Relationship between obesity and respiratory muscle strength, functional capacity, and physical activity level in patients with chronic obstructive pulmonary disease

Öz

Purpose: A high body mass index (BMI) provides an advantage for survival in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate the effects of obesity on respiratory muscle strength, exercise capacity, and physical activity level in patients with COPD. Materials and Methods: Twenty-eight male COPD patients (age: 63.07±6.32 years, FEV1: 36.9±11.0%) participated in this study. The subjects were divided into two groups as overweight/obese (25≤BMI≤34.9 kg/m2, n=14) and normal (18.5≤BMI≤24.9 kg/m2, n=14). Pulmonary function testing and six-minute walk test were performed. Respiratory muscle strength was evaluated using a portable mouth pressure device. Physical activity level of the subjects was determined using an accelerometer.Results: Airway obstruction level was similar in both groups (p>0.05). Overweight/obese COPD patients’ inspiratory muscle strength (94.57±18.72 cmH2O), expiratory muscle strength (155.07±42.86 cmHO), and physical activity level (319.3 kcal/day) were statistically higher than patients with a normal BMI (inspiratory muscle strength: 79.64±26.14 cmH2O, expiratory muscle strength: 124.36±23.70 cmH2O, and physical activity level: 275.9 kcal/days, p<0.05). There was no significant difference in 6-minute walk distance between both groups, however work done during the test was significantly higher in overweight/obes group (3037.0±8662.91 kg/m ve 4240.3±10372.59 kg/m, p<0.05).Conclusion: Being overweight or obese preserves respiratory muscle strength in COPD. Although physical activity level of obese/overweight patients was higher than those of normal weight group, both groups had an insufficient physical activity levels. The clinical condition caused by being overweight or obese patients with COPD can provide a better prognosis

Anahtar Kelimeler

• Chronic obstructive pulmonary disease
• physical activity
• obesity

Kronik obstrüktif akciğer hastalarında obezitenin solunum kas kuvveti, fonksiyonel kapasite ve fiziksel aktivite düzeyi ile ilişkisi

Öz

Amaç: Vücut kitle indeksinin (VKİ) fazla olması kronik obstrüktif akciğer hastalarında (KOAH) yaşam süresi için avantajlıdır. Çalışmanın amacı, KOAH’ta obezitenin solunum kas kuvveti, egzersiz kapasitesi ve fiziksel aktivite üzerine etkisini araştırmaktı. Gereç ve Yöntem: Yirmi sekiz KOAH’lı erkek hasta (Yaş: 63.07±6.32 yıl, FEV1: % 36.9±11.0) çalışmaya alındı. Olgular aşırı kilolu/obes (25≤VKİ≤34.9 kg/m2, n=14) ve normal (18.5≤VKİ≤24.9 kg/m2, n=14) olarak iki gruba ayrıldı. Solunum fonksiyon testi ve altı dakika yürüme testi yapıldı. Solunum kas kuvveti taşınabilir ağız basıncı ölçüm cihazı ve fiziksel aktivite düzeyi akselerometre ile değerlendirildi. Sonuçlar: İki grubun havayolu obstrüksiyon düzeyi benzerdi (p>0.05). Aşırı kilolu/obes KOAH’lı hastaların inspiratuar kas kuvveti (94.57±18.72 cmHO), ekspiratuar kas kuvveti (155.07±42.86 cmH2O) ve fiziksel aktivite düzeyleri (319.3 kcal/gün), VKİ normal olan olguların değerlerinden (inspiratuar kas kuvveti: 79.64±26.14 cmH2O, ekspiratuar kas kuvveti: 124.36±23.70 cmH2O ve fiziksel aktivite düzeyi: 275.9 kcal/gün) anlamlı olarak daha yüksekti (p<0.05). İki grubun altı dakika yürüme testi mesafesi arasında anlamlı bir fark saptanmamakla birlikte, test sırasında yapılan iş istatistiksel olarak aşırı kilolu/obes grupta (3037.0±8662.91 kg/m ve 4240.3±10372.59 kg/m, p<0.05) daha yüksekti. Tartışma: KOAH’ta aşırı kilolu veya obes olmak solunum kas kuvvetini korumaktadır. Fiziksel aktivite düzeyi ise aşırı kilolu/obes grupta daha iyi olmasına rağmen, her iki grupta da düşüktür. KOAH’lı hastalarda aşırı kilolu veya obes olmanın yarattığı klinik durum, daha iyi prognoz sağlayabilir

