Chest
Volume 137, Issue 3, March 2010, Pages 585-592
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Original Research
COPD
Significant Improvement in Arterial Stiffness After Endurance Training in Patients With COPD

https://doi.org/10.1378/chest.09-1437Get rights and content

Background

Arterial stiffness, a strong predictor of cardiovascular mortality, is abnormally elevated in patients with COPD. We investigated whether exercise training may decrease arterial stiffness in patients with COPD.

Methods

Seventeen stable patients with COPD were included in this case-controlled study. Trained (n = 10) and untrained (n = 7) patients were matched for age (62 ± 7 years), disease severity (FEV1 = 50% ± 17% predicted) and walking distance (412 ± 70 m). Carotid-radial pulse wave velocity (PWV, a measure of arterial stiffness), pulmonary function, BP, plasmatic biomarkers, walking distance, and peripheral muscle function were evaluated in the two groups at baseline and after 4 weeks. In trained patients, aerobic capacity was also assessed during incremental exercise on a cycloergometer, before and after training.

Results

Baseline PWV was similar between both groups. PWV was stable after 4 weeks in untrained patients with COPD, whereas it was reduced in trained patients (from 10.3 ± 0.7 to 9.2 ± 0.8 m/s, P = .001). PWV reduction correlated with improvements in walking distance (r = −0.49), muscle endurance (r = −0.48), systolic BP (r = 0.79), and fasting glucose (r = 0.59) in all patients (P < .05), and with changes in maximal heart rate and oxygen consumption (r = −0.70, P = .02) in trained patients.

Conclusions

Arterial stiffness appears to improve after exercise training in patients with COPD proportionally to changes in exercise capacity. Suggested mechanisms for arterial stiffness improvement are training-induced reductions in systolic BP and fasting glucose.

Trial registration

clinicaltrials.gov; Identifier: NCT00404430

Section snippets

Subjects

Seventeen patients were included in the study. Patient characteristics are reported in Table 1. Inclusion criteria were: (1) moderate to severe COPD14; (2) free of respiratory exacerbation within the preceding 3 months; (3) free of diabetes, defined as fasting venous plasma glucose level ≤ 7.0 mmol/L; and (4) ability to perform exercise training. The research protocol was approved by the institutional ethics committee, and a signed informed consent was obtained from each subject.

Study Design

Consecutive

Patient Characteristics at Baseline

Patient characteristics are presented in Table 1. At baseline, trained and untrained groups were similar for age, BMI, pulmonary function, blood gases, and walking distance. No significant difference was found between groups in terms of BP, TAS, usCRP, metabolic parameters, and functional capacity. None of the patients reported an acute exacerbation during the study period and the medications remained constant in the two groups during the entire study. At baseline, mean PWV was abnormal at 10.2

Discussion

The novelty of our study was to demonstrate that arterial stiffness could significantly improve after a short endurance training program in patients with COPD. This improvement in arterial stiffness was proportional to improvement in exercise capacity after training and significantly related to changes in fasting glucose and BP after exercise. The 10% reduction in arterial stiffness obtained in the present investigation with exercise training is comparable in magnitude to what can be obtained

Acknowledgments

Author contributions: Dr Vivodtzev: contributed to the study hypothesis, study design, data collection and analyses, writing the manuscript, and sharing scientific discussions.

Dr Minet: contributed to data collection and analyses.

Dr Wuyam: contributed to writing the manuscript and sharing scientific discussions.

Dr Borel: contributed to data collection and analyses.

Dr Vottero: contributed to data collection and analyses.

Mr Monneret: contributed to data collection and analyses.

Dr Baguet:

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Funding/Support: This study was supported by grants from ATRIR “Bourse André DION” (Nyons, France); Scientific council of AGIR@dom (Meylan, France), and by an unrestricted grant from GlaxoSmithKline (20,000 Euros).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).

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