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Body composition, energy expenditure and physical activity

Clinical impact of body composition phenotypes in patients with COPD: a retrospective analysis



Abnormal body composition is an independent determinant of COPD outcomes. To date, it is already known that patient stratification into body composition phenotypes are associated with important outcomes, such as exercise capacity and inflammation, but there are no data comparing physical activity and muscle strength among these phenotypes. Thus, the aim of this study was to compare clinical characteristics and physical function in patients with COPD stratified into body composition phenotypes.


Two-hundred and seventy stable COPD patients were classified according to the 10th and 90th percentiles of sex-age-BMI-specific reference values for fat-free and fat mass indexes into four groups: Normal body composition (NBC), Obese, Sarcopenic, and Sarcopenic-obese (SO). Patients underwent assessment of exercise capacity, peripheral and respiratory muscle strength, physical activity, dyspnea severity, functional status, and symptoms of anxiety and depression.


The prevalence of patients classified as NBC, Obese, Sarcopenic, and SO was 39%, 13%, 21%, or 27%, respectively. SO presented lower 6MWT compared with NBC (P < 0.05). Sarcopenic and SO groups presented worse muscle strength compared with NBC (P < 0.05). Sarcopenic group presented more time in moderate-to-vigorous physical activity compared to all other groups (P < 0.05) and less sedentary time when compared with NBC and obese groups (P < 0.05). There were no differences regarding dyspnea severity, functional status, and symptoms of anxiety and depression (P > 0.16). Sarcopenic and SO groups had, respectively, 7.8 [95% CI: 1.6–37.7] and 9.5 [2.2–41.7] times higher odds to have a 6MWT equal or lower to 350 meters.


Body composition phenotypes are associated with physical function in patients with COPD. Sarcopenic-obese patients were the most impaired.

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Fig. 1


  1. 1.

    Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2018. Available from: Accessed: 31 July, 2018.

  2. 2.

    Spruit MA, Singh SJ, Garvey C, Zu Wallack R, Niki L, Rochester C, et al. An official American thoracic society/European respiratory society statement: Key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013;188:e-13–64.

    Article  Google Scholar 

  3. 3.

    Schols AM, Ferreira IM, Franssen FM, Gosker HR, Janssens W, Muscaritoli M, et al. Nutritional assessment and therapy in COPD: a European Respiratory Society statement. Eur Respir J. 2014;44:1504–20.

    Article  Google Scholar 

  4. 4.

    Joppa P, Tkacova R, Franssen FME, Hanson C, Rennard SI, Silverman EK, et al. Sarcopenic obesity, functional outcomes, and systemic inflammation in patients with chronic obstructive pulmonary disease. J Am Med Dir Assoc. 2016;17:712–8.

    Article  Google Scholar 

  5. 5.

    Vermeeren MAP, Creutzberg EC, AMWJ Schols, Postma DS, Pieters WR, Roldaan AC, et al. Prevalence of nutritional depletion in a large out-patient population of patients with COPD. Respir Med. 2006;100:1349–55.

    CAS  Article  Google Scholar 

  6. 6.

    RJHCG Beijers, van de Bool C, van den Borst B, FME Franssen, EFM Wouters, AMWJ Schols. Normal weight but low muscle mass and abdominally obese: Implications for the cardiometabolic risk profile in chronic obstructive pulmonary disease. J Am Med Dir Assoc. 2017;18:6–11.

    Article  Google Scholar 

  7. 7.

    Janssen I, Heymsfield SB, Ross R. Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc. 2002;50:889–96.

    Article  Google Scholar 

  8. 8.

    Bjorntorp P, Bray GA, Carroll KK, Chuchalin A, Dietz WH, Ehrlich GE, et al. Obesity: Preventing and managing the global epidemic. WHO Tech. Rep. Ser. 2000;894:i-xii, 1–253.

  9. 9.

    Probst VS, Kovelis D, Hernandes NA, Camillo CA, Cavalheri V, Pitta F. Effects of 2 Exercise Training Programs on Physical Activity in Daily Life in Patients With COPD. Respir Care. 2011;56:1799–807.

    Article  Google Scholar 

  10. 10.