Anahtar Kelimeler

• Kronik obstrüktif akciğer hastalığı
• fiziksel aktivite
• obezite

Kaynakça

1. Zutler M, Singer JP, Omachi TA, et al. Relationship of obesity with respiratory symptoms and decreased functional capa- city in adults without established COPD. Prim Care Respir J. 2012;21(2):194-201.
2. Leone N, Courbon D, Thomas F, et al. Lung function impairment and metabolic syndrome: the critical role of abdominal obesity. Am J Respir Crit Care Med. 2009;179(6):509-516.
3. Rabe KF, Hurd S, Anzueto A, et al. Global strategy for the diag- nosis, management, and prevention of chronic obstructive pul- monary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176(6):532-555.
4. İnal İnce D, Savcı S, Sağlam M, ve diğerleri. Kronik obstrüktif ak- ciğer hastalarında sigara öyküsü ve fonksiyonel kapasite arasın- daki ilişki. Fizyoter Rehabil. 2011;22:39-43.
5. Pepin V, Saey D, Laviolette L, et al. Exercise capacity in chronic obstructive pulmonary disease: mechanisms of limitation. COPD. 2007;4(3):195-204.
6. Eisner MD, Blanc PD, Sidney S, et al. Body composition and func- tional limitation in COPD. Respir Res. 2007;8:7.
7. Cote CG, Pinto-Plata V, Kasprzyk K, et al. The 6-min walk dis- tance, peak oxygen uptake, and mortality in COPD. Chest. 2007;132(6):1778-1785.
8. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000; 894; i-xii, 1-253.

9. Quanjer PH, Tammeling GJ, Cotes JE, et al. Lung volumes and forced ventilatory flows. Report working party standardization of lung function tests, European Community for Steel and Coal. Of- ficial Statement of the European Respiratory Society. Eur Respir J Suppl. 1993;16:5-40.
10. Schols AM, Wouters EF, Soeters PB, et al. Body composition by bioelectrical-impedance analysis compared with deuterium dilu- tion and skinfold anthropometry in patients with chronic obst- ructive pulmonary disease. Am J Clin Nutr. 1991;53(2):421-424.
11. ATS statement: guidelines for the six-minute walk test. Am J Res- pir Crit Care Med. 2002;166(1):111-117.
12. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377-381.
13. Fox EL, Bowers RW, Foss ML. The Physiological Basis of Physi- cal Education and Athletics.c. Dubuque: Wm C Brown Publishers. 1989:269-313.
14. Carter R, Holiday DB, Nwasuruba C, et al. 6-minute walk work for assessment of functional capacity in patients with COPD. Chest. 2003;123(5):1408-1415.
15. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002;166(4):518-624.
16. Pitta F, Troosters T, Probst VS, et al. Quantifying physical activity in daily life with questionnaires and motion sensors in COPD. Eur Respir J. 2006;27(5):1040-1055.
17. Green SB, Salkind NJ, Akey TM. Using SPSS for Windows: Analy- zing and Understanding Data. bs. 2nd ed, c. New Jersey: Prentice Hall. 2000:70-110.
18. Magnani KL and Cataneo AJ. Respiratory muscle strength in obe- se individuals and influence of upper-body fat distribution. Sao Paulo Med J. 2007;125(4):215-219.
19. Sabino PG, Silva BM and Brunetto AF. Nutritional status is rela- ted to fat-free mass, exercise capacity and inspiratory strength in severe chronic obstructive pulmonary disease patients. Clinics (Sao Paulo). 2010;65(6):599-605.
20. Kelly TM, Jensen RL, Elliott CG, et al. Maximum respiratory pres- sures in morbidly obese subjects. Respiration. 1988;54(2):73-77.
21. O’Donnell DE, O’Donnell CD, Webb KA, et al. Respiratory Consequ- ences of Mild-to-Moderate Obesity: Impact on Exercise Perfor- mance in Health and in Chronic Obstructive Pulmonary Disease. Pulm Med. 2012; 818925.
22. Pazzianotto-Forti EM, Peixoto-Souza FS, Piconi-Mendes C, et al. Behavior of respiratory muscle strength in morbidly obese wo- men by using different predictive equations. Rev Bras Fisioter. 2012;16(6):479-486.
23. Bautista J, Ehsan M, Normandin E, et al. Physiologic responses during the six minute walk test in obese and non-obese COPD patients. Respir Med. 2011;105(8):1189-1194.
24. Monteiro F, Camillo CA, Vitorasso R, et al. Obesity and phy- sical activity in the daily life of patients with COPD. Lung. 2012;190(4):403-410.
25. Kyle UG, Gremion G, Genton L, et al. Physical activity and fat-free and fat mass by bioelectrical impedance in 3853 adults. Med Sci Sports Exerc. 2001;33(4):576-584.
26. Cao C, Wang R, Wang J, et al. Body mass index and mortality in chronic obstructive pulmonary disease: a meta-analysis. PLoS One. 2012; 7(8):e43892.