The Impact of a Combined Pulmonary Rehabilitation and Resistance Training Program on Sarcopenia, Muscle Strength, and Functional Capacity in Patients with COPD: A Randomized Controlled Trial
Keywords:
Copd, Sarcopenia, Pulmonary Rehabilitation, Resistance Training, 6-Minute Walk Test, Skeletal Muscle Dysfunction.Abstract
Background: Sarcopenia, the age-related loss of skeletal muscle mass and function, is a prevalent and impactful extrapulmonary manifestation in Chronic Obstructive Pulmonary Disease (COPD). It contributes significantly to reduced functional capacity, poor quality of life, and increased mortality. Pulmonary Rehabilitation (PR) is a cornerstone of COPD management, but the specific additive effect of structured resistance training on sarcopenic patients remains a key area of investigation.
Objective: To determine the prevalence of sarcopenia in a stable COPD cohort and to evaluate the efficacy of a standard PR program augmented with high-intensity resistance training on muscle strength and functional exercise capacity.
Methods: One hundred stable COPD patients (GOLD stages 2-3) were screened for sarcopenia using the EWGSOP2 criteria (low muscle strength confirmed by low muscle quantity/quality). Participants were randomly assigned to either the Control Group (CG, n=50) receiving standard PR (aerobic exercise, education, breathing techniques) or the Intervention Group (IG, n=50) receiving standard PR plus supervised, progressive resistance training for 8 weeks. Primary outcomes were changes in limb muscle strength (1-Repetition Maximum Leg Press) and functional capacity (6-Minute Walk Test, 6MWT). Secondary outcomes included handgrip strength and sarcopenia status.
Results: The prevalence of sarcopenia in our COPD cohort was 38%. At baseline, sarcopenic patients had a significantly lower 6MWT distance compared to non-sarcopenic patients (318±45m vs. 402±52m, p<0.001). Post-intervention, the IG showed significantly greater improvements than the CG in leg press strength (IG: +32.5 kg vs. CG: +10.2 kg, p<0.001) and 6MWT distance (IG: +55.8m vs. CG: +28.4m, p<0.001). A higher proportion of sarcopenic patients in the IG (68.4%) reversed their sarcopenia status compared to the CG (21.1%, p<0.01).
Conclusion: Sarcopenia is highly prevalent in COPD and is strongly associated with impaired functional capacity. Integrating targeted resistance training into a standard pulmonary rehabilitation program yields superior improvements in muscle strength and functional exercise capacity, and is highly effective in reversing sarcopenia in COPD patients.
