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Contractile Fatigue of the Quadriceps Muscle Predicts Improvement in Exercise Performance After Pulmonary Rehabilitation

Mador, M. Jeffery MD; Mogri, Mohammed MD; Patel, Anil MD

Journal of Cardiopulmonary Rehabilitation & Prevention: January/February 2014 - Volume 34 - Issue 1 - p 54–61
doi: 10.1097/HCR.0000000000000023
Pulmonary Rehabilitation

RATIONALE: We hypothesized that among patients with chronic obstructive pulmonary disease, those who develop quadriceps contractile fatigue (QCF) after exhaustive submaximal cycle exercise would have a greater response to exercise training than those who do not develop QCF (NQCF).

METHODS: Patients (N = 132) had measurement of QCF at baseline. Six-minute walk distance (6MWD), maximal incremental cycle exercise testing, and quality of life measured by the Chronic Respiratory Questionnaire were obtained before and after pulmonary rehabilitation (PR).

RESULTS: Eighty of the 132 patients (60.6%) developed QCF following constant workload exhaustive cycle exercise. Patients who developed QCF had a significantly greater improvement in 6MWD following PR (45.3 ± 45.2 m) than those who did not (27.5 ± 45.7 m; P= .032). When baseline differences between patients who developed QCF and NQCF were accounted for, the difference in 6MWD remained significant. Patients who developed QCF were not more likely to identify leg fatigue as the factor limiting exercise (56.2% of QCF group stated that leg fatigue was the limiting factor compared with 47.9% in the NQCF group; P= .46). When baseline differences were accounted for, the symptom causing exercise termination was not a predictor of the response to PR.

CONCLUSION: Patients who were capable of developing QCF had a significantly greater improvement in 6MWD after PR compared to NQCF. Symptoms causing exercise termination could not be used to predict the development of contractile fatigue or the response to PR.

Among patients with chronic obstructive pulmonary disease, those who developed contractile fatigue of the quadriceps muscle (QCF) after exhaustive submaximal cycle exercise had a greater response to exercise training than those without QCF. Symptoms causing exercise termination could not be used to predict the development of QCF or the response to pulmonary rehabilitation.

Veteran Affairs Western New York Healthcare System (Dr Mador), and Division of Pulmonary, Critical Care and Sleep Medicine, State University of New York at Buffalo (Drs Mador, Mogri, and Patel), Buffalo, New York.

Correspondence: M. Jeffery Mador, MD, Division of Pulmonary, Critical Care and Sleep Medicine, Section 111S, 3495 Bailey Ave, Buffalo, NY 14215 (mador@buffalo.edu).

The authors declare no conflicts of interest.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins