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Chronic obstructive pulmonary disease (COPD) is more likely to conjure images of breathlessness rather than weak muscles, but can COPD also cause muscle weakness?

Research seems to show a correlation. But could muscle weakness be a related problem, or is muscle weakness caused by COPD itself?

COPD is a fairly common condition that affects the lungs and air passages. It includes emphysema and chronic bronchitis and is most often caused by smoking, though not exclusively. Many people living with COPD have never smoked.

COPD is a progressive disease, meaning it gets worse over time. The condition damages the lungs and air passages, which allows less air to flow and makes it harder to breathe.

Not smoking is the easiest way to prevent COPD, and though there is no cure, medications and lifestyle changes can lessen its progress and symptoms. Difficulty breathing, however, is not the only symptom you might experience. For many people, muscle weakness seems to go hand in hand with COPD.

Generally, the degree of muscular weakness you may experience is related to the severity of the disease. Muscular atrophy (deterioration) is more severe in cases in which emphysema is present.

COPD affects the ventilatory muscles, including the diaphragm and intercostal muscles of the rib cage, but also appears to affect the skeletal muscles that govern the mobility of joints in the upper and lower body.

People living with COPD have many symptoms, including:

  • difficulty breathing
  • wheezing
  • persistent cough
  • fatigue

One of the primary complaints is muscle weakness, often reported as fatigue and a general lack of endurance in people living with COPD.

Although muscle weakness may occur in the upper and lower extremities, participants in a 2019 study experienced a significant loss of strength and endurance in the upper leg, specifically the quadriceps.

While there is a correlation between loss of strength and COPD, there is conflicting research about whether COPD actually causes muscle loss or whether the muscle loss is the result of coexisting factors, such as:

  • heart conditions
  • nutritional abnormalities
  • sedentary lifestyle

The cause of weakening muscle and loss of muscle mass associated with COPD is complicated as muscle dysfunction comes in different forms and causes.

Some of the mechanisms that cause muscle weakness are intrinsic to the neuromuscular fibers themselves. Other mechanisms may be extrinsic, such as the chest wall remodeling that happens when respiration is inefficient.

Though some muscle loss may be caused by a decrease in physical activity because of a COPD diagnosis, some muscle wasting might be due to the advanced age of the person living with COPD. Some could be attributed to other aspects of the disease itself.

Varying degrees and causes of muscle loss are as diverse as the persons themselves. The likelihood is each person has a unique combination of exact causes.

It does seem, however, that contributing factors include:

  • the progression of COPD
  • age
  • reduced capacity for oxygenation of the muscle fibers
  • comorbidity of associated conditions such as heart disease, diabetes, or cancer

It is well-documented that muscle weakness occurring alongside COPD most often impacts the legs.

Whether this weakness is a result of inactivity and poor nutrition or some aspect of the disease is not 100% clear. Still, studies show that muscle integrity does increase the chances of survival from COPD, so there is reason to suggest that exercise and muscle hypertrophy could be beneficial.

COPD progresses with the worsening of symptoms. The primary symptoms of COPD are:

  • shortness of breath
  • wheezing
  • phlegm production
  • fatigue

If these are increasing in frequency or intensity, the disease is likely progressing.

COPD is a progressive disease, and without intervention, it can worsen. There is currently no cure for COPD, but its progression can be slowed. The best ways to do this include:

  • If you smoke, quit. A doctor can recommend products and services that may help.
  • Start an exercise routine that is safe for you.
  • Begin rehabilitation practices guided by a professional.

If COPD continues to worsen, you:

  • may need to use an oxygen tank for breathing
  • can be impacted by limited mobility and difficulty performing daily tasks
  • have more frequent doctor and hospital visits
  • experience memory loss

As many of these symptoms also show up in other conditions, it is important to follow the treatment as prescribed.

Depending on the progression of the disease, COPD can affect mobility significantly.

One 2018 study showed that particular mobility tasks were more greatly impacted than others.

For instance, activities such as walking stairs or carrying objects were more significantly affected by COPD, in terms of feeling weak and breathless. But more strength-oriented activities — such as moving something heavy — were less affected.

It would appear, then, that mobility may be affected more by a lack of endurance rather than strength loss or joint mobility.

Endurance-based exercise, and walking in particular, has been shown to improve the prognosis of people living COPD.

One study showed that after walking for 1 hour a day, people with COPD reduced their hospital recidivism by 50%. Logging 5,000 steps a day was used as a good target to improve the rate of the progression of COPD.

For people with the mobility and strength to walk, it is a simple exercise that can be done as slowly and as comfortably as possible. Walking will ease the symptoms of COPD and likely slow its progression.

Chronic obstructive pulmonary disease is a degenerative condition, but if kept to its mild form, can have a lessened impact on your life, health, and mobility. If unchecked, COPD is likely to lead to difficulty breathing, muscle loss, reduced mobility, and a lessened ability to perform daily activities.

Though there is currently no cure for COPD, some easy steps can greatly increase the survival rate and life more independent, healthy, and comfortable.

The best first step one can take is to stop smoking. Also, talk with a doctor or rehabilitative specialist and consider strength exercising and walking for cardiovascular endurance. These strategies can improve your quality of life.