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Vol. 60. Issue 7.
Pages 410-416 (July 2024)
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Vol. 60. Issue 7.
Pages 410-416 (July 2024)
Original Article
The Influence of Lung Function and Respiratory Muscle Strength on Quadriceps Muscle Fatigability in COPD Patients Under Long-term Oxygen Therapy
Mara Paneronia,
Corresponding author

Corresponding author.
, Alessandro Cavicchiaa, Salvi Beatricea, Laura Bertacchinia, Massimo Venturellib, Michele Vitaccaa
a Respiratory Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy
b Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy

  • Factors that influence muscle fatigability (MF) after exercise in COPD were studied.

  • COPD patients with very severe (VSO) and severe lung obstruction (SO) were compared.

  • VSO patients experience lower MF (less reduction in MVC) compared to SO.

  • Dyspnea is higher in the VSO group at the beginning and end of the exercise.

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Figures (2)
Tables (2)
Table 1. Comparison of Patients with Severe Obstruction (SO) (FEV1 <50% and >30%) and Very Severe Obstruction (VSO) (FEV1 ≤30%).
Table 2. Multivariate Linear Regression Model Explaining the Quadriceps MF, According to Lung Function and Oxygenation Status.
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This research investigates quadriceps muscle fatigability (MF) in chronic obstructive pulmonary disease (COPD) patients with chronic respiratory failure (CRF) at different levels of lung obstruction [severe obstruction (SO)=FEV1 <50% and >30% versus very severe obstruction (VSO)=FEV1 ≤30%]. It explores the relationships between quadriceps MF and lung function, respiratory muscles, and oxygenation status.


A post hoc cross-over analysis in 45 COPD patients (20 SO and 25 VSO) undergoing long-term oxygen therapy was performed. Delta change in quadriceps maximum voluntary contraction (MVC) (absolute value and percentage) before and after a constant workload was calculated. Associations between quadriceps MF and lung function, respiratory muscles, and gas exchange were examined using Pearson's correlation and multivariate linear regression analysis.


SO patients experience a more substantial reduction in MVC compared to VSO (−15.15±9.13% vs −9.29±8.90%, p=0.0357), despite comparable resting MVC. Dyspnea is more pronounced in VSO at the beginning and end of the exercise. Correlations were found between MF and maximal inspiratory pressure (MIP) (r=−0.4412, p=0.0056), maximal expiratory pressure (MEP) (r=−0.3561, p=0.0282), and a tendency for FEV1% (r=−0.2931, p=0.0507). The regression model (R2=0.4719) indicates that lower MIP and FEV1 and high total lung capacity are significant factors in reducing quadriceps muscle fatigability after a fatiguing task.


COPD patients with more severe pulmonary obstruction and hyperinflation and lower respiratory muscle strength have lower quadriceps MF but higher dyspnea both at rest and during exercise.

Muscle fatigability


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