Lower-limb muscle function is a determinant of exercise tolerance after lung resection surgery in patients with lung cancer

Chris Burtin; Frits M E Franssen; Lowie E G W Vanfleteren; Miriam T J Groenen; Emiel F M Wouters; Martijn A Spruit

doi:10.1111/resp.13041

Lower-limb muscle function is a determinant of exercise tolerance after lung resection surgery in patients with lung cancer

Respirology. 2017 Aug;22(6):1185-1189. doi: 10.1111/resp.13041. Epub 2017 Mar 30.

Authors

Chris Burtin¹, Frits M E Franssen^{2

3}, Lowie E G W Vanfleteren^{2

3}, Miriam T J Groenen², Emiel F M Wouters^{2

3}, Martijn A Spruit^{1

2

4}

Affiliations

¹ Faculty of Medicine and Life Sciences, Rehabilitation Research Centre, Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium.
² Department of Research and Education, CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands.
³ Department of Respiratory Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
⁴ Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.

PMID: 28370836
DOI: 10.1111/resp.13041

Abstract

Background and objective: This study aims to investigate the association between exercise tolerance, pulmonary function and lower-limb muscle function in patients with lung cancer who underwent lung resection surgery in the previous year.

Methods: Sixty-four patients (age: 67 ± 11 years, 66% males) performed a symptom-limited incremental cycle test to define peak oxygen consumption (VO₂ peak) and peak workload (Wpeak). The best of two 6-min walking distance (6MWD) tests was also included. Isometric quadriceps strength and isokinetic quadriceps endurance were measured. Post-bronchodilator spirometry, lung volumes and diffusing capacity of the lung for carbon monoxide (DL_CO ) measurements were assessed. Univariate correlation analysis and multiple regression analyses were performed.

Results: VO₂ peak, W peak and 6MWD showed moderate to strong correlations with quadriceps strength/endurance and DL_CO while weak to moderate correlations were found with forced expiratory volume in 1 s (FEV₁₎ , functional residual capacity (FRC) and body weight. Multiple regression showed that peak isometric quadriceps strength (P < 0.001) and DL_CO (P < 0.001) were significant predictors of VO₂ peak (explained variance R² = 0.67), while quadriceps endurance (P = 0.0015) and DL_CO (P < 0.0001) were significant predictors of W peak (R² = 0.61). Quadriceps endurance capacity (P = 0.013), but not DL_CO , significantly contributed to the 6MWD model (R² = 0.29).

Conclusion: We identified a strong significant relationship between peak aerobic capacity and quadriceps muscle function and lung diffusing capacity. 6MWD was significantly related to quadriceps muscle function but not to pulmonary function. These findings suggest that accurate assessment of lower-limb muscle strength has a role in the accurate interpretation of exercise tests and in selecting optimal candidates for resistance training interventions targeting the lower-limb muscles after resection surgery.

Keywords: 6-min walking distance; lung cancer; peak aerobic capacity; quadriceps endurance; quadriceps strength.

MeSH terms

Aged
Cross-Sectional Studies
Exercise Test
Exercise Tolerance / physiology*
Female
Humans
Lung Neoplasms / physiopathology*
Lung Neoplasms / surgery*
Male
Middle Aged
Muscle Strength / physiology*
Oxygen Consumption
Pneumonectomy*
Quadriceps Muscle / physiopathology*
Respiratory Function Tests