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      Effects of daily vitamin D supplementation on respiratory muscle strength and physical performance in vitamin D-deficient COPD patients: a pilot trial

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          Although vitamin D is well known for its function in calcium homeostasis and bone mineralization, several studies have shown positive effects on muscle strength and physical function. In addition, vitamin D has been associated with pulmonary function and the incidence of airway infections. As vitamin D deficiency is highly prevalent in chronic obstructive pulmonary disease (COPD) patients, supplementation might have a beneficial effect in these patients.


          To assess the effect of vitamin D supplementation on respiratory muscle strength and physical performance in vitamin D-deficient COPD patients. Secondary outcomes are pulmonary function, handgrip strength, exacerbation rate, and quality of life.


          We performed a randomized, double-blind, placebo-controlled pilot trial. Participants were randomly allocated to receive 1,200 IU vitamin D3 per day (n=24) or placebo (n=26) during 6 months. Study visits were conducted at baseline, and at 3 and 6 months after randomization. During the visits, blood was collected, respiratory muscle strength was measured (maximum inspiratory and expiratory pressure), physical performance and 6-minute walking tests were performed, and handgrip strength and pulmonary function were assessed. In addition, participants kept a diary card in which they registered respiratory symptoms.


          At baseline, the mean (standard deviation [SD]) serum 25-hydroxyvitamin D (25(OH)D) concentration (nmol/L) was 42.3 (15.2) in the vitamin D group and 40.6 (17.0) in the placebo group. Participants with vitamin D supplementation had a larger increase in serum 25(OH)D compared to the placebo group after 6 months (mean difference (SD): +52.8 (29.8) vs +12.3 (25.1), P<0.001). Primary outcomes, respiratory muscle strength and physical performance, did not differ between the groups after 6 months. In addition, no differences were found in the 6-minute walking test results, handgrip strength, pulmonary function, exacerbation rate, or quality of life.


          Vitamin D supplementation did not affect (respiratory) muscle strength or physical performance in this pilot trial in vitamin D-deficient COPD patients.

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          Most cited references 18

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          Comparison of the LASA Physical Activity Questionnaire with a 7-day diary and pedometer.

          First, to validate the LASA Physical Activity Questionnaire (LAPAQ) by a 7-day diary and a pedometer in older persons. Second, to assess the repeatability of the LAPAQ. Third, to compare the feasibility of these methods. The study was performed in a subsample (n=439, aged 69-92 years) of the Longitudinal Aging Study Amsterdam (LASA). The LAPAQ was completed twice (1998/1999, 1999/2000). Respondents completed a 7-day activity diary and wore a pedometer for 7 days (1999/2000). The LAPAQ was highly correlated with the 7-day diary (r=0.68, P<.001), and moderately with the pedometer (r=0.56, P<.001). The repeatability of the LAPAQ was reasonably good (weighted kappa: 0.65-0.75). The LAPAQ was completed in 5.7+/-2.7 min, and 0.5% of the respondents had missing values. The LAPAQ appears to be a valid and reliable instrument for classifying physical activity in older people. The LAPAQ was easier to use than the 7-day diary and pedometer.
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            Relationship between serum 25-hydroxyvitamin d and pulmonary function in the third national health and nutrition examination survey.

            Age, gender, height, ethnicity, and smoking are important determinants of lung function but do not explain all of the variation between individuals. Low concentrations of vitamin D have been associated with a number of diseases, including osteoporosis, hypertension, and type I diabetes. It is possible that serum concentrations of vitamin D might also influence pulmonary function. To determine the relationship between serum concentrations of 25-hydroxy vitamin D and pulmonary function. The analysis was conducted using data from the Third National Health and Nutrition Examination Survey, which was a cross-sectional survey of the US civilian population that was conducted from 1988 to 1994. The analyses were restricted to 14,091 people who > or = 20 years of age, were interviewed at mobile examination centers, and had undergone spirometry, and in whom serum 25-hydroxy vitamin D levels had been measured. After adjustment for age, gender, height, body mass index, ethnicity, and smoking history, the mean FEV1 was 126 mL (SE, 22 mL), and the mean FVC was 172 mL (SE, 26 mL) greater for the highest quintile of serum 25-hydroxy vitamin D level (> or = 85.7 nmol/L) compared with the lowest quintile (< or = 40.4 nmol/L; p < 0.0001). With further adjustment for physical activity, the intake of vitamin D supplements, milk intake, and the level of serum antioxidants, the mean difference between the highest and lowest quintiles of 25-hydroxy vitamin D was 106 mL (SE, 24 mL) for FEV1, and 142 mL (SE, 29 mL) for FVC (p < 0.0001). There is a strong relationship between serum concentrations of 25-hydroxy vitamin D, FEV1, and FVC. Further studies are necessary to determine whether supplementation with vitamin D is of any benefit in patients with respiratory disease.
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              High doses of vitamin D to reduce exacerbations in chronic obstructive pulmonary disease: a randomized trial.

              Low serum 25-hydroxyvitamin D (25-[OH]D) levels have been associated with lower FEV(1), impaired immunologic control, and increased airway inflammation. Because many patients with chronic obstructive pulmonary disease (COPD) have vitamin D deficiency, effects of vitamin D supplementation may extend beyond preventing osteoporosis. To explore whether supplementation with high doses of vitamin D could reduce the incidence of COPD exacerbations. Randomized, single-center, double-blind, placebo-controlled trial. ( registration number: NCT00666367) University Hospitals Leuven, Leuven, Belgium. 182 patients with moderate to very severe COPD and a history of recent exacerbations. 100,000 IU of vitamin D supplementation or placebo every 4 weeks for 1 year. The primary outcome was time to first exacerbation. Secondary outcomes were exacerbation rate, time to first hospitalization, time to second exacerbation, FEV(1), quality of life, and death. Mean serum 25-(OH)D levels increased significantly in the vitamin D group compared with the placebo group (mean between-group difference, 30 ng/mL [95% CI, 27 to 33 ng/mL]; P < 0.001). The median time to first exacerbation did not significantly differ between the groups (hazard ratio, 1.1 [CI, 0.82 to 1.56]; P = 0.41), nor did exacerbation rates, FEV(1), hospitalization, quality of life, and death. However, a post hoc analysis in 30 participants with severe vitamin D deficiency (serum 25-[OH]D levels <10 ng/mL) at baseline showed a significant reduction in exacerbations in the vitamin D group (rate ratio, 0.57 [CI, 0.33 to 0.98]; P = 0.042). This was a single-center study with a small sample size. High-dose vitamin D supplementation in a sample of patients with COPD did not reduce the incidence of exacerbations. In participants with severe vitamin D deficiency at baseline, supplementation may reduce exacerbations. Applied Biomedical Research Program, Agency for Innovation by Science and Technology (IWT-TBM).

                Author and article information

                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                28 August 2017
                : 12
                : 2583-2592
                [1 ]Department of Internal Medicine and Endocrinology, VU University Medical Center, Amsterdam
                [2 ]Department of Pulmonary Diseases, Northwest Hospital group, Alkmaar
                [3 ]Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, the Netherlands
                Author notes
                Correspondence: Rachida Rafiq, Department of Internal Medicine and Endocrinology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands, Email ra.rafiq@
                © 2017 Rafiq et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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