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Introduction: The lack of reference values of lower-limb muscle function hinders the clinical recommendations of its measurement in patients with COPD. Therefore, this study aimed to develop reference equations to predict reference values for quadriceps strength, endurance and power and evaluate their construct validity in patients with COPD. Methods: Quadriceps strength, endurance and power were assessed in 158 healthy individuals and 87 patients with COPD. In addition, patients with COPD performed a 6-min walk test (6MWT) and a 1-min sit-to-stand test (1STS). Multiple linear regressions were performed to develop reference equations. The proportion of patients with COPD with reduced quadriceps function was determined, and correlations between quadriceps strength, endurance and power expressed in percentage of predicted values and 6MWT and 1STS performance were used to document the construct validity of the reference equation. Results: Except for quadriceps isometric endurance, the proposed reference equations explained 50-70% of the variance of the quadriceps properties in healthy individuals. All quadriceps properties were systematically reduced in a large proportion of patients with COPD compared to healthy individuals. Correlation coefficients between quadriceps properties expressed in percentage of predicted values and 6MWT and 1STS performance ranged between 0.28 and 0.49 (all p<0.05). Conclusion: In healthy individuals, age, sex, height and body mass index explained 50-70% of the variance of quadriceps strength, endurance and power. When expressed in percentage of predicted values, these quadriceps properties correlated with 6MWT and 1STS performance, suggesting construct validity of the reference values in patients with COPD., Originally included in thesis in manuscript form.

Introduction: Quadriceps dysfunction is a common systemic manifestation of chronic obstructive pulmonary disease (COPD), for which treatment using resistance training is highly recommended. Even though training volume is suggested to be a key explanatory factor for intramuscular adaptation to resistance training in healthy older adults, knowledge is scarce on the role of progression of training volume for intramuscular adaptations in COPD. Methods: This study was a sub-analysis of a parallel-group randomized controlled trial. Thirteen patients with severe to very severe COPD (median 66 yrs, forced expiratory volume in 1 s 44% predicted) performed 8 weeks of low-load resistance training. In a post hoc analysis, they were divided into two groups according to their training volume progression. Those in whom training volume continued to increase after the first 4 weeks of training outlined the continued progression group (n = 9), while those with limited increase (<5%) or even reduction in training volume after the initial 4 weeks composed the discontinued progression group (n = 4). Fiber-type distribution and oxidative muscle protein levels, i.e., citrate synthase (CS), hydroxyacyl-coenzyme A dehydrogenase (HADH), mitochondrial transcription factor A (TfAM) as well as quadriceps endurance measures (total work from elastic band and isokinetic knee extension tests), were assessed before and after the intervention period. Results: The continued progression group sustained their training volume progression during weeks 5-8 compared to weeks 1-4 (median +25%), while the discontinued progression group did not (median -2%) (p = 0.007 between groups). Compared with baseline values, significant between-group differences in fiber type distribution and TfAM muscle protein levels (range ± 17-62%, p < 0.05) and in individual responses to change in Type I and Type IIa fiber type proportion, CS, HADH, and TfAM muscle protein levels outcomes (median 89 vs. 50%, p = 0.001) were s

Les maladies respiratoires chroniques s’accompagnent souvent de nombreuses comorbidités qui contribuent à la diminution de la capacité à l’exercice et d’une altération des capacités fonctionnelles et musculaires qui affectent la qualité de vie des personnes qui en sont atteintes et qui peuvent toutes être améliorées par la réadaptation respiratoire. Dans le contexte de la réadaptation, l’évaluation de ces pertes de capacité et de fonction avec des tests appropriés et sensibles au changement est nécessaire afin de personnaliser les différentes interventions physiques et d’en évaluer l’efficacité à court et à long terme. Le clinicien dispose actuellement d’un large éventail de tests et mesures pour juger de la capacité physique et fonctionnelle des personnes ayant une maladie respiratoire chronique. Cette revue a pour but de faire une synthèse pragmatique des tests de capacité physique, fonctionnelle et musculaire les plus couramment utilisés dans un contexte de réadaptation respiratoire. Ultimement, elle devrait aider le clinicien à cibler les évaluations pertinentes en fonction des objectifs de la personne et de son parcours de soins, mais aussi en fonction des ressources disponibles, du lieu de réalisation et des qualités spécifiques de chacun des tests., [Which physical tests for which objectives in pulmonary rehabilitation?]. Chronic respiratory disease is a major cause of morbidity and mortality worldwide and an important cause of disability including a reduction of exercise, functional and muscle capacity contributing to a decreased quality of life. In the context of pulmonary rehabilitation, a thorough patient-centered outcome assessment, including not only measures of lung function, but also exercise functional and muscle capacity, is imperative for a comprehensive disease management. Assessment of these impairments and dysfunctions with appropriate and change-sensitive procedures is thus necessary for personalizing the physical interventions and assessing the short- and long-term effectiveness of the intervention. The clinician currently has a wide variety of tests and measurements available to assess the physical and functional capacity of people with chronic respiratory disease. The aim of this review is to provide a pragmatic synthesis of the physical, functional and muscle capacity tests most commonly used in pulmonary rehabilitation. Ultimately, it should help the clinician to identify the relevant evaluations according to the objectives of the patients but also according to the available resources, the setting of pulmonary rehabilitation and the specific qualities of each test.

