{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,11]],"date-time":"2026-11-11T22:16:47Z","timestamp":1794435407548,"version":"4.9.1"},"reference-count":146,"publisher":"European Respiratory Society (ERS)","issue":"181","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir Rev"],"accepted":{"date-parts":[[2026,6,22]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:p>Chronic obstructive pulmonary disease (COPD) is increasingly recognised as a systemic disorder that extends beyond the lungs, representing a clinical model of accelerated ageing. Frailty, a multidimensional syndrome characterised by reduced physiological reserve and increased vulnerability to stressors, is highly prevalent among individuals with COPD and contributes to adverse outcomes. Both conditions share common biological mechanisms, including chronic inflammation, oxidative stress, endocrine dysregulation, mitochondrial dysfunction and skeletal muscle atrophy. Exercise acts as a physiological stressor that elicits hormetic responses, triggering favourable molecular adaptations such as enhanced mitochondrial biogenesis, improved redox balance and the upregulation of antioxidant and cellular repair pathways. These adaptations translate into improved muscle function, metabolic efficiency and immune homeostasis, thereby counteracting the catabolic processes that underlie both frailty and COPD progression. Scientific evidence supports the role of combined aerobic, resistance and balance training as the most effective approach to improving functional status and quality of life in frail individuals with COPD. Frailty in COPD represents a potentially reversible state of systemic vulnerability rooted in accelerated biological ageing. Exercise thus constitutes a powerful, multi-target intervention capable of reprogramming molecular ageing pathways and promoting resilience across organ systems. Integrating exercise physiology with the principles of geroscience offers a promising framework for personalised rehabilitation strategies aimed at extending health span in patients with COPD. This narrative review summarises current evidence on the biological and clinical interplay between COPD, frailty and exercise, exploring how physical activity exerts systemic anti-ageing effects through modulation of inflammation, oxidative stress, mitochondrial and myokine signalling, ultimately restoring physiological resilience.<\/jats:p>","DOI":"10.1183\/16000617.0340-2025","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T08:30:23Z","timestamp":1788942623000},"page":"250340","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Frailty and COPD: a bidirectional relationship in the context of systemic and accelerated ageing"],"prefix":"10.1183","volume":"35","author":[{"given":"Mauro","family":"Maniscalco","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Candia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Fuschillo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pasquale","family":"Ambrosino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9419-2426","authenticated-orcid":false,"given":"Klara","family":"Komici","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Rengo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"2026090901301513000_35.181.250340.1","doi-asserted-by":"publisher","DOI":"10.1186\/s12931-025-03356-w"},{"key":"2026090901301513000_35.181.250340.2","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/S2213-2600(17)30293-X","article-title":"Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990\u20132015: a systematic analysis for the Global Burden of Disease Study 2015","volume":"5","year":"2017","journal-title":"Lancet Respir Med"},{"key":"2026090901301513000_35.181.250340.3","doi-asserted-by":"publisher","DOI":"10.1378\/chest.08-1419"},{"key":"2026090901301513000_35.181.250340.4","doi-asserted-by":"crossref","first-page":"S429","DOI":"10.1513\/AnnalsATS.201602-124AW","article-title":"Is chronic obstructive pulmonary disease an accelerated aging disease?","volume":"13","author":"MacNee","year":"2016","journal-title":"Ann Am Thorac Soc"},{"key":"2026090901301513000_35.181.250340.5","doi-asserted-by":"publisher","DOI":"10.3349\/ymj.2019.60.5.407"},{"key":"2026090901301513000_35.181.250340.6","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1080\/17476348.2025.2492800","article-title":"A tale as old as time \u2013 the importance of accelerated lung aging in chronic obstructive pulmonary disease","volume":"19","author":"Wang","year":"2025","journal-title":"Expert Rev Respir