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 ) .
Ghrelin Treatment of Cachectic Patients with Chronic Obstructive Pulmonary Disease: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial
Background Pulmonary cachexia is common in advanced chronic obstructive pulmonary disease ( COPD ) , culminating in exercise intolerance and a poor prognosis . Ghrelin is a novel growth hormone (GH)-releasing peptide with GH-independent effects . The efficacy and safety of adding ghrelin to pulmonary rehabilitation ( PR ) in cachectic COPD patients were investigated . Methodology /Principal Findings In a multicenter , r and omized , double-blind , placebo-controlled trial , 33 cachectic COPD patients were r and omly assigned PR with intravenous ghrelin ( 2 µg/kg ) or placebo twice daily for 3 weeks in hospital . The primary outcomes were changes in 6-min walk distance ( 6-MWD ) and the St. George Respiratory Question naire ( SGRQ ) score . Secondary outcomes included changes in the Medical Research Council ( MRC ) scale , and respiratory muscle strength . At pre-treatment , serum GH levels were increased from baseline levels by a single dose of ghrelin ( mean change , + 46.5 ng/ml ; between-group p<0.0001 ) , the effect of which continued during the 3-week treatment . In the ghrelin group , the mean change from pre-treatment in 6-MWD was improved at Week 3 ( + 40 m , within-group p = 0.033 ) and was maintained at Week 7 ( + 47 m , within-group p = 0.017 ) , although the difference between ghrelin and placebo was not significant . At Week 7 , the mean changes in SGRQ symptoms ( between-group p = 0.026 ) , in MRC ( between-group p = 0.030 ) , and in maximal expiratory pressure ( MEP ; between-group p = 0.015 ) were better in the ghrelin group than in the placebo group . Additionally , repeated- measures analysis of variance ( ANOVA ) indicated significant time course effects of ghrelin versus  placebo in SGRQ symptoms ( p = 0.049 ) and MEP ( p = 0.021 ) . Ghrelin treatment was well tolerated . Conclusions / Significance In cachectic COPD patients , with the safety profile , ghrelin administration provided improvements in symptoms and respiratory strength , despite the lack of a significant between-group difference in 6-MWD . Trial Registration UMIN Clinical Trial Registry
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 ) .