Impact of pulmonary rehabilitation on body composition in patients with COPD

<bold>Introduction:</bold> Many COPD patients referred for pulmonary rehabilitation (PR) have abnormal body composition. Exercise training and dietary counselling are expected to positively impact lean mass (LM) and fat mass (FM) in these patients. To date, a detailed analysis of the impact of PR on LM and FM is lacking. Therefore, this study assessed the effects of inpatient PR on body composition in patients with COPD. <bold>Methods:</bold> 2936 patients (52% women; age: 66 (60-72) years, BMI 25.8 (22.5-29.6) kg/m2, FEV1: (44 (32-61) %pred) who completed an 8-week inpatient PR program in Ciro were analysed. Patients were grouped by baseline BMI: underweight (UW) <18.5; normal weight (NW) 18.5-24.9, overweight (OW) 25-29.9, obese (OB) 30-34.9, severely obese 35-39.9 (sOB) or morbidly obese (mOB) >39.9 kg/m2) and baseline fat-free mass index (FFMI; age-, sex- and BMI-specific cut-offs were used; Franssen et al. JAMDA 2014). LM and FM were measured by DXA before and after PR. <bold>Results:</bold> Overall, in 47.6% of the patients the increase in FFMI exceeded the MCID (Jenkins et al. Pulmonology 2024) of 0.35 kg/m2. The largest median improvements in LM were found in UW, NW and OW (+1.6, +1.1 and +0.8 kg, respectively). Largest median reductions in FM were observed in OB, sOB and mOB (-2.0, -2.5, -3.2 kg, respectively), with preserved or even increased LM. Patients with low FFMI had a larger increase in LM within all BMI groups except for sOB and mOB when compared to normal FFMI. <bold>Conclusion:</bold> Pulmonary rehabilitation, including exercise training and nutritional counselling results in improvements in body composition in COPD patients, irrespective of baseline body weight or composition. <bold>Funding:</bold> Lung Foundation Netherlands (Grant #5.1.18.232).