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The Journal of Sports Medicine and Physical Fitness 2001 December;41(4):500-4

Copyright © 2002 EDIZIONI MINERVA MEDICA

language: English

Branched-chain aminoacids and retraining of patients with chronic obstructive lung disease

Menier R. *°, Talmud J. °, Laplaud D. *, Bernard M. P. *

From the * CHRU Dupuytren, Service d’Explorations Fonctionnelles Physiologiques, Limoges ° Centre Médical Toki-Eder, Cambo, France


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Back­ground. The aim of ­this ­work was to ­improve the effi­ca­cy of reha­bil­i­ta­tion by retrain­ing, by ­oral sup­ply in ­branched-­chain ami­no­ac­ids (­BCAA). ­Patients ­with chron­ic res­pir­a­to­ry insuf­fi­cien­cy main­ly suf­fer ­from obstruc­tive bron­chitis due to tobac­co or asth­ma. Nutri­tion­al assess­ment is one of the com­po­nents of res­pir­a­to­ry reha­bil­i­ta­tion, ­with retrain­ing. ­Intense phys­i­cal train­ing for sev­er­al ­days negat­i­vates the nitro­gen bal­ance, the begin­ning of a train­ing pro­gramme for sed­en­tary ­patients increas­es ­their ­need in pro­teins. An addi­tion­al sup­ply in ­branched-­chain ami­no­ac­ids increas­es pro­te­ic ana­bo­lism, by syn­the­sis ­increase and catab­o­lism slack­en­ing of pro­teins. More­over it is ­known ­that expo­sure to ­high alti­tude reduc­es ­lean ­mass by induc­ing a mus­cu­lar atro­phy, ­which can be avoid­ed by the ­BCAA pro­vid­ed. ­This ­leads to won­der if ­extra sup­ply of ­BCAA ­could ­play sim­i­lar ­role in mus­cu­lar ­mass ­loss ­induced by path­o­log­i­cal chron­ic hypox­ia.
Meth­ods. The pros­pec­tive and com­par­a­tive sur­vey car­ried out in ­Toki-­Eder (pri­vate hos­pi­tal in Cam­bo) con­sist­ed in sup­ply­ing (dur­ing ­five ­weeks or ­more) 30 ­retrained ­patients suf­fer­ing ­from chron­ic obstruc­tive bron­chitis, and in match­ing ­them ­with 30 wit­ness­es (obstruc­tive ­patients ­retrained with­out addi­tion­al sup­ply in ­BCAA). ­Their ­mean hypox­e­mia amount­ed to 7 ­torr for age.
­Results. ­Each of ­them ­improved ­their ­reached max­i­mal pow­er, and ­their VO2 SL, ­very high­ly sig­nif­i­cant­ly. ­Each of ­them devel­oped a mod­er­ate meta­bol­ic aci­do­sis (­whose pos­sible mech­a­nisms are dis­cussed) and slight­ly ­increased ­their ven­ti­la­tion at ­rest. On the oth­er ­hand ­only the sup­plied ­patients ­improved ­their PaO2 at ­rest high­ly sig­nif­i­cant­ly, a ­result ­which pos­es the ques­tion of the respon­sible mech­a­nism, ­most like­ly a ­decrease of pul­mo­nary ­shunt ­effect. The hypoth­e­ses con­cern­ing the ­acid ­load due to ­BCAA inges­tion are dis­cussed. ­Only the sup­plied ­patients devel­oped hypo­cap­nia express­ing a gas­e­ous alcal­o­sis ­which ­might be due to a ­direct ­effect of ­BCAA on the res­pir­a­to­ry cen­ters.
Con­clu­sions. ­This obser­va­tion ­could ­have prac­ti­cal out­comes in the man­age­ment of reha­bil­i­ta­tion of chron­ic res­pir­a­to­ry insuf­fi­cien­cy: it ­should be use­ful to system­at­i­cal­ly sup­ple­ment the ­patients ­with ­BCAA dur­ing ­their retrain­ing in ­order to ­obtain a ­more effec­tive improve­ment of ­their res­pir­a­to­ry func­tion.

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