Med"},{"key":"2026090901301513000_35.181.250340.7","doi-asserted-by":"publisher","DOI":"10.4103\/lungindia.lungindia_266_17"},{"key":"2026090901301513000_35.181.250340.8","doi-asserted-by":"publisher","DOI":"10.3390\/ijms21186924"},{"key":"2026090901301513000_35.181.250340.9","first-page":"e220005","article-title":"Aging diminishes mucociliary clearance of the lung","volume":"4","author":"Bailey","year":"2022","journal-title":"Adv Geriatr Med Res"},{"key":"2026090901301513000_35.181.250340.10","doi-asserted-by":"publisher","DOI":"10.1152\/ajpcell.00110.2016"},{"key":"2026090901301513000_35.181.250340.11","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1038\/s41392-022-01251-0","article-title":"Aging and aging-related diseases: from molecular mechanisms to interventions and treatments","volume":"7","author":"Guo","year":"2022","journal-title":"Signal Transduct Target Ther"},{"key":"2026090901301513000_35.181.250340.12","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00186914"},{"key":"2026090901301513000_35.181.250340.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2013.03.022"},{"key":"2026090901301513000_35.181.250340.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.cger.2010.08.009"},{"key":"2026090901301513000_35.181.250340.15","doi-asserted-by":"crossref","first-page":"2445","DOI":"10.2147\/COPD.S522862","article-title":"Frailty in COPD: clinical impact, diagnosis, biomarkers, and management strategies","volume":"20","author":"Azhimamatova","year":"2025","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"2026090901301513000_35.181.250340.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2018.02.014"},{"key":"2026090901301513000_35.181.250340.17","doi-asserted-by":"publisher","DOI":"10.1136\/bmjresp-2022-001314"},{"key":"2026090901301513000_35.181.250340.18","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00442-2023"},{"key":"2026090901301513000_35.181.250340.19","doi-asserted-by":"publisher","DOI":"10.1136\/bmjoq-2025-003366"},{"key":"2026090901301513000_35.181.250340.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.arr.2015.09.005"},{"key":"2026090901301513000_35.181.250340.21","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.2147\/COPD.S134233","article-title":"Frailty syndrome in ambulatory patients with COPD","volume":"12","author":"Limpawattana","year":"2017","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"2026090901301513000_35.181.250340.22","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glv154"},{"key":"2026090901301513000_35.181.250340.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2011.06.024"},{"key":"2026090901301513000_35.181.250340.24","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.pccm.2025.02.002","article-title":"Advances in pathophysiology and assessment methods of chronic obstructive pulmonary disease with frailty","volume":"3","author":"Wang","year":"2025","journal-title":"Chin Med J Pulm Crit Care Med"},{"key":"2026090901301513000_35.181.250340.25","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1159\/000381134","article-title":"Frailty, inflammation and immunosenescence","volume":"41","author":"Fulop","year":"2015","journal-title":"Interdiscip Top Gerontol Geriatr"},{"key":"2026090901301513000_35.181.250340.26","doi-asserted-by":"crossref","first-page":"e0320304","DOI":"10.1371\/journal.pone.0320304","article-title":"Bidirectional genetic links between chronic obstructive pulmonary disease and frailty: genome-wide association study insights","volume":"20","author":"Yan","year":"2025","journal-title":"PLoS One"},{"key":"2026090901301513000_35.181.250340.27","doi-asserted-by":"crossref","first-page":"193","DOI":"10.2147\/COPD.S501635","article-title":"Exploring the causal relationship between frailty and chronic obstructive pulmonary disease: insights from bidirectional Mendelian randomization and mediation analysis","volume":"20","author":"Cheng","year":"2025","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"2026090901301513000_35.181.250340.28","doi-asserted-by":"crossref","first-page":"105310","DOI":"10.1016\/j.archger.2023.105310","article-title":"Causal relationship between frailty and chronic obstructive pulmonary disease or asthma: a two sample bidirectional Mendelian randomization study","volume":"118","author":"Qu","year":"2024","journal-title":"Arch Gerontol Geriatr"},{"key":"2026090901301513000_35.181.250340.29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41533-022-00324-5","article-title":"Systematic review and meta-analysis of prevalence, trajectories, and clinical outcomes for frailty in COPD","volume":"33","author":"Hanlon","year":"2023","journal-title":"NPJ Prim Care Respir