Quadriceps Endurance Increases Following Cycling Exercise With Non-Invasive Ventilation In Moderate-To-Severe COPD Patients. A Non-Randomized Controlled Study

Abstract

Pierre Labeix,1,2 Mathieu Berger,3 Isabelle Court Fortune,4 Léonard Feasson,2,5 Samuel Verges,6 Frédéric Costes7,8 1Centre VISAS, Service de Physiologie Clinique et de l’Exercice, CHU St Etienne, France; 2Univ Lyon, UJM Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, Saint-Etienne F-42023, France; 3Univ Lyon, UJM Saint-Etienne, laboratoire SNA-EPIS, EA4607, Saint-Etienne, France; 4Service de Pneumologie et d’Oncologie Thoracique, CHU St Etienne, France; 5Unité de Myologie, CHU St Etienne, France; 6Université Grenoble Alpes, Inserm, Laboratoire HP2, Grenoble, France; 7Université Clermont Auvergne, INRA, UNH Clermont Ferrand, France; 8Service de Médecine du Sport et des Explorations Fonctionnelles, CHU Clermont Ferrand, FranceCorrespondence: Frédéric CostesService de Médecine du Sport et des Explorations Fonctionnelles CHU Gabriel Montpied, 58 rue Montalembert, F63002 Clermont Ferrand cedex 1, FranceTel [phone]Email [email protected]: Application of non-invasive ventilation (NIV) during exercise improves exercise tolerance in severe COPD patients; however, the underlying mechanism is only partially unraveled. As part of its known effect to unload the respiratory muscles, we looked for the influence of NIV on post-exercise quadriceps muscle endurance.Patients and methods: We included 25 severe COPD patients entering an outpatient pulmonary rehabilitation program. They performed, on successive days, three quadriceps endurance tests at 70% of the maximal strength (1RM) to task failure (TlimQ); 1) control condition; 2) following constant load cycling exercise to exhaustion without Inspiratory Pressure Support (TlimQ IPS-); 3) following the same cycling exercise with IPS (TlmQ IPS+).Results: Dyspnea Borg score was significantly reduced at the end of the constant load cycling exercise with IPS+ compared to IPS- (3.5±2.6 to 4.3±2.3, p<0.05). Compared to controlled condition, TlimQ was reduced from 78.9±22.7 s to 64.7±22.1 s (p<0.01) with IPS+ and to 48.9±13.7 s (p<0.001) with IPS-. Sensitive analysis revealed a positive effect of NIV on TlimQ in only 15 of the 25 included patients (60%) and was unpredictable from exercise tolerance or maximal quadriceps strength.Conclusion: Using a simple muscle endurance test, we showed the protective effect of NIV on the exercise-induced quadriceps dysfunction. This beneficial effect is inconstant in our small series of patients and could not be predicted by exercise capacity or endurance to exercise. However, measuring quadriceps muscle endurance following a session of exercise could determine in which patient NIV would improve the benefit of pulmonary rehabilitation.Keywords: limb muscle, endurance, non-invasive ventilation, exercise, COPD

Keywords

• limb muscle
• endurance
• non invasive ventilation
• exercise
• copd