Most relevant training modalities currently in use to treat skeletal muscle dysfunction in chronic obstructive pulmonary disease

Skeletal muscle dysfunction and sarcopenia are key systemic manifestations of COPD. These changes contribute to exercise intolerance, reduced daily physical activity levels, and health related quality of life, whilst they constitute independent predictors of morbidity and mortality. The aim of this review is to provide a narrative review of the effects of different exercise training modalities on peripheral muscle structure and function in patients with COPD. Evidence from randomised trials and mechanistic studies evaluating resistance, endurance (continuous and interval) training modalities, and combined endurance and resistance programmes was synthesised. Outcomes include muscle fibre cross-sectional area, fibre-type composition, oxidative capacity, quadriceps muscle strength, and lean body mass. Resistance and combined training programmes promote muscle strength and muscle hypertrophy, whilst endurance training alone enhances oxidative capacity. Biopsy-informed evidence remains limited and heterogeneous. Resistance-based interventions are most effective for restoring muscle size and strength, supporting individualised exercise prescriptions to counteract sarcopenia and optimise functional outcomes.