Med"},{"key":"2026090901301513000_35.181.250340.30","doi-asserted-by":"publisher","DOI":"10.2147\/CIA.S303852"},{"key":"2026090901301513000_35.181.250340.31","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.2147\/CIA.S173239","article-title":"Frailty assessment in older adults with chronic obstructive respiratory diseases","volume":"13","author":"Guan","year":"2018","journal-title":"Clin Interv Aging"},{"key":"2026090901301513000_35.181.250340.32","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2016-208460"},{"key":"2026090901301513000_35.181.250340.33","doi-asserted-by":"crossref","first-page":"2423","DOI":"10.1007\/s11739-023-03405-6","article-title":"Frailty and its influence on mortality and morbidity in COPD: a systematic review and meta-analysis","volume":"18","author":"Verduri","year":"2023","journal-title":"Intern Emerg Med"},{"key":"2026090901301513000_35.181.250340.34","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.tem.2025.07.001","article-title":"A multidimensional epidemiological perspective on frailty dynamics and prevention","volume":"37","author":"Jiang","year":"2026","journal-title":"Trends Endocrinol Metab"},{"key":"2026090901301513000_35.181.250340.35","doi-asserted-by":"publisher","DOI":"10.1007\/s12603-019-1273-z"},{"key":"2026090901301513000_35.181.250340.36","first-page":"32","article-title":"Frailty: role of nutrition and exercise","volume":"17","author":"Kelaiditi","year":"2014","journal-title":"Curr Opin Clin Nutr Metab Care"},{"key":"2026090901301513000_35.181.250340.37","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1186\/s12890-025-03595-z","article-title":"The impact of frailty on clinical outcomes among individuals with COPD: a systematic review and meta-analysis","volume":"25","author":"Cherian","year":"2025","journal-title":"BMC Pulm Med"},{"key":"2026090901301513000_35.181.250340.38","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1186\/s12890-019-0824-8","article-title":"Determinants of frailty in primary care patients with COPD: the Greek UNLOCK study","volume":"19","author":"Ierodiakonou","year":"2019","journal-title":"BMC Pulm Med"},{"key":"2026090901301513000_35.181.250340.39","doi-asserted-by":"crossref","first-page":"984","DOI":"10.3390\/jcm13040984","article-title":"Impact of frailty on symptom burden in chronic obstructive pulmonary disease","volume":"13","author":"Verduri","year":"2024","journal-title":"J Clin Med"},{"key":"2026090901301513000_35.181.250340.40","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1007\/978-3-031-88361-3_22","article-title":"Skeletal muscle as endocrine organ","volume":"1478","author":"Ma","year":"2025","journal-title":"Adv Exp Med Biol"},{"key":"2026090901301513000_35.181.250340.41","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201402-0373ST"},{"key":"2026090901301513000_35.181.250340.42","first-page":"209","article-title":"Prevalence of sarcopenia in a population of nursing home residents according to their frailty status: results of the SENIOR cohort","volume":"17","author":"Buckinx","year":"2017","journal-title":"J Musculoskelet Neuronal Interact"},{"key":"2026090901301513000_35.181.250340.43","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/56.3.M146"},{"key":"2026090901301513000_35.181.250340.44","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1042\/CS20231197","article-title":"Skeletal muscle dysfunction with advancing age","volume":"138","author":"Pabla","year":"2024","journal-title":"Clin Sci"},{"key":"2026090901301513000_35.181.250340.45","doi-asserted-by":"crossref","first-page":"104","DOI":"10.3389\/fphys.2014.00104","article-title":"Structural alterations of skeletal muscle in COPD","volume":"5","author":"Mathur","year":"2014","journal-title":"Front Physiol"},{"key":"2026090901301513000_35.181.250340.46","doi-asserted-by":"crossref","first-page":"100138","DOI":"10.1016\/j.crphys.2024.100138","article-title":"From molecular to physical function: the aging trajectory","volume":"8","author":"Janssen","year":"2025","journal-title":"Curr Res Physiol"},{"key":"2026090901301513000_35.181.250340.47","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.2012.06738.x"},{"key":"2026090901301513000_35.181.250340.48","doi-asserted-by":"crossref","first-page":"26","DOI":"10.3390\/muscles4030026","article-title":"Mechanisms underlying muscle-related diseases and aging: insights into pathophysiology and therapeutic strategies","volume":"4","author":"Fan","year":"2025","journal-title":"Muscles"},{"key":"2026090901301513000_35.181.250340.49","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1152\/japplphysiol.00723.2019","article-title":"Resistance exercise training promotes fiber type-specific myonuclear adaptations in older