Dr Michael Steiner
Consultant Respiratory Physician
University Hospitals of Leicester NHS Trust
+44 (0)116 256 3450
MRC ref: G0501985; UHL 10146
Molecular approaches to reversing skeletal muscle wasting in chronic obstructive pulmonary disease (COPD): the role of resistance training and protein supplementation - a double-blind randomised placebo-controlled trial
This project will test the following principal hypotheses:
1. That muscle wasting in chronic obstructive pulmonary disease (COPD) is characterised by alterations in the expression of catabolic and anabolic genes (mRNA) and signalling pathways (protein and protein phosphorylation) that have been implicitly associated with the regulation of skeletal muscle protein degradation and synthesis when compared with non-wasted COPD patients, and similar aged healthy controls.
2. That a carefully controlled resistance training programme known to restore muscle mass in immobilised young healthy humans will have similar restorative effects in COPD patients and that these benefits will be mediated through changes in these candidate gene and signalling pathways. We will also determine how these effects differ between wasted and non wasted COPD patients and between patients and healthy controls.
3. That changes in the expression and activation of these regulatory pathways occurs early (within 24 hours) from the onset of rehabilitation as was seen following limb immobilisation in young healthy subjects.
4. That the positive effects of resistance training on skeletal muscle mass in COPD patients can be augmented when training is combined with dietary protein supplementation.
More details can be found at the following links:
UK Clinical Research Network Study Portfolio: http://public.ukcrn.org.uk/Search/StudyDetail.aspx?StudyID=4049
MRC research portfolio: http://www.mrc.ac.uk/ResearchPortfolio/Grant/Record.htm?GrantRef=G0501985&CaseId=6937
1. Leicestershire, Northamptonshire & Rutland Research Ethics Committee 1, 26/09/2006, ref: 06/Q2501/138
2. University Hospitals of Leicester (UHL) NHS Trust R&D, 05/01/2007, ref: 10146
3. Leicester City Primary Care Trust (PCT), 12/02/2008, ref: LNR PCRA 0696
Double-blind randomised placebo-controlled single-centre trial
Primary study design
Secondary study design
Randomised controlled trial
Patient information sheet
Not available in web format, please use the contact details below to request a patient information sheet
Chronic obstructive pulmonary disease (COPD)
1. Resistance training: The training programme will last 8 weeks and comprise three supervised half-hour lower limb resistance training sessions per week. Training will take place on an isokinetic dynamometer (Cybex II Norm: CSMi, USA). Subjects will perform 5 sets of 30 maximal knee extensions performed at 180 degrees/sec. Sets will be separated by 1 minute rest. Both legs will be trained.
2. Protein supplementation: COPD patients will be randomly allocated to receive a dietary protein (with carbohydrate) supplement or placebo throughout training. Healthy volunteers will receive a placebo. The supplement will contain 19 g protein and 49 g carbohydrate (Vitargo® Gainers Gold: Swecarb, Sweden) made up to 500 ml of water. The placebo will be an identical volume non-nutritive and non-caloric drink. Supplementation will take place immediately following each training session, as the timing of protein intake appears to be critical.
Primary outcome measures
Muscle gene and protein expression (vastus lateralis needle biopsy samples) at baseline, 24 hours, 4 weeks and 8 weeks.
Secondary outcome measures
1. Muscle strength (isometric and isokinetic quadriceps strength) at baseline, 4 weeks, 8 weeks and 6 months
2. Total body and quadriceps fat-free (muscle) mass (dual energy X-ray absorptiometry [DEXA]) at baseline, 4 weeks and 8 weeks
3. Circulating inflammatory cytokines (blood tests) at baseline, 24 hours, 4 weeks and 8 weeks
4. Whole-body exercise performance (incremental cycle ergometry test) at baseline and 8 weeks
5. Physical activity (questionnaire and activity monitor) at baseline and 8 weeks
6. Lung function and capillary blood gas tensions at baseline
Overall trial start date
Overall trial end date
Participant inclusion criteria
For both COPD subjects and healthy control subjects:
1. Both males and females, aged between 50-85 years
1. Moderate-severe airflow obstruction (Forced expiratory volume in one second [FEV1] <50% predicted, FEV1/forced vital capacity [FVC] ratio <70%)
2. Reduced exercise tolerance (MRC grades III-V)
4. Able to carry out lower-limb resistance training
Healthy age-matched control subjects:
1. No evidence of airflow obstruction (FEV1 >80% predicted)
2. Able to carry out lower-limb resistance training
Target number of participants
Participant exclusion criteria
1. Long-term oral corticosteriods
2. Anticoagulant therapy or disorders
3. long term oxygen therapy (LTOT)
5. Co-morbid conditions preventing exercise training
6. Subects who have completed pulmonary rehabilitation in the previous 12-months
Healthy age-matched controls:
Same as for COPD subjects, also those who meet the criteria for fat-free mass depletion are excluded.
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
University Hospitals of Leicester NHS Trust (UK)
Research & Development Offices
Leicester General Hospital
+44 (0)116 258 4109
Medical Research Council (ref: G0501985; grant ID: 77170)
Funding Body Type
private sector organisation
Funding Body Subtype
Results and Publications
Publication and dissemination plan
Not provided at time of registration
Intention to publish date
Participant level data
Not provided at time of registration
Results - basic reporting
2012 results (inflammatory and satellite cells in the quadriceps) in http://www.ncbi.nlm.nih.gov/pubmed/22459782
2012 results (ultrasound assessment of lower limb muscle mass) in http://www.ncbi.nlm.nih.gov/pubmed/23273255
2014 results (ventilatory requirements of quadriceps resistance training) in http://www.ncbi.nlm.nih.gov/pubmed/24940055
Menon MK, Houchen L, Singh SJ, Morgan MD, Bradding P, Steiner MC, Inflammatory and satellite cells in the quadriceps of patients with COPD and response to resistance training., Chest, 2012, 142, 5, 1134-1142, doi: 10.1378/chest.11-2144.
Menon MK, Houchen L, Harrison S, Singh SJ, Morgan MD, Steiner MC, Ultrasound assessment of lower limb muscle mass in response to resistance training in COPD., Respir. Res., 2012, 13, 119, doi: 10.1186/1465-9921-13-119.
Houchen-Wolloff L, Sandland CJ, Harrison SL, Menon MK, Morgan MD, Steiner MC, Singh SJ, Ventilatory requirements of quadriceps resistance training in people with COPD and healthy controls, Int J Chron Obstruct Pulmon Dis, 2014, 9, 589-595, doi: 10.2147/COPD.S59164.