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American Journal of Clinical Nutrition, Vol. 71, No. 5, 1033-1047, May 2000
© 2000 American Society for Clinical Nutrition

Review Article

Skeletal muscle dysfunction in chronic obstructive pulmonary disease and chronic heart failure: underlying mechanisms and therapy perspectives1,2,3

Harry R Gosker, Emiel FM Wouters, Ger J van der Vusse and Annemie MWJ Schols

1 From the Departments of Pulmonology and Physiology, Maastricht University, Maastricht, Netherlands.

Low exercise tolerance has a large influence on health status in chronic obstructive pulmonary disease and chronic heart failure. In addition to primary organ dysfunction, impaired skeletal muscle performance is a strong predictor of low exercise capacity. There are striking similarities between both disorders with respect to the muscular alterations underlying the impairment. However, different alterations occur in different muscle types. Histologic and metabolic data show that peripheral muscles undergo a shift from oxidative to glycolytic energy metabolism, whereas the opposite is observed in the diaphragm. These findings are in line with the notion that peripheral and diaphragm muscle are limited mainly by endurance and strength capacity, respectively. In both diseases, muscular impairment is multifactorially determined; hypoxia, oxidative stress, disuse, medication, nutritional depletion, and systemic inflammation may contribute to the observed muscle abnormalities and each factor has its own potential for innovative treatment approaches.

Key Words: Chronic obstructive pulmonary disease • COPD • chronic heart failure • CHF • skeletal muscle • peripheral muscle • respiratory muscle • exercise intolerance • muscle performance • muscle morphology • muscle metabolism • hypoxia • oxidative stress • medication • disuse • nutritional depletion • systemic inflammation • oxygen therapy • antioxidant status • training • nutritional support • anabolic steroids • review




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