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Pathophysiology of Muscle in Pulmonary and Cardiovascular Conditions

Kasawara, Karina Tamy, BScPT, MSc, PhD1; Castellanos, Maria Miñana, MD2; Hanada, Masatoshi, BScPT, MSc, PhD3; Reid, W Darlene, BMR(PT), PhD1,4,5

Cardiopulmonary Physical Therapy Journal: January 2019 - Volume 30 - Issue 1 - p 5–14
doi: 10.1097/CPT.0000000000000096
Literature Review

Purpose: To provide an overview of skeletal muscle pathophysiology in pulmonary and cardiovascular conditions commonly managed by physical therapists.

Summary of Key Points: This review describes the muscle pathophysiology associated with congestive heart failure, chronic obstructive pulmonary disease, interstitial lung disease, cystic fibrosis, intensive care unit–acquired weakness, immobilization, and aging. Causes of poor muscle performance are multifactorial; disease-specific and generic factors can contribute to the etiology. The time course of deterioration of peripheral and ventilatory muscle may each follow a distinctive course dependent on disease severity, its progression, and other influencing factors. Generic factors that are common in many respiratory and cardiovascular conditions are systemic inflammation and oxidative stress leading to peripheral and ventilatory muscle dysfunction that is accentuated by reduced physical activity. Loss of muscle function associated with aging is also reflected in both peripheral and ventilatory muscles. Evidence of how exercise training can counter the deleterious effects of disease on physical function is outlined.

Statement of Conclusions: Patients with pulmonary and cardiovascular conditions may experience atrophy and weakness due to macroscopic, cellular, and metabolic alterations. Physical therapy interventions to improve muscle function need to consider the potential reversibility and related time course of the underlying pathophysiology of muscle dysfunction.

1Department of Physical Therapy, University of Toronto, Toronto, ON, Canada

2Universitat Pompeu Fabra and Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain

3Cardiorespiratory Division, Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan

4Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada

5Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada

Correspondence: Karina Tamy Kasawara, BScPT, MSc, PhD, Department of Physical Therapy, Rehabilitation Sciences Building, Room 160, 500 University Avenue, Toronto, ON M5G 1V7, Canada (

The authors declare no conflicts of interest.

© 2019 Cardiovascular and Pulmonary Section, APTA
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