Molecular and Structural Changes, and Skeletal Muscle Strength and Endurance in Chronic Obstructive Pulmonary Disease and Interstitial Lung Disease: Practical Applications of Assessment and Management

Chronic obstructive pulmonary disease, interstitial lung disease, and post-lung trans-plantation are often accompanied by skeletal muscle dysfunction that worsens the quality of life. Such physiological changes are driven by physical inactivity, systemic inflammation, oxidative stress, anabolic and hormonal resistance, and medication effects. Structural changes include impaired capillarization, fiber-type shifts (slow-to-fast in limb muscle and fast-to-slow in respiratory muscles), mitochondrial dysfunction, reduced oxidative capacity, and early lactate accumulation. Electromyography and dynamometry, both isokinetic and isometric, quantify neuromuscular drive through measuring strength, power, and endurance and are associated with functional outcomes (6-min walk, sit-to-stand, stair climbing tests). Pulmonary rehabilitation (PR) improves neuromuscular efficiency, dyspnea, exercise tolerance, and quality of life by combining resistance, endurance, and eccentric training. The effects of PR generally plateau at three months, emphasizing the need for maintenance and the personalization of rehabilitation plans. While nutritional optimization is important, supplements have shown little benefit. Future priorities include defining EMG/dynamometry thresholds to allow standardized routine testing for comparable benchmarks and more precise PR protocols. Future research targeting mitochondrial remodeling, inflammatory signaling, and anabolic resistance offer potential pathways for preventing and reversing muscle wasting.