Exercise and the inflammatory response in chronic obstructive pulmonary disease (COPD)—Does training confer anti-inflammatory properties in COPD?

SummaryThere is increasing evidence that systemic inflammation plays an important role in the pathogenesis of COPD. Inflammatory markers show relationships with exercise performance, health related quality of life and breathlessness. These are important clinical outcomes in the management of COPD. Even more so is the consideration that systemic inflammation in COPD may be directly associated with mortality and deterioration of disease. Long-term exercise training clearly has beneficial properties in healthy subjects, whether the same is true in COPD remains to be seen. This review discusses aspects of the anti-inflammatory effects of exercise in relation to patients with COPD. There is intriguing evidence that the exercise-induced cytokine response differs in COPD patients compared with healthy subjects. We consider the role of IL-6 in the manifestation of fatigue in COPD and consider the implications of raised CRP- and TNF-α. Early data suggests beneficial effects of polyunsaturated fatty acid PUFA supplementation and exercise training in combination with appropriate nutritional support may yield rewarding therapeutic benefits. This review raises the hypothesis that physical training in COPD is associated with immunological changes that may confer anti-inflammatory benefits and in part, explain changes seen after pulmonary rehabilitation in COPD patients.