BODY COMPOSITION ABNORMALITIES
Since the previous Statement, some data have indicated that
a program of exercise and standardized nutritional supplements
in individuals with mild to moderate COPD and low fat-free
mass index (FFMI) may have clinical and health service use benefits
compared with usual care (110). At the other end of the
disease severity spectrum, a randomized controlled trial of 3
months of home rehabilitation (including health education, oral
nutritional supplements, exercise, and oral testosterone) evaluated
exercise performance, body composition, and survival in
122 underweight individuals with chronic respiratory failure
(111). Improvements were seen in body mass index, FFMI, peak
cycling work rate, and quadriceps muscle function. However, no
significant improvement in the primary outcome, 6-minute walk
distance (6MWD), was noted and there was no overall survival
benefit up to 15 months (111). Creatine supplementation has
not been found to enhance outcomes in patients with COPD
participating in pulmonary rehabilitation (112, 113).