[Advances in pathogenic mechanisms and pulmonary rehabilitation strategies for skeletal muscle dysfunction in chronic obstructive pulmonary disease]

Chronic obstructive pulmonary disease (COPD) is a complex heterogeneous chronic respiratory disease and third leading cause of death worldwide. In addition to damage to the respiratory system, COPD has significant extra-pulmonary effects, of which skeletal muscle dysfunction is one of the most prominent. Skeletal muscle dysfunction in COPD can manifest as impaired muscle strength, loss of muscle mass, or decreased endurance, etc. Possible pathogenic mechanisms include abnormal neuro-muscular stimulation, dysregulated protein synthesis, hypoxia, inflammation, oxidative stress, mitochondrial dysfunction, impaired regenerative capacity, etc. Pulmonary rehabilitation (PR) can improve limb muscle function, exercise tolerance and quality of life of COPD patients. Exercise training is usually the main component of any PR program. Currently, PR is the main intervention for skeletal muscle dysfunction in COPD and could be executed in PR center, at home, or in the community using state-of-the-art technology. In this review, we summarized recent advances in pathogenic mechanisms and pulmonary rehabilitation strategies for skeletal muscle dysfunction in COPD, in particular exercise training protocols, respiratory support and feedback in PR, and so on.