adults","volume":"128","author":"Moro","year":"2020","journal-title":"J Appl Physiol"},{"key":"2026090901301513000_35.181.250340.50","doi-asserted-by":"crossref","first-page":"1404615","DOI":"10.3389\/fimmu.2024.1404615","article-title":"Inflammation mechanism and research progress of COPD","volume":"15","author":"Xu","year":"2024","journal-title":"Front Immunol"},{"key":"2026090901301513000_35.181.250340.51","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.5732"},{"key":"2026090901301513000_35.181.250340.52","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2005.10.049"},{"key":"2026090901301513000_35.181.250340.53","doi-asserted-by":"crossref","first-page":"1887","DOI":"10.1007\/s11739-023-03339-z","article-title":"Sarcopenia, a condition shared by various diseases: can we alleviate or delay the progression?","volume":"18","author":"Tarantino","year":"2023","journal-title":"Intern Emerg Med"},{"key":"2026090901301513000_35.181.250340.54","doi-asserted-by":"crossref","first-page":"e34596","DOI":"10.1097\/MD.0000000000034596","article-title":"Systemic immune\u2013inflammation index: a new marker in differentiation of different thyroid diseases","volume":"102","author":"Vural","year":"2023","journal-title":"Medicine"},{"key":"2026090901301513000_35.181.250340.55","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1186\/s12890-023-02583-5","article-title":"Association between systemic immune\u2013inflammation index and chronic obstructive pulmonary disease: a population-based study","volume":"23","author":"Ye","year":"2023","journal-title":"BMC Pulm Med"},{"key":"2026090901301513000_35.181.250340.56","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1615\/CritRevImmunol.2020033210","article-title":"Inflammation, NF-\u03baB, and chronic diseases: how are they linked?","volume":"40","author":"Kunnumakkara","year":"2020","journal-title":"Crit Rev Immunol"},{"key":"2026090901301513000_35.181.250340.57","doi-asserted-by":"publisher","DOI":"10.1101\/gad.1971610"},{"key":"2026090901301513000_35.181.250340.58","doi-asserted-by":"publisher","DOI":"10.1007\/978-981-13-1435-3_12"},{"key":"2026090901301513000_35.181.250340.59","doi-asserted-by":"crossref","first-page":"912","DOI":"10.3390\/ph15080912","article-title":"Immunomodulatory and antiaging mechanisms of resveratrol, rapamycin, and metformin: focus on mTOR and AMPK signaling networks","volume":"15","author":"Sorrenti","year":"2022","journal-title":"Pharmaceuticals"},{"key":"2026090901301513000_35.181.250340.60","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1038\/s41392-025-02371-z","article-title":"Immunosenescence: signaling pathways, diseases and therapeutic targets","volume":"10","author":"Fu","year":"2025","journal-title":"Signal Transduct Target Ther"},{"key":"2026090901301513000_35.181.250340.61","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2005.02.003"},{"key":"2026090901301513000_35.181.250340.62","doi-asserted-by":"publisher","DOI":"10.1016\/j.cyto.2019.01.013"},{"key":"2026090901301513000_35.181.250340.63","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2013.05.039"},{"key":"2026090901301513000_35.181.250340.64","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1016\/j.rmr.2014.07.015","article-title":"S\u00e9nescence cellulaire et pathologies pulmonaires: exemple de la BPCO [Cellular senescence and pulmonary disease: COPD as an example]","volume":"31","author":"Boyer","year":"2014","journal-title":"Rev Mal Respir"},{"key":"2026090901301513000_35.181.250340.65","doi-asserted-by":"publisher","DOI":"10.1016\/j.arr.2016.08.006"},{"key":"2026090901301513000_35.181.250340.66","doi-asserted-by":"crossref","first-page":"3267","DOI":"10.1007\/s11357-023-00960-w","article-title":"Cellular senescence and frailty: a comprehensive insight into the causal links","volume":"45","author":"Marcozzi","year":"2023","journal-title":"Geroscience"},{"key":"2026090901301513000_35.181.250340.67","doi-asserted-by":"publisher","DOI":"10.1016\/bs.pmbts.2015.08.001"},{"key":"2026090901301513000_35.181.250340.68","doi-asserted-by":"publisher","DOI":"10.1016\/j.freeradbiomed.2007.02.001"},{"key":"2026090901301513000_35.181.250340.69","doi-asserted-by":"publisher","DOI":"10.1159\/000380881"},{"key":"2026090901301513000_35.181.250340.70","doi-asserted-by":"publisher","DOI":"10.1016\/j.maturitas.2017.01.006"},{"key":"2026090901301513000_35.181.250340.71","doi-asserted-by":"crossref","first-page":"965","DOI":"10.3390\/antiox11050965","article-title":"Oxidative stress in chronic obstructive pulmonary disease","volume":"11","author":"Barnes","year":"2022","journal-title":"Antioxidants"},{"key":"2026090901301513000_35.181.250340.72","doi-asserted-by":"crossref","first-page":"21","DOI":"10.3390\/jcm6020021","article-title":"Oxidative