Meta- analysis revealed few clinical ly relevant and statistically significant benefits of " add-on " therapies on exercise performance compared with exercise training .
The aim of this review was to identify the effectiveness of therapies added on to conventional exercise training to maximise exercise capacity in patients with chronic obstructive pulmonary disease ( COPD ) .
A role for anabolic steroids in the rehabilitation of patients with COPD? A double-blind, placebo-controlled, randomized trial.
STUDY OBJECTIVES Skeletal muscle weakness commonly occurs in patients with COPD . Long-term use of systemic glucocorticosteroids further contributes to muscle weakness . Anabolic steroids could be an additional mode of intervention to improve outcome of pulmonary rehabilitation by increasing physiologic functioning , possibly mediated by increasing erythropoietic function . PATIENTS AND METHODS We r and omly assigned 63 male patients with COPD to receive on days 1 , 15 , 29 , and 43 a deep IM injection of 50 mg of n and rolone decanoate ( ND ) [ Deca-Durabolin ; N.V. Organon ; Oss , The Netherl and s ] in 1 mL of arachis oil , or 1 mL of arachis oil alone ( placebo ) in a double-blind design . All patients participated in a st and ardized pulmonary rehabilitation program . Outcome measures were body composition by deuterium and bromide dilution , respiratory and peripheral muscle function , incremental exercise testing , and health status by the St. George 's Respiratory Question naire . RESULTS Treatment with ND relative to placebo result ed in higher increases in fat-free mass ( FFM ; mean , 1.7 kg [ SD , 2.5 ] vs 0.3 kg [ SD , 1.9 ] ; p = 0.015 ) owing to a rise in intracellular mass ( mean , 1.8 kg [ SD , 3.1 ] vs - 0.5 kg [ SD , 3.1 ] ; p = 0.002 ) . Muscle function , exercise capacity , and health status improved in both groups to the same extent . Only after ND were increases in erythropoietic parameters seen ( erythropoietin : mean , 2.08 U/L [ SD , 5.56 ] , p = 0.067 ; hemoglobin : mean , 0.29 mmol/L [ SD , 0.73 ] , p = 0.055 ) . In the total group , the changes in maximal inspiratory mouth pressure ( PImax ) and peak workload were positively correlated with the change in hemoglobin ( r = 0.30 , p = 0.032 , and r = 0.34 , p = 0.016 , respectively ) , whereas the change in isokinetic leg work was correlated with the change in erythropoietin ( r = 0.38 , p = 0.013 ) . In the patients receiving maintenance treatment with low-dose oral glucocorticosteroids ( 31 of 63 patients ; mean , 7.5 mg/24 h [ SD , 2.4 ] ) , greater improvements in PImax ( mean , 6.0 cm H(2)O [ SD , 8.82 ] vs - 2.18 cm H(2)O [ SD , 11.08 ] , p = 0.046 ) , and peak workload ( mean , 20.47 W [ SD , 19.82 ] vs 4.80 W [ SD , 7.74 ] , p = 0.023 ) were seen after 8 weeks of treatment with ND vs placebo . CONCLUSIONS In conclusion , a short-term course of ND had an overall positive effect relative to placebo on FFM without exp and ing extracellular water in patients with COPD . In the total group , the improvements in muscle function and exercise capacity were associated with improvements in erythropoietic parameters . The use of low-dose oral glucocorticosteroids as maintenance medication significantly impaired the response to pulmonary rehabilitation with respect to respiratory muscle function and exercise capacity , which could be restored by ND treatment
Meta- analysis revealed few clinical ly relevant and statistically significant benefits of " add-on " therapies on exercise performance compared with exercise training .
The aim of this review was to identify the effectiveness of therapies added on to conventional exercise training to maximise exercise capacity in patients with chronic obstructive pulmonary disease ( COPD ) .