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Assesment of muscle function in chronic lung disease

Assesment of muscle function in chronic lung disease. Deniz İNAL İNCE, PhD, PT Associated Professor Hacettepe University Faculty of Health Sciences Department of Physical Therapy & Rehabilitation. PATOLO GY / I NFLAM MATION / H IPOXEMIA DRUGS INACTIVITY / DECONDITIONING. Q CO 2.

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Assesment of muscle function in chronic lung disease

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  1. Assesment of muscle function in chronic lung disease Deniz İNAL İNCE, PhD, PT Associated Professor Hacettepe University Faculty of Health Sciences Department of Physical Therapy & Rehabilitation

  2. PATOLOGY / INFLAMMATION / HIPOXEMIA DRUGS INACTIVITY / DECONDITIONING QCO2 VCO2 Heart Circulation Muscle Lungs QO2 VO2 Oxygen transport Wasserman K et al. Principles of Exercise Testing & Interpretation, 2005

  3. Skeletal muscles

  4. Chronic Lung Disease Hypoxia Acidosis Malnutrition  Anabolism Inactivity Drugs SYSTEMIC INFLAMMATION Deconditioning Muscle mass  Atrophy Fiber type Muscle metabolism Exercise capacity  Health status  QOL  Mortality 

  5. Hypoxia (oxidative stress) Muscle oksidative stress Mitokondria Myofilament • Stimulus transmission • Ca sensitivity  ATP level  Oksidative capacity Contractile fatigue Muscle disfunction

  6. Inactivity  Physical activity  Lower leg activity  Motor neuron activity Muscle mass  Fiber type Energy metabolism Antioxidant effect 

  7. Disease severity Systemic inflammation Muscle oxidative stress  Anabolic factors Myoflament contractility   FFM  Oxidatif capacity Skeletal muscle dysfunction

  8. Muscle enzyme activity  Metabolic fuel storage   protein & caloric intake Protein katabolism  Muscle mass Malnutrition  Caloric intake Weight loss

  9. Corticosteroids • Conractile proteins  • Glycolitic activity  • Growth factors  • Protein catabolism  • Tip 2 fiber atrophy

  10. Changes in muscle structure & metabolism • Tip 1 muscle fiber  • Oksidative enzymes  • CSA  • Aerobic capasity  • Earlier anaerobic metabolism • Muscle mass  • Muscle strength  • Muscle endurance  • Muscle fatigue  • Lactate • Blood ammonia • Pi • Earlier muscle acidosis

  11. Muscle function Muscle group STRENGTH Contraction type ENDURANCE Movement velocity Equipment ROM FATIGUE Practice session Specific protocol

  12. Evaluation of skeletal muscle strength Muscle mass FFM Volitional Nonvolitional Manual muscle testing 1 RM Dinamometer Electrical stimulation Magnetic stimulation

  13. Manual muscle testing • 5-pointMRC • Percentages of normal values  • Ambulated patients  • ICU: 12 muscles

  14. Dinamometer Back lift dinamometer Isometric Hand grip Isometricdinamometer

  15. Isotonic evaluation 1 repetition maximum (1 RM) Free weights Dumbbells Exercise machines

  16. Dynamic contractions against hydraulic resistance

  17. Evaluation of skeletal muscle strength Volitional Nonvolitional Manual muscle testing 1 RM Dinamometer Electrical stimulation Magnetic stimulation

  18. Magnetic stimulation • Action potential • Depolarization • At rest • Maximal voluntary ventilation

  19. Quadriceps muscle strength 

  20. *p=0.01, ICU patients were weaker Mean ICU stay 18.5 days

  21. ☐Stength ■Endurance COPD

  22. Endurance • Capacity of muscle to maintain a given level of force or work for a period of time • Assessment •  strength below target • Number of repetitions • % of  force • Equipments: Same as strength evaluation

  23. Fatigue Endurance Reversible reduction in the force generated by the muscle itself for a given neural input

  24. Symptoms at peak exercise Leg fatigue Dyspnea & Leg fatigue 43% 31% Dyspnea 26% Killian et al. Exercise capacity and ventilatory, circulatory, and symptom limitation in patients with chronic airflow limitation. Am Rev Respir Dis 1992;146:935-940.

  25. Motor neuron Neuromuscular junction Conractile mechanism (Ca) Early anaerobic metabolism Lactic acid accumulation Blood ammonia  ATP-PC depletion Muscle glycogen depletion Mechanisms of fatigue

  26. Evaluation of fatigue Functional Metabolic Lactic acid Blood ammonia Strength before & after a given task Subjective Volitional Nonvolitional Borg scale VAS Fatigue scales Motivational factors 

  27. Magnetic stimulation Quadriceps fatigue

  28. Metabolic fatigue • Lactic acid level

  29. Metabolic fatigue • Blood ammonia level

  30. Subjective fatigue 0 100

  31. Relationship between Disease severity & Periferal Muscle Endurance & Fatigue in Patients with Chronic Obstructive Pulmonary Disease Melda Sağlam, Ebru Çalık, Naciye Vardar-Yağlı, Sema Savcı, Deniz İnal-İnce, Hülya Arıkan, Meral Boşnak-Güçlü, Lütfi Çöplü • 22 COPD (62.5 years) • FEV1: 50±29% • GOLD Stage IV n=7 (31.8% ) Stage III n=6 (27.3% ) Stage II n=4 (18.2% ) Stage I n=5 (22.7% ) • 6MWT: 507±128 m • SAFE: 3.7±2.5 • Fatigue Impact: 32.9±31.3 • Fatigue Severity: 40.6±17.0 r= 0.67, p<0.05 Toraks 2009

  32. Thank you

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