stress in COPD: sources, markers, and potential mechanisms","volume":"6","author":"McGuinness","year":"2017","journal-title":"J Clin Med"},{"key":"2026090901301513000_35.181.250340.73","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.cotox.2017.11.002","article-title":"NF-\u03baB in oxidative stress","volume":"7","author":"Lingappan","year":"2018","journal-title":"Curr Opin Toxicol"},{"key":"2026090901301513000_35.181.250340.74","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.freeradbiomed.2024.11.046","article-title":"Reactive oxygen species in the pathogenesis of sarcopenia","volume":"227","author":"Xu","year":"2025","journal-title":"Free Radic Biol Med"},{"key":"2026090901301513000_35.181.250340.75","doi-asserted-by":"crossref","first-page":"e25750","DOI":"10.1016\/j.heliyon.2024.e25750","article-title":"Association between oxidative balance score and frailty in chronic obstructive pulmonary disease","volume":"10","author":"He","year":"2024","journal-title":"Heliyon"},{"key":"2026090901301513000_35.181.250340.76","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.R900010200"},{"key":"2026090901301513000_35.181.250340.77","doi-asserted-by":"publisher","DOI":"10.3164\/jcbn.14-134"},{"key":"2026090901301513000_35.181.250340.78","doi-asserted-by":"publisher","DOI":"10.1016\/j.freeradbiomed.2015.04.036"},{"key":"2026090901301513000_35.181.250340.79","doi-asserted-by":"publisher","DOI":"10.1016\/j.exger.2019.01.022"},{"key":"2026090901301513000_35.181.250340.80","doi-asserted-by":"crossref","first-page":"e13998","DOI":"10.14814\/phy2.13998","article-title":"Effects of Nrf2 deficiency on mitochondrial oxidative stress in aged skeletal muscle","volume":"7","author":"Kitaoka","year":"2019","journal-title":"Physiol Rep"},{"key":"2026090901301513000_35.181.250340.81","first-page":"e42178","article-title":"Exploring the role of oxidative stress in skeletal muscle atrophy: mechanisms and implications","volume":"15","author":"Agrawal","year":"2023","journal-title":"Cureus"},{"key":"2026090901301513000_35.181.250340.82","doi-asserted-by":"publisher","DOI":"10.1016\/j.mam.2016.06.001"},{"key":"2026090901301513000_35.181.250340.83","doi-asserted-by":"publisher","DOI":"10.1016\/j.arr.2007.08.007"},{"key":"2026090901301513000_35.181.250340.84","doi-asserted-by":"crossref","first-page":"101513","DOI":"10.1016\/j.redox.2020.101513","article-title":"Physical activity and exercise: strategies to manage frailty","volume":"35","author":"Angulo","year":"2020","journal-title":"Redox Biol"},{"key":"2026090901301513000_35.181.250340.85","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1159\/000545266","article-title":"Prehabilitation: do we need metabolic flexibility?","volume":"81","author":"Tetlow","year":"2025","journal-title":"Ann Nutr Metab"},{"key":"2026090901301513000_35.181.250340.86","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.2002.tb02085.x"},{"key":"2026090901301513000_35.181.250340.87","doi-asserted-by":"publisher","DOI":"10.1152\/ajpcell.2001.280.3.C621"},{"key":"2026090901301513000_35.181.250340.88","doi-asserted-by":"publisher","DOI":"10.1016\/j.freeradbiomed.2018.11.038"},{"key":"2026090901301513000_35.181.250340.89","doi-asserted-by":"crossref","first-page":"102588","DOI":"10.1016\/j.arr.2024.102588","article-title":"The catabolic\u2013anabolic cycling hormesis model of health and resilience","volume":"102","author":"Calabrese","year":"2024","journal-title":"Ageing Res Rev"},{"key":"2026090901301513000_35.181.250340.90","doi-asserted-by":"crossref","first-page":"588","DOI":"10.3390\/antiox10040588","article-title":"Mitochondrial dysfunction is a common denominator linking skeletal muscle wasting due to disease, aging, and prolonged inactivity","volume":"10","author":"Hyatt","year":"2021","journal-title":"Antioxidants"},{"key":"2026090901301513000_35.181.250340.91","doi-asserted-by":"publisher","DOI":"10.1083\/jcb.153.2.319"},{"key":"2026090901301513000_35.181.250340.92","doi-asserted-by":"crossref","first-page":"609","DOI":"10.21037\/cdt-23-123","article-title":"Apoptosis-inducing factor: a mitochondrial protein associated with metabolic diseases\u2013a narrative review","volume":"13","author":"Zong","year":"2023","journal-title":"Cardiovasc Diagn Ther"},{"key":"2026090901301513000_35.181.250340.93","doi-asserted-by":"publisher","DOI":"10.3390\/ijms19103125"},{"key":"2026090901301513000_35.181.250340.94","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.M705325200"},{"key":"2026090901301513000_35.181.250340.95","doi-asserted-by":"crossref","first-page":"C461","DOI":"10.1152\/ajpcell.00388.2021","article-title":"The