 Oct 15;164(8 Pt 1):1414–1418. doi: 10.1164/ajrccm.164.8.2008109. [DOI] [PubMed] [Google Scholar]
  10. Ferrari K., Goti P., Misuri G., Amendola M., Rosi E., Grazzini M., Iandelli I., Duranti R., Scano G. Chronic exertional dyspnea and respiratory muscle function in patients with chronic obstructive pulmonary disease. Lung. 1997;175(5):311–319. doi: 10.1007/pl00007577. [DOI] [PubMed] [Google Scholar]
  11. Gosselink R., Troosters T., Decramer M. Distribution of muscle weakness in patients with stable chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2000 Nov-Dec;20(6):353–360. doi: 10.1097/00008483-200011000-00004. [DOI] [PubMed] [Google Scholar]
  12. Gosselink R., Troosters T., Decramer M. Peripheral muscle weakness contributes to exercise limitation in COPD. Am J Respir Crit Care Med. 1996 Mar;153(3):976–980. doi: 10.1164/ajrccm.153.3.8630582. [DOI] [PubMed] [Google Scholar]
  13. Heijdra Yvonne F., Pinto-Plata Victor, Frants Regina, Rassulo John, Kenney Lawrence, Celli Bartolome R. Muscle strength and exercise kinetics in COPD patients with a normal fat-free mass index are comparable to control subjects. Chest. 2003 Jul;124(1):75–82. doi: 10.1378/chest.124.1.75. [DOI] [PubMed] [Google Scholar]
  14. Hopkinson N. S., Man W. D. C., Dayer M. J., Ross E. T., Nickol A. H., Hart N., Moxham J., Polkey M. I. Acute effect of oral steroids on muscle function in chronic obstructive pulmonary disease. Eur Respir J. 2004 Jul;24(1):137–142. doi: 10.1183/09031936.04.00139003. [DOI] [PubMed] [Google Scholar]
  15. Hopkinson Nicholas S., Nickol Annabel H., Payne John, Hawe Emma, Man William D-C, Moxham John, Montgomery Hugh, Polkey Michael I. Angiotensin converting enzyme genotype and strength in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004 Apr 29;170(4):395–399. doi: 10.1164/rccm.200304-578OC. [DOI] [PubMed] [Google Scholar]
  16. Johnson M. A., Polgar J., Weightman D., Appleton D. Data on the distribution of fibre types in thirty-six human muscles. An autopsy study. J Neurol Sci. 1973 Jan;18(1):111–129. doi: 10.1016/0022-510x(73)90023-3. [DOI] [PubMed] [Google Scholar]
  17. Kyroussis D., Polkey M. I., Mills G. H., Hughes P. D., Moxham J., Green M. Simulation of cough in man by magnetic stimulation of the thoracic nerve roots. Am J Respir Crit Care Med. 1997 Nov;156(5):1696–1699. doi: 10.1164/ajrccm.156.5.9702008. [DOI] [PubMed] [Google Scholar]
  18. Maltais F., Sullivan M. J., LeBlanc P., Duscha B. D., Schachat F. H., Simard C., Blank J. M., Jobin J. Altered expression of myosin heavy chain in the vastus lateralis muscle in patients with COPD. Eur Respir J. 1999 Apr;13(4):850–854. doi: 10.1034/j.1399-3003.1999.13d26.x. [DOI] [PubMed] [Google Scholar]
  19. Man W. D-C, Moxham J., Polkey M. I. Magnetic stimulation for the measurement of respiratory and skeletal muscle function. Eur Respir J. 2004 Nov;24(5):846–860. doi: 10.1183/09031936.04.00029004. [DOI] [PubMed] [Google Scholar]
  20. Man W. D-C, Soliman M. G. G., Nikoletou D., Harris M. L., Rafferty G. F., Mustfa N., Polkey M. I., Moxham J. Non-volitional assessment of skeletal muscle strength in patients with chronic obstructive pulmonary disease. Thorax. 2003 Aug;58(8):665–669. doi: 10.1136/thorax.58.8.665. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Man W. D. C., Mustfa N., Nikoletou D., Kaul S., Hart N., Rafferty G. F., Donaldson N., Polkey M. I., Moxham J. Effect of salmeterol on respiratory muscle activity during exercise in poorly reversible COPD. Thorax. 2004 Jun;59(6):471–476. doi: 10.1136/thx.2003.019620. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Man William D-C, Kyroussis Dimitris, Fleming Tracey A., Chetta Alfredo, Harraf Farzaneh, Mustfa Naveed, Rafferty Gerrard F., Polkey Michael I., Moxham John. Cough gastric pressure and maximum expiratory mouth pressure in humans. Am J Respir Crit Care Med. 2003 Jul 11;168(6):714–717. doi: 10.1164/rccm.200303-334BC. [DOI] [PubMed] [Google Scholar]
