Femoral bone mineral density and rectus femoris phenotype as sarcopenia indicators after a pulmonary rehabilitation protocol in patients with chronic respiratory disease

Abstract

INTRODUCTION: Patients with chronic respiratory disease (CRDs) have a disorder in muscle structure and function, but their function increases with physical progress and decreases the risk of general and muscular weakness. CRDs patients with muscle weakness also have higher mortality rates than patients without muscle weakness and they are more likely to develop sarcopenia and the incidence of pathogens. The Main objective of the present study was to evaluate the indicators of Sarcopenia in chronic respiratory patients with a greater focus on musculoskeletal structure and function and quality of life in these patients, which can highest affect their mortality. METHODS: We randomly selected patients (N=38) with mean age of 72±1.0 years old men and women elderly with chronic respiratory diseases such as asthma, COPD, bronshiectasis and obesity with dyspnea score ≥ 2 in Medical Research Council (MRC) index. All patients after receiving research information and signing informed consent they have gone on performed assessments of pre and post rehabilitation protocol in spirometry for lung function, hand-grip dynamometer, quadriceps strength grading test, body mass index (BMI), skeletal muscle Index (SMI), 6-minute walking test (6-MWT) and quality of life questionnaire SF-36 in rehabilitation and pulmonology departments at the Health Parc Sant Joan de Deu. Then, they have done femor bone mineral density (FBMD) and ultrasound on rectus femoris in mid-tight cross sectional area (RFMTCSA) on quadriceps muscle at the electro-diagnosis department. They have had a 4-month long term a pulmonary rehabilitation protocol, which included: Exercise tests- incremental and constant, 12 weeks, 3 times a week, duration of each session was 1h :15 min. Breathing techniques, respiratory muscle training and self-management, (ATS-ERS guidelines, 2013-2016). RESULTS: After the rehabilitation protocol, significant changes in BMI were seen in all patients, pre rehabilitation, BMI= 30±1.06 kg/m2 and post rehabilitation, BMI=29±1.00 kg/m2. In the analysis of Pearson’s correlation r =0.607 between T-scores and Z-score in Femur Bone Mineral Density (FBMD) and Rectus femoris Mid-Tight Cross Sectional Area (RFMTCSA) in pre-rehabilitation, there is a little bit significant correlation between the variables (P<0.00). But, in the analysis of the Pearson’s correlation r =0.910 in post-rehabilitation between T-score and Z-scores in FBMD and RFMTCSA, there have a high significant correlation between variables than pre-rehabilitation on P<0.00. DISCUSSION: When we compared femur bone, rectus femoris muscle parameters and quality of life as indicators diagnosis of sarcopenia in chronic respiratory patients, we observed that in rectus femoris muscle ultrasound as the most effective foot muscle in detecting sarcopenia was the determination of the parameters of RFMTCSA and Circumference muscle, and we found significant change in the test of DEXA scan in T-score some more than Z-score. Also, we observed that T-score and Z-score in femur bone and RFMTCSA had a high significant correlation after the pulmonary rehabilitation protocol. I conclude that it is not necessary to investigate all factors in order to accurately determine the severity of sarcopenia in patients with chronic respiratory disease, and if specialists are considering rectus femoris ultrasound and femoral DEXA as the main intervention of sarcopenic in chronic respiratory patients, they can follow the latest situation health and mortality of them should be more accurately diagnosed.