Inflammatory responses to acute exercise during pulmonary rehabilitation in patients with COPD

Alex R Jenkins,Neil S Holden,Arwel W Jones

doi:10.1007/s00421-020-04452-z

Abstract

ObjectivePulmonary rehabilitation is a cornerstone treatment in the management of chronic obstructive pulmonary disease (COPD). Acute bouts of exercise can lead to short bursts of inflammation in healthy individuals. However, it is unclear how COPD patients respond to acute bouts of exercise. This study assessed inflammatory responses to exercise in COPD patients at the start (phase 1) and end (phase 2) of pulmonary rehabilitation.MethodsBlood samples were collected before and after an acute exercise bout at the start (phase 1, n = 40) and end (phase 2, n = 27) of pulmonary rehabilitation. The primary outcome was change in fibrinogen concentrations. Secondary outcomes were changes in CRP concentrations, total/differential leukocyte counts, markers of neutrophil activation (CD11b, CD62L and CD66b), and neutrophil subsets (mature, suppressive, immature, progenitor).ResultsAcute exercise (phase 1) did not induce significant changes in fibrinogen (p = 0.242) or CRP (p = 0.476). Total leukocyte count [mean difference (MD), 0.5 ± 1.1 (109 L−1); p = 0.004], neutrophil count [MD, 0.4 ± 0.8 (109 L−1); p < 0.001], and immature neutrophils (MD, 0.6 ± 0.8%; p < 0.001) increased post-exercise. Neutrophil activation markers, CD11b (p = 0.470), CD66b (p = 0.334), and CD62L (p = 0.352) were not significantly altered post-exercise. In comparison to the start of pulmonary rehabilitation (phase 2), acute exercise at the end of pulmonary rehabilitation led to a greater fibrinogen response (MD, 84 mg/dL (95% CI − 14, 182); p = 0.045).ConclusionAn acute bout of exercise does not appear to induce significant alterations in the concentrations of inflammatory mediators but can increase white blood cell subsets post-exercise. A greater fibrinogen response to acute exercise is seen at the end of pulmonary rehabilitation when compared to the start. Further research is required to understand the clinical context of these acute inflammatory responses to exercise.

Highlights

Pulmonary rehabilitation, an exercise and education-based intervention, is considered a cornerstone treatment in the management of chronic obstructive pulmonary disease (COPD)
The purpose of this study was to assess inflammatory responses to acute bouts of exercise at the beginning and end of pulmonary rehabilitation to see how inflammatory responses to exercise differ with exercise training progression in patients with COPD
The main findings from this study suggest that acute exercise in COPD patients at the start of pulmonary rehabilitation does not result in significant increases in circulating concentrations of fibrinogen and CRP

Summary

Introduction

An exercise and education-based intervention, is considered a cornerstone treatment in the management of chronic obstructive pulmonary disease (COPD). The effects of acute bouts of exercise in COPD patients are unclear whereby short bursts of inflammation resulting from exercise have been proposed to increase the risk of exacerbation (van der Vlist and Janssen 2010). Previous research has suggested that acute exercise triggers an inflammatory response in healthy individuals as characterised by the mobilisation of neutrophils and increased concentrations of fibrinogen and CRP (Bizheh and Jaafari 2011; Montgomery et al 1996; Nieman et al 2005). Acute bouts of exercise have been seen to induce changes in the expression of cell surface receptors of neutrophils in healthy populations (Gray et al 1993; Smith et al 1996; van Eeden et al 1999). Increases in neutrophil activation may have deleterious effects in a population such as COPD that are characterised by neutrophilic inflammation (Hoenderdos and Condliffe 2013; Quint and Wedzicha 2007)

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