Table 2.
Current Therapies for Muscle Dysfunction
| Therapeutic Approach | Category | Examples of Interventions | Pros/Cons |
|---|---|---|---|
| Nutritional support | High-protein diet | >1.5 g of protein (4, 38) | May be appropriate after thorough nutritional evaluation; may be nitrogen load |
| Complete oral nutrition supplementation | Formulas vary; brands include ENSURE, BOOST | Potential link to reduced readmission, however, hospital formulations vary (34) | |
| Other nutritional supplements | Creatine (67, 68) | Mixed or negative data on effectiveness; insufficient evaluations in hospitalized AECOPD setting | |
| Coenzyme Q (68) | |||
| Vitamin D | |||
| Pulmonary rehabilitation | General | Varies: resistance, cardio; includes limb-specific exercises | Shown to increased exercise capacity and feelings of independence |
| Early initiation may not improve patient-reported outcomes (63) and may be linked to increased mortality (62) | |||
| Upper limb | Supported: arm weight is supported, including cycle ergometry, rear deltoid row, chest press, and biceps flexion with vertical shoulder press (59) | Improvement in both performance and endurance but not always dyspnea (59, 61) | |
| Unsupported: requires the activation of muscles that may be involved in respiration and/or in the support of the shoulder girdle during ADLs (e.g., lifting free weights) (59) | Potential risks of upper limb training are dynamic hyperinflation, a phenomenon usually seen at >50% of the maximum load obtained (126) | ||
| Lower limb | Exercises for lower limb include heel raises, knee extension with heel touching floor, hip flexion, knee extension with dorsal flexion of ankle (128) | Can improve quadriceps mass and strength, which are linked to mortality outcomes (61, 127) | |
| Neuromuscular electrical stimulation | NMES | NMES only | Generally, has been shown to be safe but higher mortality in intervention group in Greening and colleagues study (62) |
| NMES and PR | NMES PR |
Definition of abbreviations: ADLs = activities of daily living; AECOPD = acute exacerbation of chronic obstructive pulmonary disease; NMES = neuromuscular electrical stimulation; PR = pulmonary rehabilitation.