Cardiovascular and metabolic risk in patients with COPD and the effect of exercise training

    Beijers R.J.H.C.G. | NUTRIM School of Nutrition and Translation Research in Metabolism Maastricht University Department of Respiratory Medicine | 3 januari 2017 | 7.2.16.125CO (3.4.12.023)

Chronic obstructive pulmonary disease (COPD) patients are not only characterized with irreversible airflow limitation but also by extrapulmonary manifestations such as cardiovascular disease and skeletal muscle wasting. Two major phenotypic characteristics for the higher cardiovascular and reduced metabolic health in COPD are abdominal obesity and low muscle mass (1). It is unknown if exercise training influences cardiometabolic health in this COPD phenotype. This report will highlight ERS 2016 presentations about cardiovascular and metabolic risk in patients with COPD and the effect of exercise training.

Cardiometabolic risk in COPD

Patients with COPD have traditionally been divided into the ‘pink buffer’ and the ‘blue bloater’. However, as presented by prof. Wouters these descriptions are not valid and largely based on assumptions. Therefore, more longitudinal data are needed on relationship between body composition and lung morphology. As shown by Mohan et al. in the ERICA study, in COPD the prevalence of cardiovascular disease and skeletal muscle dysfunction in COPD is 25.0% and 22.2%, respectively (2). However, 21.4% of the patients had both cardiovascular disease and muscle dysfunction which was associated with worse functional and patient reported outcomes than presence of cardiovascular disease alone. During the ERS congress I presented a poster in a poster discussion session called ‘Cardiometabolic risk profile in COPD patients with low muscle mass and abdominal obesity and the responsiveness to exercise training’ (3). In this study we found a high prevalence of abdominal obesity in normal weight COPD patients with low muscle mass who showed an increased cardiometabolic risk compared to patients without abdominal obesity.

Exercise training to reduce the cardiometabolic risk in COPD

The primary aim of exercise training in state-of-the art pulmonary rehabilitation programs is to improve dyspnea, functional capacity and quality of life (4). Current rehabilitation programs have been effective in improving these aspects, which was also confirmed in several presentations during the ERS congress. For example, Dimitrova et al. showed that long term physical therapy had positive effects on pulmonary and functional status in elderly patients with COPD (5) and Jácome et al. showed that pulmonary rehabilitation improved exercise tolerance, peripheral muscle strength and health-related quality of life in patients with mild COPD as in patients with moderate-to-severe COPD (6). However, whether the exercise training might also improve the cardiometabolic risk of COPD patients is unknown. Sciriha et al. showed on their poster that no statistically significant changes were found on inflammatory markers after exercise training (7), which corresponds to what we found in our study. We found no alterations in the cardiometabolic risk profile of the COPD patients with abdominal obesity and low muscle mass after 4 months of exercise training (3). Therefore, more studies are needed to investigate the modulating potential of different exercise training types and intensities. As shown by Furlanetto et al. mortality is higher in patients with COPD who spend more than 8.5 hours/day in sedentary activities (8). Decreasing sedentary time and increasing the intensity of activities might lead to increase survival and maybe also decrease the cardiometabolic risk.  

Furthermore, nutritional interventions alone or in combination with exercise training might also affect the cardiometabolic risk profile in COPD. Maury et al. for example showed that additional antioxidant supplementation improves the pulmonary rehabilitation effects on muscle strength and muscle cross-sectional area by enhancing antioxidant capacity of COPD patients (9).

Conclusion

COPD patients with low muscle mass and abdominal obesity have an increased cardiometabolic risk profile. More studies are needed to investigate interventions, i.e. exercise training and nutritional interventions, to decrease the cardiometabolic risk in this COPD phenotype.

References

1. van den Borst B, Gosker HR, Schols AM. Central fat and peripheral muscle: partners in crime in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2013;187(1):8-13.
2. Mohan D, Polkey M, Forman J, McEniery C, Bolton C, Cockroft J, Fuld J, Marchong M, Gale N, Fisk M, et al. LATE-BREAKING ABSTRACT: Cardiovascular and skeletal muscle manifestations in COPD: The ERICA study. Abstract ERS congress London 2016.
3. Beijers RJHCG, van de Bool C, van den Borst B, Franssen FM, Wouters EF, Schols AMWJ. Cardiometabolic risk profile in muscle wasted COPD patients with abdominal obesity and the effect of pulmonary rehabilitation. Abstract ERS Congress London 2016.
4. Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, Hill K, Holland AE, Lareau SC, Man WD, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013;188(8):e13-64.
5. Dimitrova A, Lubenova D, Grigorova-Petrova K, Maznev I, Nikolova M. The effectiveness of long term physical therapy in elderly patients with chronic obstructive pulmonary disease. Abstract ERS Congress London 2016.
6. Jácome C, Marques A. Pulmonary rehabilitation: Is it feasible and beneficial in mild COPD? Abstract ERS Congress London 2016.
7. Sciriha A, Lungaro-Mifsud S, Bonello A, Agius T, Scerri J, Ellul B, Fenech A, Camilleri L, Montefort S. Pulmonary rehabilitation does not affect systemic inflammation in chronic obstructive pulmonary disease. Abstract ERS Congress London 2016.
8. Furlanetto K, Donária L, Schneider L, Lopes J, Ribeiro M, Fernandes K, Camillo C, N. H, Pitta F. How much time spent per day in sedentary behavior increases mortality risk in patients with COPD? Abstract ERS Congress London 2016.
9. Maury K, Héraud N, De Rigal P, Maolinary N, Pincemail J, Laoudj-Chenivesse D, Bughin F, Poulain M, Blaquière M, Mercier J, et al. LATE-BREAKING ABSTRACT: Antioxidant supplementation in chronic obstructive pulmonary disease (COPD): A relevant way to optimize pulmonary rehabilitation effects. Abstract ERS Congress London 2016.

Keyword: COPD Cardiometabolic risk

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