Identification of Explanatory Factors for the Lack of Muscle Strength Gain Following a Pulmonary Rehabilitation Program in COPD Patients

Chronic Obstructive Pulmonary Disease (COPD) is a chronic respiratory disease. Beyond respiratory symptoms, COPD is linked to comorbidities like muscle weakness (MW), significantly worrying due to its impact on patients' quality of life and survival. MW affects 32% to 57% of patients, predominantly in the lower limbs, contributing to exercise intolerance, reduced quality of life, and increased healthcare costs.

To address MW, muscle strengthening is incorporated into pulmonary rehabilitation (PR) programs. Despite significant average improvements in quadriceps muscle strength reported in the literature, a recent study highlight that 50% of patients did not clinically enhance their strength and were called non-responders (NR).

To understand this non-response, it's crucial to investigate the impact of muscle strengthening programs on the determinants of strength loss. While muscle atrophy was initially considered a major factor, studies have shown that muscle mass does not entirely explain the loss of strength. Impairment of motor control has emerged as a significant secondary determinant of muscle strength loss.

Peripheral muscle adaptations, including increased muscle surface and lean thigh mass, are well-documented. However, regarding motor control adaptations, a single study using a reference method on the quadriceps indicates a lack of effect of PR programs on central control. This observation suggests that non-responders in terms of strength may exhibit impaired motor control from the onset of the PR program.

Inclusion criteria

• Patients aged 40 to 80 years
• Patients admitted to a 4-week inpatient pulmonary rehabilitation program
• Patients diagnosed with COPD (Stage I to IV) according to internationally recognized criteria determined by the GOLD
• Patients able to understanding, speaking, reading, and writing French
• Patients for whom informed consent will be obtained after a maximum 24-hour reflection period
• Patients affiliated with a French social security system or beneficiaries of such a system

Exclusion criteria

• Diagnosis of neurological and/or cerebrovascular disease corresponding to code 8 of the International Classification of Diseases (ICD-11)
• Possession of any invasive metallic medical devices (pacemaker, prosthesis, etc.) except for dental prostheses (crowns and bridges).
• Epileptic risk factors (chronic alcoholism, brain surgery, recent head trauma)
• Orthopedic conditions that may affect the completion of protocol tests and assessments
• Recent exacerbation (within 4 weeks)
• Patients in a period of relative exclusion compared to another protocol
• Adults protected by law or patients under guardianship or conservatorship
• Individuals deprived of liberty by a judicial or administrative decision
• Pregnant or breastfeeding women