Analysis of three different equations for predicting quadriceps femoris muscle strength in patients with COPD

Nellessen, Aline Gonçalves; Donária, Leila; Hernandes, Nidia Aparecida; Pitta, Fabio

doi:10.1590/S1806-37132015000004515

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Original Articles • J. bras. pneumol. 41 (4) • Jul-Aug 2015 • https://doi.org/10.1590/S1806-37132015000004515 copy

Analysis of three different equations for predicting quadriceps femoris muscle strength in patients with COPD^* * Study carried out at the Laboratório de Pesquisa em Fisioterapia Pulmonar, Departamento de Fisioterapia, Universidade Estadual de Londrina, Londrina (PR) Brasil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To compare equations for predicting peak quadriceps femoris (QF) muscle force; to determine the agreement among the equations in identifying QF muscle weakness in COPD patients; and to assess the differences in characteristics among the groups of patients classified as having or not having QF muscle weakness by each equation.

Methods:

Fifty-six COPD patients underwent assessment of peak QF muscle force by dynamometry (maximal voluntary isometric contraction of knee extension). Predicted values were calculated with three equations: an age-height-weight-gender equation (Eq-AHWG); an age-weight-gender equation (Eq-AWG); and an age-fat-free mass-gender equation (Eq-AFFMG).

Results:

Comparison of the percentage of predicted values obtained with the three equations showed that the Eq-AHWG gave higher values than did the Eq-AWG and Eq-AFFMG, with no difference between the last two. The Eq-AHWG showed moderate agreement with the Eq-AWG and Eq-AFFMG, whereas the last two also showed moderate, albeit lower, agreement with each other. In the sample as a whole, QF muscle weakness (< 80% of predicted) was identified by the Eq-AHWG, Eq-AWG, and Eq-AFFMG in 59%, 68%, and 70% of the patients, respectively (p > 0.05). Age, fat-free mass, and body mass index are characteristics that differentiate between patients with and without QF muscle weakness.

Conclusions:

The three equations were statistically equivalent in classifying COPD patients as having or not having QF muscle weakness. However, the Eq-AHWG gave higher peak force values than did the Eq-AWG and the Eq-AFFMG, as well as showing greater agreement with the other equations.

Keywords:
Pulmonary disease, chronic obstructive; Muscle strength; Quadriceps muscle; Reference values

Characteristic	(N = 56)
Gender, M/F	33/23
Age, years	66 ± 9
BMI, kg.m⁻²	26 [20-30]
Fat-free mass, kg	45 ± 10
Fat-free mass, % of predicted	66 ± 10
FEV₁, L	1.0 [0.8-1.5]
FEV₁, % of predicted	44 ± 17
FVC, L	2.2 [1.6-2.7]
FVC, % of predicted	66 ± 15
FEV₁/FVC, %	51 [39-67]
GOLD, I/II/III/IV	1/20/23/12
Peak QF muscle force, N m	89 ± 29
Peak QF muscle force, kg	29 ± 10

Characteristic	Equation of Neder et al.¹⁶16 . Neder JA, Nery LE, Shinzato GT, Andrade MS, Peres C, Silva AC. Reference values for concentric knee isokinetic strength and power in nonathletic men and women from 20 to 80 years old. J Orthop Sports Phys Ther. 1999;29(2):116-26. http://dx.doi.org/10.2519/jospt.1999.29.2.116 http://dx.doi.org/10.2519/jospt.1999.29....		Equation of Decramer et al.¹²12 . Decramer M, Gosselink R, Troosters T, Verschueren M, Evers G. Muscle weakness is related to utilization of health care resources in COPD patients. Eur Respir J. 1997;10(2):417-23. http://dx.doi.org/10.1183/09031936.97.10020417 http://dx.doi.org/10.1183/09031936.97.10...		Equation of Seymour et al.⁸8 . Seymour JM, Spruit MA, Hopkinson NS, Natanek SA, Man WD, Jackson A, et al. The prevalence of quadriceps weakness in COPD and the relationship with disease severity. Eur Respir J. 2010;36(1):81-8. http://dx.doi.org/10.1183/09031936.00104909 http://dx.doi.org/10.1183/09031936.00104...
	< 80% of predicted	≥ 80% of predicted	< 80% of predicted	≥ 80% of predicted	< 80% of predicted	≥ 80% of predicted
	(n = 33)	(n = 23)	(n = 38)	(n = 18)	(n = 41)	(n = 15)
Gender, M/F	19/14	14/9	24/14	9/9	21/20	12/3
Age, years	64 ± 7	70 ± 9*	64 ± 8	70 ± 9*	65 ± 8	68 ± 10
BMI, kg.m⁻²	24 [20-30]	26 [21-30]	27 [20-32]	22 [19-26]*	26 [20-30]	23 [19-29]
FFM, kg	45 ± 10	45 ± 9	47 ± 10	41 ± 8*	44 ± 10	47 ± 9
FFM, % of predicted	66 ± 11	66 ± 9	64 ± 10	70 ± 10*	63 [57-75]	67 [62-76]
FEV₁, L	1.1 [0.8-1.5]	1.1 [0.8-1.5]	1.1 [0.8-1.5]	1.0 [0.7-1.5]	1.1 [0.8-1.5]	1.2 [0.9-1.7]
FEV₁, % of predicted	42 ± 15	48 ± 20	44 ± 17	47 ± 18	44 ± 16	47 ± 20
FVC, L	2 [1.6-3.0]	2.1 [1.6-2.7]	2.1 [1.7-2.8]	2.3 [1.6-2.7]	2.1 [1.6-2.7]	2.4 [2.0-3.4]
FVC, % of predicted	67 ± 16	67 ± 15	67 ± 16	66 ± 14	66 ± 15	68 ± 16
FEV₁/FVC, %	50 [39-63]	64 [40-69]	51 [38-67]	59 [44-67]	52 ± 14	53 ± 17
GOLD, I/II/III/IV	0/10/15/8	1/10/8/4	0/14/14/10	1/6/9/2	0/14/18/9	1/6/5/3
Peak QF muscle force, N m	76 ± 23	107 ± 27*	83 ± 25	100 ± 34*	76 ± 21	121 ± 20*
Peak QF muscle force, kg	25 ± 8	35 ± 9*	27 ± 8	33 ± 11*	25 ± 7	40 ± 7*

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[1] Correspondence to: Fabio Pitta. Laboratório de Pesquisa em Fisioterapia Pulmonar (LFIP), Departamento de Fisioterapia, Avenida Robert Koch, 60, Vila Operária, CEP 86038-350, Londrina, PR, Brasil. Tel.: 55 43 3371-2477. E-mail: fabiopitta@uol.com.br

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Analysis of three different equations for predicting quadriceps femoris muscle strength in patients with COPD* * Study carried out at the Laboratório de Pesquisa em Fisioterapia Pulmonar, Departamento de Fisioterapia, Universidade Estadual de Londrina, Londrina (PR) Brasil.

Abstract

Objective:

Methods:

Results:

Conclusions:

Analysis of three different equations for predicting quadriceps femoris muscle strength in patients with COPD^* * Study carried out at the Laboratório de Pesquisa em Fisioterapia Pulmonar, Departamento de Fisioterapia, Universidade Estadual de Londrina, Londrina (PR) Brasil.