importance of mitochondrial quality control for maintaining skeletal muscle function across health span","volume":"322","author":"Sligar","year":"2022","journal-title":"Am J Physiol Cell Physiol"},{"key":"2026090901301513000_35.181.250340.96","first-page":"32","article-title":"Mitochondrial quality control in human health and disease","volume":"11","author":"Liu","year":"2024","journal-title":"Mil Med Res"},{"key":"2026090901301513000_35.181.250340.97","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2019.00042"},{"key":"2026090901301513000_35.181.250340.98","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2020.00091"},{"key":"2026090901301513000_35.181.250340.99","doi-asserted-by":"publisher","DOI":"10.1210\/endrev\/bnaa016"},{"key":"2026090901301513000_35.181.250340.100","doi-asserted-by":"publisher","DOI":"10.1002\/jcp.30033"},{"key":"2026090901301513000_35.181.250340.101","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.3390\/biom14101205","article-title":"Myokines may be the answer to the beneficial immunomodulation of tailored exercise-a narrative review","volume":"14","author":"Lu","year":"2024","journal-title":"Biomolecules"},{"key":"2026090901301513000_35.181.250340.102","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1007\/s00421-009-1033-6","article-title":"Chronic resistance training decreases MuRF-1 and atrogin-1 gene expression but does not modify Akt, GSK-3\u03b2 and p70S6K levels in rats","volume":"106","author":"Zanchi","year":"2009","journal-title":"Eur J Appl Physiol"},{"key":"2026090901301513000_35.181.250340.103","doi-asserted-by":"crossref","first-page":"117326","DOI":"10.1016\/j.bcp.2025.117326","article-title":"Myokine-mediated muscle-organ interactions: molecular mechanisms and clinical significance","volume":"242","author":"Yi","year":"2025","journal-title":"Biochem Pharmacol"},{"key":"2026090901301513000_35.181.250340.104","doi-asserted-by":"crossref","first-page":"929926","DOI":"10.3389\/fphys.2022.929926","article-title":"Dysregulated myokines and signaling pathways in skeletal muscle dysfunction in a cigarette smoke-induced model of chronic obstructive pulmonary disease","volume":"13","author":"Zhang","year":"2022","journal-title":"Front Physiol"},{"key":"2026090901301513000_35.181.250340.105","first-page":"1976","article-title":"The role of interleukin 15 in protein degradation in skeletal muscles in rats of chronic obstructive pulmonary disease","volume":"8","author":"Liu","year":"2015","journal-title":"Int J Clin Exp Med"},{"key":"2026090901301513000_35.181.250340.106","doi-asserted-by":"crossref","first-page":"1665708","DOI":"10.3389\/fmed.2025.1665708","article-title":"The role and mechanisms of myokines in sarcopenia: new intervention strategies for the challenges of aging","volume":"12","author":"Cui","year":"2025","journal-title":"Front Med"},{"key":"2026090901301513000_35.181.250340.107","doi-asserted-by":"crossref","first-page":"2758","DOI":"10.3390\/nu17172758","article-title":"Muscle biomarkers as molecular signatures for early detection and monitoring of muscle health in aging","volume":"17","author":"LeDrew","year":"2025","journal-title":"Nutrients"},{"key":"2026090901301513000_35.181.250340.108","doi-asserted-by":"publisher","DOI":"10.1111\/febs.12338"},{"key":"2026090901301513000_35.181.250340.109","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmet.2007.11.011"},{"key":"2026090901301513000_35.181.250340.110","doi-asserted-by":"crossref","first-page":"1975","DOI":"10.3390\/biomedicines12091975","article-title":"\u201cExerkines\u201d: a comprehensive term for the factors produced in response to exercise","volume":"12","author":"Novelli","year":"2024","journal-title":"Biomedicines"},{"key":"2026090901301513000_35.181.250340.111","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.3390\/ph18081222","article-title":"Exercise-induced muscle\u2013fat crosstalk: molecular mediators and their pharmacological modulation for the maintenance of metabolic flexibility in aging","volume":"18","author":"Tero-Vescan","year":"2025","journal-title":"Pharmaceuticals"},{"key":"2026090901301513000_35.181.250340.112","doi-asserted-by":"publisher","DOI":"10.1038\/s41580-018-0093-z"},{"key":"2026090901301513000_35.181.250340.113","doi-asserted-by":"crossref","first-page":"1426551","DOI":"10.3389\/fnut.2024.1426551","article-title":"Diet and physical exercise as key players to tackle MASLD through improvement of insulin resistance and metabolic flexibility","volume":"11","author":"Mambrini","year":"2024","journal-title":"Front