    Felcar JM, Probst VS, de Carvalho DR, Merli MF, Mesquita R, Vidotto LS, et al. Effects of exercise training in water and on land in patients with COPD: a randomised clinical trial. Physiotherapy. (Epub ahead of print).

  11. 11.

    Lukaski HC, Bolonchuk WW, Hall CB, Siders WA. Validation of tetrapolar bioelectrical impedance method to assess human body composition. J Appl Physiol. 1986;60:1327–32.

    CAS  Article  Google Scholar 

  12. 12.

    Steiner MC, Barton RL, Singh SJ, Morgan MDL. Bedside methods versus dual energy X-ray absorptiometry for body composition measurement in COPD. Eur Respir J. 2002;19:626–31.

    CAS  Article  Google Scholar 

  13. 13.

    Franssen FME, Rutten EPA, Groenen MTJ, Vanfleteren LE, Wouters EFM, Spruit MA. New reference values for body composition by bioelectrical impedance analysis in the general population: Results from the UK biobank. J Am Med Dir Assoc. 2014;15:1–6.

    Article  Google Scholar 

  14. 14.

    Kovelis D, Segretti NO, Probst VS, Lareau SC, Brunetto AF, Pitta F. Validation of the modified pulmonary functional status and dyspnea questionnaire and the medical research council scale for use in Brazilian patients with chronic obstructive pulmonary disease. J Bras Pneumol. 2008;34:1008–18.

    Article  Google Scholar 

  15. 15.

    Pitta F, Probst VS, Kovelis D, Segretti NO, Mt Leoni A, Garod R, et al. [Validation of the Portuguese version of the London Chest Activity of Daily Living Scale (LCADL) in chronic obstructive pulmonary disease patients]. Rev Portu Pneumol. 2008;14:27–47.

    Article  Google Scholar 

  16. 16.

    Botega NJ, Bio MR, Zomignani MA, Garcia C Jr., Pereira WA. [Mood disorders among inpatients in ambulatory and validation of the anxiety and depression scale HAD]. Rev Saude Publica. 1995;29:355–63.

    CAS  Article  Google Scholar 

  17. 17.

    Holland AE, Spruit MA, Troosters T, Puhan MA, Pepin V, Saey D, et al. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J. 2014;44:1428–46.

    Article  Google Scholar 

  18. 18.

    Britto RR, Probst VS, Dornelas De Andrade AF, Samora GAR, Hernandes NA, Marinho PEM, et al. Reference equations for the six-minute walk distance based on a Brazilian multicenter study. Brazilian J Phys Ther. 2013;17:556–63.

    Article  Google Scholar 

  19. 19.

    Brown LE, Weir JP. ASEP procedures recommendation I: accurate assessment of Muscular strength and Power. J Exerc Physiol. 2001;4:1–21.

    Google Scholar 

  20. 20.

    Black LF, Hyatt RE. Maximal respiratory pressures: normal values and relationship to age and sex. Am Rev Respir Dis. 1969;99:696–702.

    CAS  PubMed  Google Scholar 

  21. 21.

    Neder JA, Andreoni S, Lerario MC, Nery LE. Reference values for lung function tests. II. Maximal respiratory pressures and voluntary ventilation. Braz J Med Biol Res. 1999;32:719–27.

    CAS  Article  Google Scholar 

  22. 22.

    van Remoortel H, Raste Y, Louvaris Z, Giavedoni S, Burtin C, Langer D, et al. Validity of six activity monitors in chronic obstructive pulmonary disease: A comparison with indirect calorimetry. PLoS ONE. 2012;7:1–11.

    Google Scholar 

  23. 23.

    Langer D, Gosselink R, Sena R, Burtin C, Decramer M, Troosters T. Validation of two activity monitors in patients with COPD. Thorax. 2009;64:641–2.

    CAS  Article  Google Scholar 

  24. 24.

    Pitta F, Troosters T, Spruit MA, Probst VS, Decramer M, Gosselink R. Characteristics of physical activities in daily life in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005;171:972–7.

    Article  Google Scholar 

  25. 25.

