Chest
Volume 145, Issue 5, May 2014, Pages 1016-1024
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Original Research
Phenotypic Characteristics Associated With Reduced Short Physical Performance Battery Score in COPD

https://doi.org/10.1378/chest.13-1398Get rights and content

Background

The Short Physical Performance Battery (SPPB) is commonly used in gerontology, but its determinants have not been previously evaluated in COPD. In particular, it is unknown whether pulmonary aspects of COPD would limit the value of SPPB as an assessment tool of lower limb function.

Methods

In 109 patients with COPD, we measured SPPB score, spirometry, 6-min walk distance, quadriceps strength, rectus femoris cross-sectional area, fat-free mass, physical activity, health status, and Medical Research Council dyspnea score. In a subset of 31 patients with COPD, a vastus lateralis biopsy was performed, and the biopsy specimen was examined to evaluate the structural muscle characteristics associated with SPPB score. The phenotypic characteristics of patients stratified according to SPPB were determined.

Results

Quadriceps strength and 6-min walk distance were the only independent predictors of SPPB score in a multivariate regression model. Furthermore, while age, dyspnea, and health status were also univariate predictors of SPPB score, FEV1 was not. Stratification by reduced SPPB score identified patients with locomotor muscle atrophy and increasing impairment in strength, exercise capacity, and daily physical activity. Patients with mild or major impairment defined as an SPPB score < 10 had a higher proportion of type 2 fibers (71% [14] vs 58% [15], P = .04).

Conclusions

The SPPB is a valid and simple assessment tool that may detect a phenotype with functional impairment, loss of muscle mass, and structural muscle abnormality in stable patients with COPD.

Section snippets

Materials and Methods

The data were prospectively collected from four studies with shared protocols investigating the pathophysiologic determinants and associations of skeletal muscle dysfunction in COPD. Each study received ethical committee approval (West London REC 3: 10/H0706/9; North West London REC: 11/LO/1636; North London REC: 11/H0717/3; NRES Committee London–Chelsea: 12/LO/0523); all patients provided written informed consent.

One hundred nine stable patients diagnosed with COPD according to GOLD (Global

Results

The demographic data, clinical characteristics, and predictors of the SPPB are shown in Table 1; data from the biopsy cohort are shown in Table 2. Daily steps could not be entered into the regression analysis as the data were skewed.

In the full cohort (N = 109), age, MRC dyspnea score, SGRQ, QMVC, RFCSA, and 6MWD were univariate predictors of SPPB score; sex, height, FEV1 % predicted, BMI, and FFMI were not predictors. In a multivariate analysis excluding RFCSA due to the strong colinearity

Discussion

The main finding of this study is that the principal determinants of the SPPB were quadriceps strength and functional exercise capacity rather than lung function as judged by FEV1. In a biopsy substudy, patients with SPPB limitation were also more likely to have fiber shift, suggesting a possible role for the test as a biomarker. The data show that the SPPB remains a valid measure of lower extremity function despite the presence of COPD and that SPPB limitation arises primarily because of

Acknowledgments

Author contributions: Prof Polkey is the guarantor of the paper, taking responsibility for the integrity of the work as a whole, from inception to published article.

Dr Patel: contributed to the design of the study, analysis of data, and preparation of the final manuscript; conceived the idea; recruited patients and collected the data; and drafting of the manuscript.

Dr Mohan: contributed to the drafting and preparation of the final manuscript, recruited patients, and collected the data.

Ms

References (46)

  • JM Guralnik et al.

    A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission

    J Gerontol

    (1994)
  • JM Guralnik et al.

    Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability

    N Engl J Med

    (1995)
  • ML Puthoff et al.

    Relationships among impairments in lower-extremity strength and power, functional limitations, and disability in older adults

    Phys Ther

    (2007)
  • SS Kon et al.

    Reliability and validity of the 4-metre gait speed in COPD

    Eur Respir J

    (2013)
  • SE Jones et al.

    The five-repetition sit-to-stand test as a functional outcome measure in COPD

    Thorax

    (2013)
  • MD Eisner et al.

    Body composition and functional limitation in COPD

    Respir Res

    (2007)
  • MC Steiner et al.

    Prospects for the development of effective pharmacotherapy targeted at the skeletal muscles in chronic obstructive pulmonary disease: a translational review

    Thorax

    (2012)
  • KF Rabe et al.

    Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary

    Am J Respir Crit Care Med

    (2007)
  • JM Guralnik
  • Guidelines for the measurement of respiratory function. Recommendations of the British Thoracic Society and the Association of Respiratory Technicians and Physiologists

    Respir Med

    (1994)
  • JC Bestall et al.

    Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease

    Thorax

    (1999)
  • PW Jones et al.

    A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire

    Am Rev Respir Dis

    (1992)
  • MC Steiner et al.

    Bedside methods versus dual energy X-ray absorptiometry for body composition measurement in COPD

    Eur Respir J

    (2002)
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    Funding/Support: This project was supported by an unrestricted grant from AstraZeneca and by the NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton & Harefield NHS Foundation Trust and Imperial College London, who partly fund Prof Polkey's and completely fund Dr Canavan's salary. Dr Kon is supported by the Medical Research Council. Dr Man is supported by an NIHR Clinician Scientist Award, Medical Research Council New Investigator Grant, and an NIHR Clinical Trials Fellowship.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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