Background: Training volume is paramount in the magnitude of physiological adaptations following resistance training. However, patients with severe COPD are limited by dyspnea during traditional two-limb low-load/high-repetition resistance training (LLHR-RT), resulting in suboptimal training volumes. During a single exercise session, single-limb LLHR-RT decreases the ventilatory load and enables higher localized training volumes compared with two-limb LLHR-RT. Research Question: Does single-limb LLHR-RT lead to more profound effects compared with two-limb LLHR-RT on exercise capacity (6-min walk distance [6MWD]), health status, muscle function, and limb adaptations in patients with severe COPD? Study Design and Methods: Thirty-three patients (mean age 66 ± 7 years; FEV1 39 ± 10% predicted) were randomized to 8 weeks of single- or two-limb LLHR-RT. Exercise capacity (6MWD), health status, and muscle function were compared between groups. Quadriceps muscle biopsy specimens were collected to examine physiological responses. Results: Single-limb LLHR-RT did not further enhance 6MWD compared with two-limb LLHR-RT (difference, 14 [–12 to 39 m]. However, 73% in the single-limb group exceeded the known minimal clinically important difference of 30 m compared with 25% in the two-limb group (P = .02). Health status and muscle function improved to a similar extent in both groups. During training, single-limb LLHR-RT resulted in a clinically relevant reduction in dyspnea during training compared with two-limb LLHR-RT (–1.75; P = .01), but training volume was not significantly increased (23%; P = .179). Quadriceps muscle citrate synthase activity (19%; P = .03), hydroxyacyl-coenzyme A dehydrogenase protein levels (32%; P < .01), and capillary-to-fiber ratio (41%; P < .01) were increased compared with baseline after pooling muscle biopsy data from all participants. Interpretation: Single-limb LLHR-RT did not further increase mean 6MWD compared with two-limb LLHR-RT, but it, Part of this article has been presented at the 2017 European Respiratory Society Congress, September 9-13, 2017, Milan, Italy, and the 2018 European Respiratory Society Congress, September 15-19, 2018, Paris, France.Available online 13 December 2020.

Sarah Gephine,1,2 Patrick Mucci,1 Jean-Marie Grosbois,3 François Maltais,2 Didier Saey2 1University Lille, University Artois, University Littoral Côte d’Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, F-59000, France; 2Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada; 3Formaction Santé, Pérenchies, FranceCorrespondence: Didier SaeyInstitut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, 2725 Chemin Sainte-Foy, Québec, QC, G1V 4G5 CanadaEmail Didier.saey@rea.ulaval.caBackground: The prevalence of physical frailty and its clinical characteristics in advanced chronic obstructive pulmonary disease (COPD) is unknown, as well as the usefulness of functional capacity tests to screen for physical frailty. The aim of the study was to evaluate the proportion and clinical portrait of COPD patients with chronic respiratory failure exhibiting physical frailty at the time of referral to home-based pulmonary rehabilitation. We also evaluate the usefulness of the short physical performance battery (SPPB) and timed-up and go (TUG) as potential screening tools for physical frailty. Finally, we evaluated the specific contribution of gait speed to the frailty Fried total score.Methods: This was a prospective observational study in which physical frailty was defined using Fried criteria (body mass loss, exhaustion, low physical activity, slower walking and weakness). Clinical portrait was documented from daily physical activity, exercise tolerance, functional capacity, anxiety and depressive symptoms, health-related quality of life, and fatigue scores. The ability of the SPPB and TUG to predict physical frailty was investigated using receiver operating characteristic curves. Contribu