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Quadriceps Strength Predicts Mortality in COPD

One in twenty Australians age 45+ live with COPD.1 The resulting dyspnoea, reduced exercise tolerance, and communication hindrance strongly impact quality of life. What’s more, each year, roughly one in five people with moderate to severe COPD experience an acute exacerbation requiring urgent care.

Hospitalisation is also common in these instances.2 To moderate the risks of COPD and improve quality of life, doctors and practice nurses can refer to exercise physiology at Advanced Physiotherapy for efficient and effective outpatient COPD rehab. The triggers and timing for these referrals may be somewhat subjective, but research is ongoing to provide practitioners with easily accessible, objective data that supports care planning. To this end, an international team of researcers recently conducted a first-of-its-kind study to find cut-offs in the association of quadriceps weakness and mortality among patients with COPD.3 They reported one cut-off point. Patients who could not extend their quadriceps to push 31% of their own weight bilaterally, while seated in weight-training equipment, proved 173% more likely to experience mortality within four years. This was compared to the subset of their group who could push their own weight. In an older study, researchers established that COPD patients who could not produce enough force to move 120% of their own body mass with their dominant leg had 10% higher mortality rates, compared to patients who could produce that much force.4

While more research to create a straightforward clinical tool would be helpful, we can see that even mild loss of quadriceps strength predicts higher mortality risk in COPD. As quadriceps approach moderate and severe weakness, that weakness predicts profound increases in all-cause mortality risk. On the other hand, simple programs to improve exercise capacity in COPD have been found to produce rapid improvements. Programs involve patient education, upper limb exercises, lower limb exercises, and cardiovascular fitness. After eight or more visits, one study measured mean maximum-phonation-time (MPT) improvement from 5.8 seconds to 12.1 seconds and mean peak-expiratory-flow (PEF) improvement from 190.7 litres per minute to 324.5 litres per minute.5 MPT proves important for supporting speech function, while good PEF is known to prevent aspiration pneumonia.6 Similarly, other studies find that outpatient exercise therapy can reduce overall healthcare utilisation, decrease hospitalisations 27%, improve survival, decrease emergency department visits 21%, improve exercise tolerance, and improve dyspnea.7-12


1. Australian Bureau of Statistics. National Health Survey First Results (2017 - 2018). Last accessed August 2021. Available at: -survey-first-results/latest-release.

2. Rubí M, Renom F, Ramis F, Medinas M, Centeno MJ, Górriz M, et al. Effectiveness of pulmonary rehabilitation in reducing health resources use in chronic obstructive pulmonary disease. Arch Phys Med Rehabil. 2010;91: 364–368.

3. Spositon T, Oliveira JM, Rodrigues A, Fonseca J, Santin L, Machado FV, Hernandes NA, Marques A, Pitta F, Furlanetto KC. Quadriceps weakness associated with mortality in individuals with chronic obstructive pulmonary. Annals of Physical and Rehabilitation Medicine. 2022;65:101587.

4. Swallow EB, Reyes D, Hopkinson NS, Man WD, Porcher R, Cetti EJ, Moore AJ, Moxham J, Polkey MI. Quadriceps strength predicts mortality in patients with moderate to severe chronic obstructive pulmonary disease. Thorax. 2007 Feb 1;62(2):115-20.

5. Bausek N, Havenga L, Aldarondo S. Respiratory muscle training improves speech and pulmonary function in COPD patients in a home health setting-a pilot study. BioRxiv. 2019 Jan 1:523746.

6. Kim J, Davenport P, Sapienza C. Effect of expiratory muscle strength training on elderly cough function. Arch Gerontol Geriatr. 2009;48: 361–366.

7. Coultas DB, Jackson BE, Russo R, Peoples J, Singh KP, Sloan J, et al. Home-based physical activity coaching, physical activity, and health care utilization in chronic obstructive pulmonary disease. Chronic Obstructive Pulmonary Disease Self-Management Activation Research Trial Secondary Outcomes. Ann Am Thorac Soc. 2018;15: 470–478.

8. Kessler R, Casan-Clara P, Koehler D, Tognella S, Viejo JL, Dal Negro RW, Díaz-Lobato S, Reissig K, González-Moro JM, Devouassoux G, Chavaillon JM. COMET: a multicomponent home-based diseasemanagement programme versus routine care in severe COPD. European Respiratory Journal. 2018 Jan 1;51(1):1701612.

9. Bourbeau J; Julien M, Maltais F, et al. Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: a disease-specific self-management intervention. Arch Intern Med. 2003; 163 (5): 585-91.

10. Gadoury M, Schwartzman K, Rouleau M. et al. Self-management reduces both short- and long-term hospitalisation in COPD. Eur Respir J. 2005; 26 (5): 853-7.

11. Salman G, Mosier M, Beasley B, et al. Rehabilitation for patients with chronic obstructive pulmonary disease: meta-analysis of randomized controlled trials. J Gen Intern Med. 2003: 18a (3): 213-21.

12. Murphy N, Bell C, Costello R. Extending a home from hospital care programme for COPD exacerbations to include pulmonary rehabilitation. Respir Med. 2005; 99(10): 1297-302


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