Abstract
Obesity is a known risk factor for poor health outcomes, but paradoxically in COPD it is associated with improved survival and lung function. Weight loss can lead to loss of not only fat, but also skeletal muscle mass.
Aim: To determine if weight reduction, combined with resistance training, would reduce inflammation and improve clinical outcomes in obese COPD.
Method: In a before-after clinical trial, obese (BMI>30kg/m2) COPD patients (n=36) received a 12 week weight reduction program involving meal replacements, dietary counselling and resistance training. Patients were reviewed face to face by a dietician and physiotherapist every 2 weeks.
Results: 26 participants completed the intervention. The mean (SD) age was 67.9 (6.5) years, 61% were male, and mean FEV1%predicted was 63.3 (20.7). Mean BMI was 36.5kg/m2 (4.6) at baseline and reduced by 2.5kg/m2 (p<0.0001). Body fat mass was reduced, while skeletal muscle mass was maintained. Clinical outcomes improved with weight loss: 6MWD (Δ33.8m; p=0.0008); St George Respiratory Questionnaire (Δ10.7 units;p=0.0001) and BODE index (Δ1.4 units;p<0.0001). There was no difference in CRP post intervention (Δ1.9mg/L; p=0.7000), but depression scores improved (p=0.0100).
Conclusion: In obese COPD patients, dietary energy restriction coupled with resistance strength training results in clinically significant improvements in BMI, exercise tolerance and health status, whilst preserving skeletal muscle mass. Importantly, this intervention resulted in an improved prognostic score, but longer term follow up is required. This novel study provides a framework for development of guidelines and in guiding future research.
- © 2014 ERS
