© 2003 BMJ Publishing Group & British Thoracic Society
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An important objective of treatment in COPD is to improve physical performance and daily activities. Physical training is an essential component of pulmonary rehabilitation although the response can be variable and strategies to enhance training are required. In this issue of Thorax Steiner and colleagues describe a randomised controlled trial of nutritional supplementation using a carbohydrate rich diet during pulmonary rehabilitation; the results are further discussed in the accompanying editorial by Wouters. Although patients in the supplement group gained weight and those in the placebo group lost weight, there was no overall effect of the supplement on exercise performance. However, in patients who were well nourished with a BMI of >19 kg/m2, exercise performance was better in the supplemented group. The authors point out that physical activity imposes a high energy cost and this may limit optimal training. However, there may be a role for nutritional supplementation in selected
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