Earlier this month we reported the results of a study that showed combining nutritional supplementation with low intensity exercise training improved physical performance among malnourished/underweight COPD patients. In that study, the researchers theorized that the combination of an anabolic stimulus (exercise) with high-energy content nutritional supplementation sparked improvements in physical performance more than nutritional supplementation alone has shown in previous studies. Click here to read the article.
Now, a new Swedish study published online ahead of print reports that dietary counseling offered as part of a pulmonary rehab program improved physical performance and increased positive changes in body weight among underweight COPD patients. What’s striking about the results is that none of the COPD patients received nutritional supplementation or participated in an exercise program as part of the study. (Farooqi N, et al. Changes in body weight and physical performance after receiving dietary advice in patients with chronic obstructive pulmonary disease (COPD), 1-year follow-up. Archives of Gerontology and Geriatrics. 2010, doi: 10.1016/j.archger.2010.06.005)
While the results of these two studies seem to contradict each other on the surface, we believe they depict complementary results. Certainly, there are many studies on exercise training for COPD patients that clearly show improved physical performance with no nutrition counseling or supplementation involved. On the nutrition front, the research team in the Archives of Gerontology and Geriatrics study acknowledged that the results of the COPD patients in their study would likely have experienced even greater improvements if nutritional supplementation had been provided.
But it is interesting to note that the study subjects’ body weight and physical performance did improve at 3-months and 12-months after the initial dietary counseling based on that counseling alone. The research team speculated that the reason for the successful outcome of their study may be rooted in the longer follow-up period (12 months). By way of explanation, the article authors said, “This study differs from most of the previous nutritional studies in COPD patients, in that the nutritional intervention consisted of dietary advice alone rather than of oral nutritional supplements and that the follow-up time was longer. To achieve substantial changes in physiological functions by nutritional intervention, a longer follow-up period might be beneficial.”
In other words, past studies might have shown greater improvements in COPD patient performance and body weight due to nutritional intervention if the previous research teams had followed up with patients on their progress over a longer period of time. Most studies tend to look at performance improvement at 3-months or 6-months after interventions (exercise or nutrition). Part of the reason for shorter duration studies is to discern whether the examined interventions offer immediate, statistically significant improvements. Additionally, it is expensive to conduct longer-term studies and patient participation over longer time periods tends to wane (which skews and/or dilutes research results).
In this particular research project, 41 COPD patients were recruited after being referred to a pulmonary rehabilitation program at a Swedish hospital (20 women, 21 men). The study subjects received a nutritional assessment from a trained dietician and then were provided counseling on specific foods/portions to improve their diet. Over the course of the study, 7 patients dropped out.
The dietician analyzed each patient’s current total energy (calorie) intake as compared to the total energy intake necessary to achieve ideal body weight (IBW). The dietician did this by asking each COPD patient to recall what and how much they ate within the previous 24-hour period. The dietician then calculated each patient’s corresponding consumed calories based on their self-reported dietary intake.
At the outset of the study, the results of this analysis showed the mean energy intake of the COPD patients was 76% of the amount required for ideal body weight (meaning the patients on average were not consuming enough calories each day to reach their ideal body weight – and indeed the mean average body weight of the study subjects was 95% of their ideal body weight at the beginning of the study).
The dietician’s recommended diet plan (foods/portions) was intended to boost energy intake and bring the study subjects closer to their ideal body weight over time. For the underweight patients in the study (the significant majority of the study subjects), the recommendations including eating breakfast, lunch, dinner and 3-4 snacks each day. Foods rich in protein and calories were recommended (including meat, poultry, fish, egg, dairy products) and advice on complementing their diet with nutrient-fortified foods was provided. Then, the patients were sent on their way to follow their recommended diet plans.
The researchers had the patients return at 3 months and at 12 months after their initial dietician consultation for follow-up consultations. For those follow-up visits, each patient was provided a 3-day food log to record their dietary intake for the 3 days leading up to each follow-up visit. Again, the dietician examined the energy (calorie) content of the food logs and calculated the patients’ intakes in relation to the energy required to achieve ideal body weight.
The 3-month results showed that energy intake by the participating COPD patients rose to 90% of the energy required to achieve ideal body weight (an 18% improvement over the baseline measurement). At 12-months, this calculation climbed slightly higher to 91% (20% over the baseline measurement). As a result of the higher caloric intake over the 12-month period, the COPD patients in the study saw their mean body weight rise to 97% of ideal body weight.
The researchers also evaluated handgrip strength and the distance walked by the study subjects in 12 minutes as measures of physical performance. They took baseline readings for both measures at the outset of the study and again tested the COPD patients at 3 months and 12 months thereafter.
While both measures did improve, the most impressive result from these physical performance measures was that mean distance walked in 12 minutes rose by 18% over the baseline measure at 3-months and by 16% at 12-months. That’s pretty remarkable given that no exercise component was included in either the rehab program or as part of the follow-up regimen for the study participants.
The researchers suggested that the higher caloric intake resulting from the dietician’s recommendations boosted energy levels and strengthened muscles in the study participants which in turn allowed the COPD patients who completed the study to perform physical activity at a higher level.
So, if you are underweight and suffer from chronic shortness of breath, you might consider asking your physician to at refer you to a local dietician. After doing an initial nutritional assessment of your current diet, the dietician can/should develop a food/portion plan for you designed to boost your caloric intake (taking into account other health factors particular to your own circumstance).
In our opinion, if you do this and combine it with an exercise program you will experience gains in physical strength, endurance, and body weight. If past research is any indication, you should also benefit in terms of reduced shortness of breath and improved sense of well being.
The best resource for an exercise program geared for COPD patients is pulmonary rehabilitation. Ask your doctor for a referral to a program in your area. They are notoriously difficult to get into but you risk nothing by asking. If you can’t gain entry to a rehab program, and you need guidance for an exercise program geared specifically for people with COPD or chronic shortness of breath, we suggest you consider purchasing our Breathe Better for Life guide/CD, www.breathebetterforlife.com. Our guide recommendations are based on guidelines published by the American Thoracic Society, European Respiratory Society and the American College of Sports Medicine. If you decide to follow our recommendations, please consult with your physician first to ensure our recommendations are appropriate for your particular situation.
Alternatively, ask your doctor to recommend an exercise or walking program or consult a fitness instructor at a local health club/community center who is certified to construct exercise programs for people with chronic health conditions.
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