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IMPACT DE LA FAIBLESSE MUSCULAIRE SUR LA TOLERANCE A L'EFFORT ET LA QUALITE DE VIE DES PATIENTS ATTEINTS DE BPCO : BENEFICE DU REENTRAINEMENT A L'EFFORT

Abstract : Chronic obstructive pulmonary disease (COPD) is a growing health problem both in primary and secondary care. Among systemic abnormalities, peripheral muscle dysfunction is now recognized as a main factor of physiopathology in COPD and peripheral muscle weakness is of particular interest since it has been associated with high utilization of health care resources and poor prognosis in COPD. Thus, the place of specific strength training in the rehabilitation of COPD patients is actually discussed. Although the benefit of endurance training on muscular metabolism during exercise has been proven, a poorer impact on peripheral muscle strength was reported. Furthermore, such training is not always easy to perform in severe COPD patients with early dynamic hyperinflation during muscular exercise. Thus, our research aimed to assess the role of peripheral muscle weakness in exercise tolerance and quality of life in very severe COPD patients in order to better individualize exercise training.

We first confirmed that magnetic stimulation of femoral nerve is a valid and reproducible method and that it's sensitive enough to detect little changes in muscle strength after training. Using this tool, we showed that peripheral muscle weakness is independently related to exercise intolerance in very severe COPD patients. We showed this muscle weakness was partly related to a deficit in central activation during leg extension. Any intervention leading to an increase in physical activity level improved muscle strength decreasing in turn dyspnea and leg discomfort during exercise. In this way, electrostimulation of the quadriceps muscle is an alternative strategy which appeared to be particularly well adapted for very severe COPD patients, unable to perform cycle exercise. Taken together, our results suggested mechanisms such as central adaptation could be involved in peripheral muscle strength gains after training in very severe COPD patients. Furthermore, an increase in muscle strength would be transferred into a reduction in dyspnea during daily tasks leading to better tolerance and an improved quality of life in patients after lung transplantation, in whom the respiratory function was almost normalized.

In conclusion, resistive training seems to be particularly relevant in rehabilitation of COPD patients and peripheral muscle weakness should be considered in the same way as pulmonary severity to individualize exercise training program in COPD patients.
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https://tel.archives-ouvertes.fr/tel-00174963
Contributor : Isabelle Vivodtzev <>
Submitted on : Tuesday, September 25, 2007 - 11:16:48 PM
Last modification on : Friday, October 23, 2020 - 4:40:24 PM
Long-term archiving on: : Friday, April 9, 2010 - 2:53:14 AM

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  • HAL Id : tel-00174963, version 1

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Isabelle Vivodtzev. IMPACT DE LA FAIBLESSE MUSCULAIRE SUR LA TOLERANCE A L'EFFORT ET LA QUALITE DE VIE DES PATIENTS ATTEINTS DE BPCO : BENEFICE DU REENTRAINEMENT A L'EFFORT. Physiologie [q-bio.TO]. Université Joseph-Fourier - Grenoble I, 2006. Français. ⟨tel-00174963⟩

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