Efficacy of interventions to alter measures of fat-free mass in people with COPD: a systematic review and meta-analysis

Alex R Jenkins; Kaveh Gaynor-Sodeifi; Hayley Lewthwaite; Jaycie Triandafilou; Letícia F Belo; Mayron Faria de Oliveira; Dennis Jensen

doi:10.1183/23120541.00102-2023

Efficacy of interventions to alter measures of fat-free mass in people with COPD: a systematic review and meta-analysis

ERJ Open Res. 2023 Jul 31;9(4):00102-2023. doi: 10.1183/23120541.00102-2023. eCollection 2023 Jul.

Authors

Alex R Jenkins¹, Kaveh Gaynor-Sodeifi¹, Hayley Lewthwaite^{1

2

3}, Jaycie Triandafilou¹, Letícia F Belo^{1

4}, Mayron Faria de Oliveira^{1

5}, Dennis Jensen^{1

6}

Affiliations

¹ Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada.
² Centre of Research Excellence in Treatable Traits, College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, NSW, Australia.
³ Asthma and Breathing Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia.
⁴ Laboratory of Research in Respiratory Physiotherapy, Physiotherapy Department, State University of Londrina, Londrina, Brazil.
⁵ Science Division, Exercise Science, Lyon College, Batesville, AR, USA.
⁶ Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montréal, QC, Canada.

Abstract

Introduction: Low fat-free mass (FFM) is linked to poor health outcomes in COPD, including impaired exercise tolerance and premature death. The aim of this systematic review was to synthesise evidence on the effectiveness of interventions for increasing FFM in COPD.

Methods: Searches of electronic databases (MEDLINE, Cochrane Library, Embase, Web of Science, Scopus) and trial registers (ClinicalTrials.gov) were undertaken from inception to August 2022 for randomised studies of interventions assessing measures of FFM in COPD. The primary outcome was change in FFM (including derivatives). Secondary outcomes were adverse events, compliance and attrition.

Results: 99 studies (n=5138 people with COPD) of 11 intervention components, used alone or in combination, were included. Exercise training increased mid-thigh cross-sectional area (k=3, standardised mean difference (SMD) 1.04, 95% CI 0.02-2.06; p=0.04), but not FFM (k=4, SMD 0.03, 95% CI -0.18-0.24; p=0.75). Nutritional supplementation significantly increased FFM index (k=11, SMD 0.31, 95% CI 0.13-0.50; p<0.001), but not FFM (k=19, SMD 0.16, 95% CI -0.06-0.39; p=0.16). Combined exercise training and nutritional supplementation increased measures related to FFM in 67% of studies. Anabolic steroids increased FFM (k=4, SMD 0.98, 95% CI 0.24-1.72; p=0.009). Neuromuscular electrical stimulation increased measures related to FFM in 50% of studies. No interventions were more at risk of serious adverse events, low compliance or attrition.

Discussion: Exercise training and nutritional supplementation were not effective in isolation to increase FFM, but were for localised muscle and index measures, respectively. Combined, exercise and nutritional supplementation shows promise as a strategy to increase FFM in COPD. Anabolic steroids are efficacious for increasing FFM in COPD.

Publication types

Review