Impact of Strength Training on Neuromuscular Function in COPD: Key Knowledge for Understanding Strength Gain Variability After Pulmonary Rehabilitation

Résumé fourni par la source

Strength training (ST) is a key component of pulmonary rehabilitation (PR) in COPD. However, 50% of patients fail to improve muscle strength, classifying them as non-responders (NR). To better understand this variability, this study assessed neuromuscular adaptations before and after PR and identified predictors of non-response. 41 COPD patients completed a 4-week inpatient PR program at Clinique du Souffle Inicea La Vallonie (France), which included standardized ST following ACSM international guidelines. Quadriceps maximal voluntary contraction (QMVC), rate of force development (RFD), voluntary activation (VA), corticospinal excitability (MEP/Mmax), and peripheral muscle adaptations (Pt) were assessed before and after PR. QMVC and RFD were measured using an ergometer, while VA, MEP/Mmax and Pt using transcranial and femoral magnetic stimulations. Patients with a QMVC increase <7.5Nm were classified as NR. On average, QMVC significantly improved (+5.4Nm; p=0.02), but 60.6% of patients were NR. Only responders showed a significant increase in VA (p=0.03; pNR=0.78). Corticospinal excitability and peripheral muscle adaptations improved similarly in both groups. RFD was significantly lower in NR both pre and post PR (p<0.01), and was identified as a key predictor of non-response (sensibility:95%; specificity:90%). The lack of VA improvements in NR suggests that targeted interventions focusing on central command, such as high-intensity or eccentric training, would be necessary to increase the rate of responders. Identifying RFD as a predictor of non-response provides a valuable tool for early patient stratification and personalized ST.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.