Abstract
RationalePulmonary rehabilitation is an important treatment for patients with Chronic Obstructive Pulmonary Disease, who are often vitamin D deficient. As vitamin D status is linked to skeletal muscle function, we aimed to explore if high dose vitamin D supplementation can improve the outcomes of rehabilitation in Chronic Obstructive Pulmonary Disease.Material and methodsThis study is a post-hoc subgroup analysis of a larger randomized trial comparing a monthly dose of 100.000 IU of vitamin D with placebo to reduce exacerbations. 50 Subjects who followed a rehabilitation program during the trial are included in this analysis. We report changes from baseline in muscle strength and exercise performance between both study arms after 3 months of rehabilitation.ResultsVitamin D intervention resulted in significantly higher median vitamin D levels compared to placebo (51 [44-62] ng/ml vs 15 [13-30] ng/ml; p < 0.001). Patients receiving vitamin D had significantly larger improvements in inspiratory muscle strength (-11±12 cmH2O vs 0±14 cmH2O; p = 0.004) and maximal oxygen uptake (110±211 ml/min vs -20±187 ml/min; p = 0.029). Improvements in quadriceps strength (15±16 Nm) or six minutes walking distance (40±55 meter) were not significantly different from the effects in the placebo group (7±19 Nm and 11±74 meter; p>0.050).ConclusionHigh dose vitamin D supplementation during rehabilitation may have mild additional benefits to training.
Highlights
Chronic Obstructive Pulmonary Disease (COPD) is currently appreciated as a complex disease characterized by pulmonary and extra-pulmonary manifestations [1,2]
Vitamin D is essential for maintaining skeletal health and low vitamin D serum (25-OHD) levels have been associated with reduced skeletal muscle strength and increased risk of falls [7,8,9]
Of 50 patients referred for rehabilitation exactly 25 patients were allocated to placebo, 25 patients to vitamin D supplementation and both subgroups were matched for all baseline parameters
Summary
Chronic Obstructive Pulmonary Disease (COPD) is currently appreciated as a complex disease characterized by pulmonary and extra-pulmonary manifestations [1,2]. Vitamin D is essential for maintaining skeletal health and low vitamin D serum (25-OHD) levels have been associated with reduced skeletal muscle strength and increased risk of falls [7,8,9]. Randomized trials and meta-analyses in elderly systematically demonstrate that vitamin D supplementation improves balance and reduces falls by approximately 20% [11,12]. Data are less consistent in showing direct effects of vitamin D on skeletal muscle strength. Because large cross-sectional data suggests that muscle strength continues to increase from 25-OHD levels of 9ng/ml to 37ng/ml [7], it can be speculated that beneficial effects on the muscle are only seen when higher doses of supplementation are given [14]
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