  23. Man William D-C, Polkey Michael I., Donaldson Nora, Gray Barry J., Moxham John. Community pulmonary rehabilitation after hospitalisation for acute exacerbations of chronic obstructive pulmonary disease: randomised controlled study. BMJ. 2004 Oct 25;329(7476):1209–1209. doi: 10.1136/bmj.38258.662720.3A. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Mattson J. P., Poole D. C. Pulmonary emphysema decreases hamster skeletal muscle oxidative enzyme capacity. J Appl Physiol (1985) 1998 Jul;85(1):210–214. doi: 10.1152/jappl.1998.85.1.210. [DOI] [PubMed] [Google Scholar]
  25. Ninane V., Rypens F., Yernault J. C., De Troyer A. Abdominal muscle use during breathing in patients with chronic airflow obstruction. Am Rev Respir Dis. 1992 Jul;146(1):16–21. doi: 10.1164/ajrccm/146.1.16. [DOI] [PubMed] [Google Scholar]
  26. Nishimura Y., Tsutsumi M., Nakata H., Tsunenari T., Maeda H., Yokoyama M. Relationship between respiratory muscle strength and lean body mass in men with COPD. Chest. 1995 May;107(5):1232–1236. doi: 10.1378/chest.107.5.1232. [DOI] [PubMed] [Google Scholar]
  27. Piitulainen Eeva, Areberg Johan, Lindén Mikael, Eriksson Sten, Mattsson Sören, Wollmer Per. Nutritional status and muscle strength in patients with emphysema and severe alpha(1)-antitrypsin deficiency. Chest. 2002 Oct;122(4):1240–1246. doi: 10.1378/chest.122.4.1240. [DOI] [PubMed] [Google Scholar]
  28. Polkey M. I., Kyroussis D., Hamnegard C. H., Mills G. H., Green M., Moxham J. Quadriceps strength and fatigue assessed by magnetic stimulation of the femoral nerve in man. Muscle Nerve. 1996 May;19(5):549–555. doi: 10.1002/(SICI)1097-4598(199605)19:5<549::AID-MUS1>3.0.CO;2-B. [DOI] [PubMed] [Google Scholar]
  29. Polkey M. I., Luo Y., Guleria R., Hamnegård C. H., Green M., Moxham J. Functional magnetic stimulation of the abdominal muscles in humans. Am J Respir Crit Care Med. 1999 Aug;160(2):513–522. doi: 10.1164/ajrccm.160.2.9808067. [DOI] [PubMed] [Google Scholar]
  30. Ramírez-Sarmiento A., Orozco-Levi M., Barreiro E., Méndez R., Ferrer A., Broquetas J., Gea J. Expiratory muscle endurance in chronic obstructive pulmonary disease. Thorax. 2002 Feb;57(2):132–136. doi: 10.1136/thorax.57.2.132. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Rochester D. F., Braun N. M., Arora N. S. Respiratory muscle strength in chronic obstructive pulmonary disease. Am Rev Respir Dis. 1979 Feb;119(2 Pt 2):151–154. doi: 10.1164/arrd.1979.119.2P2.151. [DOI] [PubMed] [Google Scholar]
  32. Rochester D. F., Braun N. M. Determinants of maximal inspiratory pressure in chronic obstructive pulmonary disease. Am Rev Respir Dis. 1985 Jul;132(1):42–47. doi: 10.1164/arrd.1985.132.1.42. [DOI] [PubMed] [Google Scholar]
  33. Schols A. M., Soeters P. B., Dingemans A. M., Mostert R., Frantzen P. J., Wouters E. F. Prevalence and characteristics of nutritional depletion in patients with stable COPD eligible for pulmonary rehabilitation. Am Rev Respir Dis. 1993 May;147(5):1151–1156. doi: 10.1164/ajrccm/147.5.1151. [DOI] [PubMed] [Google Scholar]
  34. Schönhofer B., Ardes P., Geibel M., Köhler D., Jones P. W. Evaluation of a movement detector to measure daily activity in patients with chronic lung disease. Eur Respir J. 1997 Dec;10(12):2814–2819. doi: 10.1183/09031936.97.10122814. [DOI] [PubMed] [Google Scholar]
  35. Spruit M. A., Gosselink R., Troosters T., Kasran A., Gayan-Ramirez G., Bogaerts P., Bouillon R., Decramer M. Muscle force during an acute exacerbation in hospitalised patients with COPD and its relationship with CXCL8 and IGF-I. Thorax. 2003 Sep;58(9):752–756. doi: 10.1136/thorax.58.9.752. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. 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]
  37. Weiner Paltiel, Magadle Rasmi, Beckerman Marinella, Weiner Margalit, Berar-Yanay Noa. Specific expiratory muscle training in COPD. Chest. 2003 Aug;124(2):468–473. doi: 10.1378/chest.124.2.468. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES