Exercise Intolerance in COPD: A Review of the Pathophysiology and Clinical Assessment
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Published:
Jun 28, 2023
Keywords:
chronic obstructive pulmonary disease, exercise intolerance, functional capacity
Main Article Content
Abstract
Introduction: Chronic obstructive pulmonary disease (COPD) frequently presents with significantimpairments that contribute to reduced functional capacity and exercise intolerance, ultimately leadingto compromised activity performance. Therefore, this study aimed to describe the pathophysiology andclinical assessment of exercise intolerance in COPD.Methods: Data used were procured through a thorough search of published literature, conducted usingboth PubMed and Google Scholar search engines. Literature was included when published in the last10 years, written in English, and available in full-text format. The types of literature used were books,original articles, narrative or systematic reviews, and case reports.Results: A total of 33 pieces of literature were identified and used to provide explanations for the subtopicsunder discussion. Out of the total pieces, 22 elucidated the pathophysiology of the topic, while theremaining 12 focused on the clinical assessment.Conclusion: Shortness of breath and leg fatigue were common symptoms of exercise intolerancefound in COPD. These symptoms were associated with impairment of the body functions such as therespiratory, cardiovascular, peripheral muscles, neuromuscular, and psychological. Furthermore, physicalinactivity caused worsening exercise intolerance, which could be evaluated using the Borg scale. Thecardiopulmonary exercise test was recommended to assess exercise intolerance in COPD patients andsome field analyses such as walk and step tests could also be carried out.
Article Details
How to Cite
Arnengsih Nazir. (2023). Exercise Intolerance in COPD: A Review of the Pathophysiology and Clinical Assessment. Indonesian Journal of Physical Medicine and Rehabilitation, 12(01), 1-12. https://doi.org/10.36803/indojpmr.v12i01.382
Section
Literature Review
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References
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4. Crisafulli E, Aiello M, Tzani P, Ielpo A, Longo C, Alfieri V, et al. A high degree of dyspnea is associated with poor maximum
exercise capacity in subjects with COPD with the same severity of air-flow obstruction. Respir Care. 2019;64(4):390-7.
5. Arena R, Myers J, Williams MA, Gulati M, Kligfield P, Balady GJ, et al. Assessment of
functional capacity in clinical and research settings: a scientific statement from the
American Heart Association Committee on Exercise, Rehabilitation, and Prevention
of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing.
Circulation. 2007;116(3):329-43.
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limitation in chronic lung diseases. Pulm Med. 2012;2012:634761.
8. Zamzam MA, Azab NY, El Wahsh RA, Ragab AZ, Allam EM. Quality of life in
COPD patients. Egypt J Chest Dis Tuberc. 2012;61(4):281-9.
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inspiratory capacity and exercise intolerance in chronic obstructive pulmonary disease.
Ann Am Thorac Soc. 2017 jul;14(Supplement 1):S30-S9.
10. Samir A. Exercise intolerance; a training guide for patients with chronic
obstructive pulmonary disease. IJPEHSS. 2021;10(1):01-7.
11. Miki K. Motor pathophysiology related to dyspnea in COPD evaluated
by cardiopulmonary exercise testing. Diagnostics. 2021;11(2):364.
12. AACVPR. Guidelines for Pulmonary Rehabilitation Programs: Human Kinetics;
2019.
13. Brody L, Hall C. Therapeutic Exercise: Moving Toward Function: Wolters Kluwer/
Lippincott Williams & Wilkins Health; 2011.
14. Nici L, Donner C, Wouters E, Zuwallack R, Ambrosino N, Bourbeau J, et al. American
thoracic society/European respiratory society statement on pulmonary rehabilitation. Am J
Respir Crit Care Med. 2006;173(12):1390-413.
15. Farkhooy A, Janson C, Arnardóttir RH, Malinovschi A, Emtner M, Hedenström
H. Impaired carbon monoxide diffusing capacity is the strongest predictor of
exercise intolerance in COPD. COPD. 2013;10(2):180-5.
16. Elbehairy AF, O’Donnell CD, Abd Elhameed A, Vincent SG, Milne KM, James MD, et al.
Low resting diffusion capacity, dyspnea, and exercise intolerance in chronic obstructive
pulmonary disease. J Appl Physiol (1985). 2019;127(4):1107-16.
17. Kerti M, Balogh Z, Kelemen K, Varga JT. The relationship between exercise
capacity and different functional markers in pulmonary rehabilitation for COPD. Int J
Chronic Obstruc Pulm Dis. 2018;13:717.
18. Faludi R, Hajdu M, Vértes V, Nógrádi Á, Varga N, Illés MB, et al. Diastolic
dysfunction is a contributing factor to exercise intolerance in COPD. COPD.
2016;13(3):345-51.
19. Maltais F, LeBlanc P, Jobin J, Casaburi R. Peripheral muscle dysfunction in chronic
obstructive pulmonary disease. Clin Chest Med. 2000;21(4):665-77.
20. Gea J, Pascual S, Casadevall C, Orozco- Levi M, Barreiro E. Muscle dysfunction
in chronic obstructive pulmonary disease: update on causes and biological findings. J
Thorac Dis. 2015 Oct;7(10):E418-E38.
21. Portillo K, Abad-Capa J, Ruiz-Manzano J. Chronic obstructive pulmonary disease and
left ventricle. Arch Bronconeumol. 2015 May;51(5):227-34.
22. Marillier M, Bernard A-C, Verges S, Neder JA. The role of peripheral muscle fatigability
on exercise intolerance in COPD. Expert Rev Respir Med. 2021;15(1):117-29.
23. Couillard A, Maltais F, Saey D, Debigaré R, Michaud A, Koechlin C, et al. Exerciseinduced
quadriceps oxidative stress and peripheral muscle dysfunction in patients
with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2003 Jun
15;167(12):1664-9.
24. Haarmann H, Folle J, Nguyen XP, Herrmann P, Heusser K, Hasenfuß G, et
al. Sympathetic activation is associated with exercise limitation in COPD. COPD.
2016;13(5):589-94.
25. Andreas S, Haarmann H, Klarner S, Hasenfuß G, Raupach T. Increased
diagnosis, management, and prevention of Chronic Obstructive Pulmonary Disease
(2021 Report). Wisconsin: Global Initiative for Obstructive Lung Disease; 2021.
2. Djibo DA, Goldstein J, Ford JG. Prevalence of disability among adults with chronic
obstructive pulmonary disease, Behavioral Risk Factor Surveillance System 2016–
2017. PLoS One. 2020;15(2):e0229404.
3. Belfer MH, Reardon JZ. Improving exercise tolerance and quality of life in patients with
chronic obstructive pulmonary disease. J Am Osteopath Assoc. 2009 May;109(5):268-78.
4. Crisafulli E, Aiello M, Tzani P, Ielpo A, Longo C, Alfieri V, et al. A high degree of dyspnea is associated with poor maximum
exercise capacity in subjects with COPD with the same severity of air-flow obstruction. Respir Care. 2019;64(4):390-7.
5. Arena R, Myers J, Williams MA, Gulati M, Kligfield P, Balady GJ, et al. Assessment of
functional capacity in clinical and research settings: a scientific statement from the
American Heart Association Committee on Exercise, Rehabilitation, and Prevention
of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing.
Circulation. 2007;116(3):329-43.
6. Vissing J. Exercise intolerance and myoglobinuria. Int J Neurol. 2016:516-9.
7. Vogiatzis I, Zakynthinos G, Andrianopoulos VJPm. Mechanisms of physical activity
limitation in chronic lung diseases. Pulm Med. 2012;2012:634761.
8. Zamzam MA, Azab NY, El Wahsh RA, Ragab AZ, Allam EM. Quality of life in
COPD patients. Egypt J Chest Dis Tuberc. 2012;61(4):281-9.
9. O’Donnell DE, Elbehairy AF, Webb KA, Neder JA. The link between reduced
inspiratory capacity and exercise intolerance in chronic obstructive pulmonary disease.
Ann Am Thorac Soc. 2017 jul;14(Supplement 1):S30-S9.
10. Samir A. Exercise intolerance; a training guide for patients with chronic
obstructive pulmonary disease. IJPEHSS. 2021;10(1):01-7.
11. Miki K. Motor pathophysiology related to dyspnea in COPD evaluated
by cardiopulmonary exercise testing. Diagnostics. 2021;11(2):364.
12. AACVPR. Guidelines for Pulmonary Rehabilitation Programs: Human Kinetics;
2019.
13. Brody L, Hall C. Therapeutic Exercise: Moving Toward Function: Wolters Kluwer/
Lippincott Williams & Wilkins Health; 2011.
14. Nici L, Donner C, Wouters E, Zuwallack R, Ambrosino N, Bourbeau J, et al. American
thoracic society/European respiratory society statement on pulmonary rehabilitation. Am J
Respir Crit Care Med. 2006;173(12):1390-413.
15. Farkhooy A, Janson C, Arnardóttir RH, Malinovschi A, Emtner M, Hedenström
H. Impaired carbon monoxide diffusing capacity is the strongest predictor of
exercise intolerance in COPD. COPD. 2013;10(2):180-5.
16. Elbehairy AF, O’Donnell CD, Abd Elhameed A, Vincent SG, Milne KM, James MD, et al.
Low resting diffusion capacity, dyspnea, and exercise intolerance in chronic obstructive
pulmonary disease. J Appl Physiol (1985). 2019;127(4):1107-16.
17. Kerti M, Balogh Z, Kelemen K, Varga JT. The relationship between exercise
capacity and different functional markers in pulmonary rehabilitation for COPD. Int J
Chronic Obstruc Pulm Dis. 2018;13:717.
18. Faludi R, Hajdu M, Vértes V, Nógrádi Á, Varga N, Illés MB, et al. Diastolic
dysfunction is a contributing factor to exercise intolerance in COPD. COPD.
2016;13(3):345-51.
19. Maltais F, LeBlanc P, Jobin J, Casaburi R. Peripheral muscle dysfunction in chronic
obstructive pulmonary disease. Clin Chest Med. 2000;21(4):665-77.
20. Gea J, Pascual S, Casadevall C, Orozco- Levi M, Barreiro E. Muscle dysfunction
in chronic obstructive pulmonary disease: update on causes and biological findings. J
Thorac Dis. 2015 Oct;7(10):E418-E38.
21. Portillo K, Abad-Capa J, Ruiz-Manzano J. Chronic obstructive pulmonary disease and
left ventricle. Arch Bronconeumol. 2015 May;51(5):227-34.
22. Marillier M, Bernard A-C, Verges S, Neder JA. The role of peripheral muscle fatigability
on exercise intolerance in COPD. Expert Rev Respir Med. 2021;15(1):117-29.
23. Couillard A, Maltais F, Saey D, Debigaré R, Michaud A, Koechlin C, et al. Exerciseinduced
quadriceps oxidative stress and peripheral muscle dysfunction in patients
with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2003 Jun
15;167(12):1664-9.
24. Haarmann H, Folle J, Nguyen XP, Herrmann P, Heusser K, Hasenfuß G, et
al. Sympathetic activation is associated with exercise limitation in COPD. COPD.
2016;13(5):589-94.
25. Andreas S, Haarmann H, Klarner S, Hasenfuß G, Raupach T. Increased