Nutr"},{"key":"2026090901301513000_35.181.250340.114","doi-asserted-by":"crossref","first-page":"112685","DOI":"10.1016\/j.exger.2025.112685","article-title":"Exercise and exerkines: mechanisms and roles in anti-aging and disease prevention","volume":"200","author":"Lu","year":"2025","journal-title":"Exp Gerontol"},{"key":"2026090901301513000_35.181.250340.115","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1002\/jcsm.13440","article-title":"Control of muscle satellite cell function by specific exercise-induced cytokines and their applications in muscle maintenance","volume":"15","author":"Guo","year":"2024","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"2026090901301513000_35.181.250340.116","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1111\/febs.16352","article-title":"Decline of regenerative potential of old muscle stem cells: contribution to muscle aging","volume":"290","author":"Sahinyan","year":"2023","journal-title":"FEBS J"},{"key":"2026090901301513000_35.181.250340.117","doi-asserted-by":"publisher","DOI":"10.1016\/j.exger.2010.08.029"},{"key":"2026090901301513000_35.181.250340.118","doi-asserted-by":"publisher","DOI":"10.14814\/phy2.15917"},{"key":"2026090901301513000_35.181.250340.119","doi-asserted-by":"publisher","DOI":"10.1113\/jp281726"},{"key":"2026090901301513000_35.181.250340.120","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1016\/j.neurol.2022.03.019","article-title":"Changes in neuromuscular function in elders: novel techniques for assessment of motor unit loss and motor unit remodeling with aging","volume":"178","author":"Verschueren","year":"2022","journal-title":"Rev Neurol"},{"key":"2026090901301513000_35.181.250340.121","doi-asserted-by":"crossref","first-page":"1731","DOI":"10.3390\/cells14211731","article-title":"Biological mechanisms involved in muscle dysfunction in COPD: an integrative damage\u2013regeneration\u2013remodeling framework","volume":"14","author":"Gea","year":"2025","journal-title":"Cells"},{"key":"2026090901301513000_35.181.250340.122","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.diabres.2018.08.018","article-title":"Brain-derived neurotrophic factor, insulin like growth factor-1 and inflammatory cytokine responses to continuous and intermittent exercise in patients with type 1 diabetes","volume":"144","author":"Zebrowska","year":"2018","journal-title":"Diabetes Res Clin Pract"},{"key":"2026090901301513000_35.181.250340.123","doi-asserted-by":"crossref","first-page":"919","DOI":"10.3390\/jpm11090919","article-title":"Prediction of sarcopenia using multiple biomarkers of neuromuscular junction degeneration in chronic obstructive pulmonary disease","volume":"11","author":"Karim","year":"2021","journal-title":"J Pers Med"},{"key":"2026090901301513000_35.181.250340.124","doi-asserted-by":"publisher","DOI":"10.1002\/mus.24095"},{"key":"2026090901301513000_35.181.250340.125","doi-asserted-by":"crossref","first-page":"7928","DOI":"10.1007\/s12035-016-0272-x","article-title":"Strength and aerobic exercises improve spatial memory in aging rats through stimulating distinct neuroplasticity mechanisms","volume":"54","author":"Vilela","year":"2017","journal-title":"Mol Neurobiol"},{"key":"2026090901301513000_35.181.250340.126","doi-asserted-by":"publisher","DOI":"10.1113\/JP275582"},{"key":"2026090901301513000_35.181.250340.127","doi-asserted-by":"crossref","first-page":"4100","DOI":"10.3390\/nu15194100","article-title":"Implementation and core components of a multimodal program including exercise and nutrition in prevention and treatment of frailty in community-dwelling older adults: a narrative review","volume":"15","author":"Delaire","year":"2023","journal-title":"Nutrients"},{"key":"2026090901301513000_35.181.250340.128","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2016.01.019"},{"key":"2026090901301513000_35.181.250340.129","doi-asserted-by":"crossref","first-page":"106284","DOI":"10.1016\/j.rmed.2020.106284","article-title":"Falls prevalence and risk factors in people with chronic obstructive pulmonary disease: a systematic review","volume":"176","author":"Oliveira","year":"2021","journal-title":"Respir Med"},{"key":"2026090901301513000_35.181.250340.130","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1007\/s12603-023-1935-8","article-title":"frailty is a risk factor for falls in the older adults: a systematic review and meta-analysis","volume":"27","author":"Yang","year":"2023","journal-title":"J Nutr Health Aging"},{"key":"2026090901301513000_35.181.250340.131","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012424.pub2"},{"key":"2026090901301513000_35.181.250340.132","doi-asserted-by":"crossref","first-page":"1236050","DOI":"10.3389\/fpubh.2023.1236050","article-title":"Tai