Chronic Obstructive Pulmonary Disease Clinical Trial
Official title:
Impact of Somatosensory Feedback on Peripheral Muscle Fatigue and Exercise Tolerance in Patients With COPD
Recently, direct evidences point to the contributing role of peripheral muscle fatigue in
exercise tolerance among patients with COPD. However, the physiological mechanisms by which
peripheral muscle fatigue impairs exercise tolerance are still unknown, as factors
regulating peripheral muscle fatigue in COPD may be complex. One possible link between limb
muscle fatigue and exercise intolerance could be enhanced afferent signals from the active
limb muscles to the central command, thereby limiting central motor output and eventually
leading to exercise termination.
A direct method to investigate the regulation of peripheral muscle fatigue during exercise
in patients with COPD is the blockade of peripheral neural afferents via lumbar anesthesia.
Consequently, investigating the interplay between the peripheral muscular component and the
central motor command during self-paced exercise could shed light on the regulation of
peripheral muscle fatigue in COPD and its implication in exercise intolerance.
The aim of the study is to characterize the role of peripheral muscle afferents on the
development of muscle fatigue, cardiorespiratory response and exercise tolerance to
constant-workrate endurance cycling exercise in patients with COPD.
In a double-blind randomized design, patients with GOLD stage II-III COPD will be recruited
and will complete a constant-workrate cycling test following either the injection of a
placebo [NaCl, interspinous L2-L3] or an opioid [Fentanyl 25 µg, intrathecal L2-L3]
inhibiting central feedback of peripheral muscles sensory afferents. Quadriceps force (TwQ)
will be measured by magnetic stimulation of the femoral nerve and central chemoreceptors
response will be assessed by CO2 rebreathing, both performed before and after the injection.
Finally, TwQ will also be measured after the endurance cycling test to assess the magnitude
of quadriceps fatigue induced by symptom-limited exercise.
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Allocation: Randomized, Intervention Model: Crossover Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
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