Effects of nutritional supplementation combined with low-intensity exercise in malnourished patients with COPD

• Published in: Respiratory medicine 2010-12, Vol.104 (12), p.1883-1889
• Main Authors: Sugawara, Keiyu, Takahashi, Hitomi, Kasai, Chikage, Kiyokawa, Noritaka, Watanabe, Tohru, Fujii, Sayaka, Kashiwagura, Tsuyoshi, Honma, Mitsunobu, Satake, Masahiro, Shioya, Takanobu
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Body mass index; Body Weight - physiology; Carbohydrates; Chronic obstructive pulmonary disease, asthma; COPD; Diet; Diet (weight control); Dietary Supplements; Exercise Tolerance - physiology; Female; Food; Health sciences; Hospitals; Humans; Interleukin-6 - metabolism; Interleukin-8 - metabolism; Japan; Low-intensity exercise training; Male; Malnutrition - diet therapy; Malnutrition - physiopathology; Medical sciences; Metabolic diseases; Miscellaneous; Nutritional support; Omega-3 PUFA-rich diet; Other nutritional diseases (malnutrition, nutritional and vitamin deficiencies...); Pneumology; Proteins; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Disease, Chronic Obstructive - therapy; Pulmonary rehabilitation; Pulmonary/Respiratory; Quality of Life; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Rehabilitation; Respiratory Function Tests; Surveys and Questionnaires; Tumor Necrosis Factor-alpha - metabolism; Walking
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2010.05.008

Summary Study objectives The first aim of this study was to investigate the effects of nutritional supplementation combined with low-intensity exercise on body components, exercise tolerance, and health-related quality of life (HRQOL) in malnourished patients with COPD. The second aim of this study was to examine the degree of systemic inflammation and the actual changes in levels of systemic CRP, TNFα, IL-6 and IL-8 actual changes after a combination of nutritional supplementation and low-intensity exercise in these patients. Design A prospective randomized trial. Patients Thirty-two moderate to severe, clinically stable malnourished COPD patients. Methods Patients were randomly divided into a nutritional supplementation with low-intensity exercise group and a control group. Lung function, maximum inspiratory and expiratory muscle force, the Chronic Respiratory Disease Questionnaire (CRQ), the 6-min walking distance (6MWD), and the Borg scale were measured at baseline and were re-assessed at 3 months after intervention. The degree of systemic inflammation and the changes in levels of systemic CRP, TNFα, IL-6 and IL-8 were assessed before and after a combination nutritional supplementation with low-intensity exercise. Results Body weight and FFM increased significantly after 12 weeks of nutritional supplementation therapy in patients with COPD. The dietary intake energy increased and the REE:REEpred ratio decreased significantly in the nutrition with low-intensity exercise group. PImax , Quadriceps muscle force and the 6-min walking distance (6MWD) increased significantly from baseline through week 12. Health status, as assessed by CRQ, improved in the domains of dyspnea and total sores significantly in the nutrition with low-intensity exercise group after intervention. In this group, hsCRP, IL-6, IL-8, and TNFα, decreased significantly after intervention compared with the control group. Conclusions The combination of nutritional supplementation with low-intensity exercise training was successful in increasing weight and energy intake as well as exercise capacity and health-related QOL in our patients. Moreover, REE and major inflammatory cytokines decreased significantly after nutritional supplementation with low-intensity exercise training. The present study results suggest a potential role for the combination of nutritional supplementation and low-intensity exercise in the management of malnourished patients with COPD.