chi for fall prevention and balance improvement in older adults: a systematic review and meta-analysis of randomized controlled trials","volume":"11","author":"Chen","year":"2023","journal-title":"Front Public Health"},{"key":"2026090901301513000_35.181.250340.133","doi-asserted-by":"crossref","first-page":"1443168","DOI":"10.3389\/fpubh.2024.1443168","article-title":"Tai chi improves balance performance in healthy older adults: a systematic review and meta-analysis","volume":"12","author":"Cui","year":"2024","journal-title":"Front Public Health"},{"key":"2026090901301513000_35.181.250340.134","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1513\/AnnalsATS.202302-129ST","article-title":"Rehabilitation for people with respiratory disease and frailty: an official American Thoracic Society workshop report","volume":"20","author":"Maddocks","year":"2023","journal-title":"Ann Am Thorac Soc"},{"key":"2026090901301513000_35.181.250340.135","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s13102-025-01074-w","article-title":"Effectiveness of high-intensity interval training in rehabilitation nursing for mild-to-moderate stable COPD patients: a randomized controlled clinical trial","volume":"17","author":"Wang","year":"2025","journal-title":"BMC Sports Sci Med Rehabil"},{"key":"2026090901301513000_35.181.250340.136","doi-asserted-by":"publisher","DOI":"10.1183\/09059180.00000513"},{"key":"2026090901301513000_35.181.250340.137","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0222-2022"},{"key":"2026090901301513000_35.181.250340.138","doi-asserted-by":"publisher","DOI":"10.1097\/HCR.0000000000000097"},{"key":"2026090901301513000_35.181.250340.139","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmet.2016.10.022"},{"key":"2026090901301513000_35.181.250340.140","doi-asserted-by":"crossref","first-page":"1640585","DOI":"10.3389\/fdgth.2025.1640585","article-title":"Digital health technologies for improving the management of people with chronic obstructive pulmonary disease","volume":"7","author":"Park","year":"2025","journal-title":"Front Digit Health"},{"key":"2026090901301513000_35.181.250340.141","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1513\/AnnalsATS.201910-800OC","article-title":"Experiences of pulmonary rehabilitation in people living with chronic obstructive pulmonary disease and frailty: a qualitative interview study","volume":"17","author":"Brighton","year":"2020","journal-title":"Ann Am Thorac Soc"},{"key":"2026090901301513000_35.181.250340.142","first-page":"15","article-title":"Home-based pulmonary rehabilitation is effective in frail COPD patients with chronic respiratory failure","volume":"9","author":"Gephine","year":"2022","journal-title":"Chronic Obstr Pulm Dis"},{"key":"2026090901301513000_35.181.250340.143","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1080\/15412555.2021.1967915","article-title":"Frailty impact during and after pulmonary rehabilitation","volume":"18","author":"Finamore","year":"2021","journal-title":"COPD"},{"key":"2026090901301513000_35.181.250340.144","doi-asserted-by":"publisher","DOI":"10.1177\/1479972316670104"},{"key":"2026090901301513000_35.181.250340.145","doi-asserted-by":"crossref","first-page":"780736","DOI":"10.3389\/fresc.2022.780736","article-title":"Embedding pulmonary rehabilitation for chronic obstructive pulmonary disease in the home and community setting: a rapid review","volume":"3","author":"de Oliveira","year":"2022","journal-title":"Front Rehabil Sci"},{"key":"2026090901301513000_35.181.250340.146","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1007\/s11845-021-02654-8","article-title":"Daily living activities, exercise capacity, cognition, and balance in COPD patients with and without frailty","volume":"191","author":"Kagiali","year":"2022","journal-title":"Ir J Med Sci"}],"container-title":["European Respiratory Review"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1183\/16000617.0340-2025","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T08:30:32Z","timestamp":1788942632000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.ersnet.org\/lookup\/doi\/10.1183\/16000617.0340-2025"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":146,"journal-issue":{"issue":"181","published-online":{"date-parts":[[2026,9,9]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1183\/16000617.0340-2025"],"URL":"https:\/\/doi.org\/10.1183\/16000617.0340-2025","relation":{},"ISSN":["0905-9180","1600-0617"],"issn-type":[{"value":"0905-9180","type":"print"},{"value":"1600-0617","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}