Measuring and monitoring skeletal muscle function in COPD: current perspectives

Figures & data

Figure 1 Overview of etiological factors, morphological and structural abnormalities and impaired skeletal muscle function in chronic obstructive pulmonary disease.

Figure 2 Factors that influence the choice of the measurement technique.

Table 1 Standardization of measurement procedure.

● Preparation guidelines: (eg, guidelines for medications, caffeine, activities etc.) ● Equipment: free weight/weight machines/dynamometer/strain-gauge, etc. ● Instructions: written/visual/oral. ● Demonstration: especially when using functional tests. ● Familiarization: mostly when using isokinetic/computerized dynamometers, to avoid learning bias and improve test–retest reliability ● Warm-up: general and/or specific warm-up of targeted muscles/movements ● Position: eg, seated with knee and hip flexed at 90° for isometric strength measurements ● The range of motion: start and end positions of tested muscle(s)/movement(s) ● Velocity of contraction: eg, fast (<1:1), traditional (1:1), moderate (1–2:1–2), slow (5:5) ● Feedback/encouragement: none/visual/oral. ● Rest: between contractions/sets/exercises (if multiple tests are performed). ● Test order: if multiple tests are performed (agonist/antagonist, upper/lower extremity)

Note: Data from Nyberg et al⁸ and Thompson et al.³⁴

Table 2 Main characteristics of physical function tests in COPD and their associations with skeletal muscle function

Tests	UULEX	SCPT	SPPB	TUG	4MGS	5STS
Brief description	Seated patient must lift a weighted plastic bar (0.2–2 kg) through 8 levels at a 30-bpm cadence, with 0.5 kg weight increases when the upper level is reached and after every minute of the test	Patient must ascend as fast and safely as possible a 10-step flight of stairs.	Patient must complete three separate tasks: balance for 10 s in three static positions, gait speed over the 4-m track and five-repetition sit-to-stand task	When instructed to start, the patient stands from a chair, walks 3 m, turns around, walks back to the chair and sits down	Patient walk over a 4-m course at his or her usual speed	Arms across the chest, the patient must fully stand from a chair five times
Outcome(s)	Time to exhaustion (s)	Stair climb time in seconds; velocity: distance (total vertical height of stairs)/time (s); power calculates by velocity times force (body mass times acceleration due to gravity) in Watt	Each task is scored from 0 (unable/ unsafe) to 4 (best performance) points, for a total ordinal score out of 12	Fastest time of two trials at the patient’s usual speed (s)	Fastest time of two trials at the patient’s usual speed (s)	Time to complete five repetitions (s)
Aspect of muscle function	Dynamic upper limb shoulder muscles flexion endurance	Dynamic lower limb muscles power	Dynamic lower limb muscles strength and power	Dynamic lower limb muscles strength and power	Dynamic lower limb muscles strength	Dynamic lower limb muscles strength and power
Correlation with skeletal muscle function*	To isometric shoulder muscle strength: r=0.56 To isokinetic shoulder muscle endurance: r=0.50	To eccentric quadriceps peak torque: r=0.53–0.72^Citation22,Citation73 To isometric quadriceps power (RTD): r=0.727^Citation73 To double leg press power at 40% of 1RM: r=0.47^Citation74	To isometric quadriceps strength: r=0.49,^Citation75 r=0.27 and isometric quadriceps endurance: r=0.07^Citation27 To dynamic average quadriceps power: r=0.46 isokinetic strength: r=0.49, isokinetic endurance: r=0.48, and isotonic endurance: r=0.46^Citation27	To eccentric quadriceps strength: r=0.90; To isometric quadriceps power (RTD): r=−0.69^Citation73	In a multivariable linear regression model: 2.4% of 4MGS variance explained by quadriceps strength^Citation52 To isometric quadriceps strength:r=−0.31^Citation28	To isometric quadriceps strength:r=−0.33^Citation76 To dynamic average quadriceps power:r=−0.32 to −0.38^Citation28
Reliability/ responsiveness in COPD	Test–retest reliability: ICC=0.98^Citation77 Responsive to change after 1) upper limb muscle strength training (SRM 1.8) 2) endurance training (MGD 127 s, effect size 1.46)^Citation78	Test–retest reliability: ICC=0.90^Citation22	Interobserver reliability^Citation79 Total score ICC=0.82 SPPB subscores 1) balance ICC=0.33; 2) gait speed ICC=0.75; 3) STS ICC=0.84	Within-day test–retest reliability: ICC among 3 trials: 0.94 with a possible learning effect between first and second trials^Citation80 Intra-/interrater reliability: ICC=0.99 and 0.92 respectively^Citation81	Test–retest reliability: ICC=0.97 Interobserver reliability: ICC=0.99^Citation82 Responsiveness to PR: 0.08 m/s; effect size 0.4^Citation83	Test–retest reliability: ICC=0.97 Interobserver reliability: ICC=0.99^Citation76 Responsiveness to PR: ≥–1.7s
Reference values	Unavailable	Unavailable	Available for adults >70 years old^Citation84	Available	Available^Citation85	Available^Citation86

Notes: *Significant correlations for SCPT and TUG with other aspects of muscle function (concentric peak torque, isometric strength, etc.) are also available in Butcher et al.⁷³ Different protocols for muscle strength/power/endurance assessments were used in the cited studies.

Abbreviations: 1RM, one-repetition maximum; 4MGS, 4-meter gait speed; 5STS, five-repetition sit-to-stand; ICC, intraclass correlation coefficient; MGD, mean group difference; PR, pulmonary rehabilitation; RTD, rate of torque development; SCPT, Stair Climb Power Test; SPPB, Short Physical Performance Battery; SRM, standardized response mean; UULEX, Unsupported Upper Limb Exercise Test.

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