    Patel SA, Benzo RP, Slivka WA, Sciurba FC. Activity monitoring and energy expenditure in COPD Patients: A validation study. COPD. J Chronic Obstr Pulm Dis. 2007;4:107–12.

    Article  Google Scholar 

  26. 26.

    Mesquita R, Meijer K, Pitta F, Azcuna H, Goertz YMJ, Essers JMN, et al. Changes in physical activity and sedentary behaviour following pulmonary rehabilitation in patients with COPD. Respir Med. 2017;126:122–9.

    Article  Google Scholar 

  27. 27.

    Demeyer H, Burtin C, Van Remoortel H, Hornikx M, Langer D, Decramer M, et al. Standardizing the analysis of physical activity in patients with COPD following a pulmonary rehabilitation program. Chest. 2014;146:318–27.

    Article  Google Scholar 

  28. 28.

    Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR Jr., Tudor-Locke C, et al. 2011 Compendium of Physical Activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011;43:1575–81.

    Article  Google Scholar 

  29. 29.

    Celli BR, Cote CG, Marin JM, Casanova C, Montes de Oca M, Mendez RA. et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004;350:1005–12.

    CAS  Article  Google Scholar 

  30. 30.

    Van De Bool C, Rutten EPA, Franssen FME, Wouters EFM, Schols AMWJ. Antagonistic implications of sarcopenia and abdominal obesity on physical performance in COPD. Eur Respir J. 2015;46:336–45.

    Article  Google Scholar 

  31. 31.

    Ischaki E, Papatheodorou G, Gaki E, Papa I, Koulouris N, Loukides S. Body mass and fat-free mass indices in COPD. Chest. 2007;132:164–9.

    Article  Google Scholar 

  32. 32.

    MPKJ Engelen, Schols AMWJ, Does JD, Wouters EFM. Skeletal muscle weakness is associated with wasting of extremity fat-free mass but not with airflow obstruction in patients with. Am J Clin Nutr. 2000;71:733–8.

    Article  Google Scholar 

  33. 33.

    Sabino PG, Silva BM, Brunetto AF. Nutritional status is related to fat-free mass, exercise capacity and inspiratory strength in severe chronic obstructive pulmonary disease patients. Clinics. 2010;65:599–605.

    Article  Google Scholar 

  34. 34.

    Luo y, Zhou L, Li Y, Guo S, Li X, Zheng J, et al. Fat-free mass index for evaluating the nutritional status and disease severity in COPD. Respir Care. 2016;61:580–8.

    Article  Google Scholar 

  35. 35.

    Ora J, Laveneziana P, Wadell K, Preston M, Webb KA, O’Donnell DE. Effect of obesity on respiratory mechanics during rest and exercise in COPD. J Appl Physiol. 2011;111:10–9.

    Article  Google Scholar 

  36. 36.

    Kyle UG, Schutz Y, Dupertuis YM, Pichard C. Body composition interpretation: Contributions of the fat-free mass index and the body fat mass index. Nutrition. 2003;19:597–604.

    Article  Google Scholar 

  37. 37.

    Maltais F, Decramer M, Casaburi R, Barreiro E, Burelle Y, Debiga R, et al. An official American thoracic society/european respiratory society statement: Update on limb muscle dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2014;189:15–62.

    Article  Google Scholar 

  38. 38.

    Watz H, Pitta F, Rochester CL, Garcia-Aymerich J, ZuWallack R, Troosters T, et al. An official European respiratory society statement on physical activity in COPD. Eur Respir J. 2014;44:1521–37.

    Article  Google Scholar 

  39. 39.

    Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Gómez JM, et al. Bioelectrical impedance analysis - Part I: Review of principles and methods. Clin Nutr. 2004;23:1226–43.

    Article  Google Scholar 

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We are grateful to the colleagues of the Laboratory of Research in Respiratory Physiotherapy for the contribution to the study. In addition, we acknowledge, the patients who participated in the study and the support of CAPES and CNPq, Brazil.

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Correspondence to Nidia A. Hernandes.

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Machado, F.V.C., Schneider, L.P., Fonseca, J. et al. Clinical impact of body composition phenotypes in patients with COPD: a retrospective analysis. Eur J Clin Nutr 73, 1512–1519 (2019).

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