{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T13:51:25Z","timestamp":1778939485284,"version":"3.51.4"},"reference-count":35,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2015,12,18]],"date-time":"2015-12-18T00:00:00Z","timestamp":1450396800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Respirology"],"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and objective<\/jats:title><jats:p>Quadriceps weakness is seen across all <jats:styled-content style=\"fixed-case\">GOLD<\/jats:styled-content> stages of <jats:styled-content style=\"fixed-case\">COPD<\/jats:styled-content> and is associated with increased morbidity and mortality. As quadriceps weakness is only weakly associated with FEV<jats:sub>1<\/jats:sub>, mechanisms other than airflow obstruction are implicated. We tested the hypothesis that insulin resistance contributes to skeletal muscle weakness in people with stable <jats:styled-content style=\"fixed-case\">COPD<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Fifty\u2010one <jats:styled-content style=\"fixed-case\">COPD<\/jats:styled-content> patients (no exacerbations preceding 6 weeks, no rehabilitation preceding 3 months) without known diabetes mellitus underwent assessment of skeletal muscle, including measurement of quadriceps maximal voluntary contraction (<jats:styled-content style=\"fixed-case\">QMVC<\/jats:styled-content>). Physical activity was measured for 7 days using a multisensory biaxial accelerometer armband. Insulin resistance (<jats:styled-content style=\"fixed-case\">HOMA2 IR<\/jats:styled-content>) was calculated from fasting blood glucose and insulin concentrations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">QMVC<\/jats:styled-content> was 30\u2009\u00b1\u200913\u2009kg (74\u2009\u00b1\u200925% predicted) and 16 (31%) participants had quadriceps weakness. There was a negative univariate correlation between HOMA2 <jats:styled-content style=\"fixed-case\">IR<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">QMVC<\/jats:styled-content> (r\u2009=\u2009\u22120.446, <jats:italic>P<\/jats:italic>\u2009=\u20090.002). <jats:styled-content style=\"fixed-case\">HOMA2 IR<\/jats:styled-content> was greater in people with quadriceps weakness (1.59\u2009\u00b1\u20090.99) than in those without (1.11\u2009\u00b1\u20090.55, <jats:italic>P<\/jats:italic>\u2009=\u20090.032). On multivariate analysis, with age, sex, weight, <jats:styled-content style=\"fixed-case\">BODE<\/jats:styled-content> index and step count per day included in the model, a one\u2010unit increase in insulin resistance was associated with a 5.9 (2.0\u20139.8)\u2010kg decrease in <jats:styled-content style=\"fixed-case\">QMVC<\/jats:styled-content> (<jats:italic>P<\/jats:italic>\u2009=\u20090.004) and a 4.2 (1.3\u201314.3)\u2010fold increased risk of quadriceps weakness (<jats:italic>P<\/jats:italic>\u2009=\u20090.02).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Insulin resistance is associated with skeletal muscle weakness in <jats:styled-content style=\"fixed-case\">COPD<\/jats:styled-content>, independent of potential confounders. Further studies are required to explore underlying mechanisms and determine whether insulin\u2010sensitizing drugs could augment pulmonary rehabilitation in building skeletal muscle strength in <jats:styled-content style=\"fixed-case\">COPD<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/resp.12716","type":"journal-article","created":{"date-parts":[[2015,12,18]],"date-time":"2015-12-18T06:57:12Z","timestamp":1450421832000},"page":"689-696","source":"Crossref","is-referenced-by-count":22,"title":["Insulin resistance is associated with skeletal muscle weakness in <scp>COPD<\/scp>"],"prefix":"10.1111","volume":"21","author":[{"given":"Claire E","family":"Wells","sequence":"first","affiliation":[{"name":"Institute of Infection and Immunity (mail point J1A) St George's, University of London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael I","family":"Polkey","sequence":"additional","affiliation":[{"name":"NIHR Respiratory Biomedical Research Unit Royal Brompton and Harefield NHS Foundation Trust and Imperial College  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emma H","family":"Baker","sequence":"additional","affiliation":[{"name":"Institute of Infection and Immunity (mail point J1A) St George's, University of London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,12,18]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2005.040709"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00104909"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.153.3.8630582"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.97.10020417"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1053\/rmed.2000.0829"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2006.062026"},{"key":"e_1_2_7_8_1","first-page":"117","article-title":"Metabolic syndrome and diabetes mellitus in COPD","volume":"59","author":"Wells CE","year":"2013","journal-title":"Eur. 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