Study proves benefits of physical exercise for people with COPD

People with chronic obstructive pulmonary disease (COPD), in general, cannot tolerate physical exercise – the tiredness, constant shortness of breath and muscle weakness associated with the condition are factors that often discourage routine physical activity.

Regular exercise, however, is considered the most effective approach in the pulmonary rehabilitation of these patients. Now, a new Brazilian study, coordinated by professor Fernanda Degobbi Lopes and supported by FAPESP, highlights the benefits of physical exercise also on the immune response of people with severe COPD, showing a decrease in inflammatory factors, greater gain in muscle mass, decreased dyspnea and improving the quality of life of these people.

The unprecedented work was conducted during Juliana Tiyaki Ito-Uchoa’s postdoctoral studies at the Laboratory of Experimental Therapeutics, of the Institute of Medical Research Laboratories of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (HC/FMUSP), with collaboration from the Physiotherapy Department, the Pulmonary Rehabilitation Service, the Pulmonology Service of the Heart Institute (Incor) and the Dermatology and Immunodeficiencies Laboratory. The results were published in the magazine Pulmonology.

For around ten years, Lopes and his research group have been studying the immune response in COPD. They demonstrated both in clinical and experimental studies that smokers who develop COPD have a failure in the immune response mediated by a specific type of cells known to control the inflammatory process.

COPD, as the name suggests, is a chronic lung disease whose main causative agent is smoking. It is a complex multifactorial disease, which causes a chronic inflammatory process of the bronchi, causes the destruction of the alveolar walls and leads to systemic effects, such as cardiovascular comorbidities, loss of muscle mass, greater bone fragility, in addition to contributing to physical deconditioning.

Its main characteristic is the limitation of pulmonary airflow, associated with an abnormal inflammatory response to the inhalation of harmful particles or gases (especially from cigarettes). This is reflected precisely in the reduction of physical fitness, causing harm to work activities and daily life. Therefore, the disease is considered one of the main causes of death and physical disability in the world.

defense cells

The inflammatory process caused by COPD provokes an immune response from the body, both in the innate response (from cells that reside in the tissue and are “ready” to respond to any exogenous factor) and in the adaptive response (which occurs when the person continues to be exposed to smoking , intensifying the inflammatory process, which leads to the condition of chronicity and activation of other more specific defense mechanisms).

In the case of COPD, some clinical and experimental studies developed by the group coordinated by Lopes, also with support from FAPESP, demonstrated that the disease induces an imbalance in Th17 and Treg defense cells (two types of lymphocytes), which contributes to a failure in controlling inflammation and the consequent progression of the disease.

Treg cells are considered anti-inflammatory and are responsible for activating the production of interleukin 10 (IL10), which helps to reduce the inflammatory response in the body. In contrast, Th17 cells are pro-inflammatory, meaning when their levels are increased, they are associated with disease progression and worsening.

The group’s studies demonstrated an increase in the response mediated by Th17 cells in the development and progression of COPD. They also demonstrated that smokers who become COPD have a reduction in the anti-inflammatory response mediated by Treg cells, which are reduced or inactivated, meaning they are unable to work properly.

“Treg cells are present in tissues, but they need a ‘signal’ to be activated and produce interleukin 10, which will act to reduce inflammation. In people who smoke and have COPD, this mechanism is not activated”, explained Lopes, lead author of the study.

The impact of exercise

The anti-inflammatory effect of physical training is well established in healthy adults: physical activity suppresses systemic inflammation through the local muscular release of myokines (proteins produced by muscles when contracted), responsible for increasing interleukin 10, for example. In people with COPD, physical training is essential for pulmonary rehabilitation, but the mechanism involved in the anti-inflammatory immune response was not yet known.

To reach the conclusion, the team evaluated 20 people with severe COPD, who were between 50 and 80 years old, were under medical treatment, clinically stable (at least 30 days without exacerbation) and were physically inactive. They were divided into two groups: the physical exercise group and the control group.

The training program in the exercise group was carried out in 24 sessions, three times a week, with each session lasting one hour. The sessions were divided into aerobic exercises (treadmill test) and resistance training (bodybuilding), supervised by a physiotherapist.

After this period of training, the group that exercised showed an increase in “activated” Treg cells, that is, those capable of carrying out anti-inflammatory action, concomitantly with a reduction in Th17 (pro-inflammatory) cells. Furthermore, the active group also showed an improvement in muscle strength and a decrease in dyspnea (shortness of breath).

“In addition to corroborating the findings on the beneficial effects of physical activity for mitigating and preventing different diseases, these results show for the first time that physical training inhibits the Th17 response and promotes an increase in Treg cells with anti-inflammatory activity in individuals with COPD. , even in advanced stages of the disease. This means an improvement in the immune response and consequent attenuation of respiratory symptoms”, says Lopes.

In practice, says the researcher, the benefits of physical activity can be extended to anyone with COPD, even if they are not critically ill. “We know that most people don’t do physical activity because of shortness of breath and tiredness. As the disease progresses, the person increasingly loses their ability to breathe. But this study brings results that will impact these people’s lives. It is essential that they understand that, little by little, physical exercise will improve physical fitness, improve muscle strength and even reduce inflammation”, highlighted the researcher.

The disease in Brazil

In industrialized countries, it is estimated that between 5% and 10% of the adult population suffers from COPD. In Brazil, a study carried out with people over 40 years of age showed a prevalence of 15.8% in the Metropolitan Region of São Paulo.

According to data from the Health Surveillance Secretariat (SVS) based on the Global Burden of Disease (GBD) methodology, here COPD is the fifth cause of death among chronic non-communicable diseases at all ages. In recent decades, it has been the fifth leading cause of hospitalization in the Unified Health System (SUS) among patients over 40 years of age.

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This content was originally published in Study proves benefits of physical exercise for people with COPD on the CNN Brasil website.

Source: CNN Brasil