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However, only FFMI increased in PR (0.1?��?0.6?kg/m2, P?=?0.02) after the intervention. Only body weight and BMI increased in PRNS (P?=?0.001 and P?EX 527 ic50 PR is effective in selleck inhibitor improving body composition, particularly lean mass and mid-thigh CSA in nutritionally depleted advanced COPD patients. Although conventional PR improved dyspnoea, exercise capacity, health-related quality of life, body weight and anxiety in both groups, the improvements in body composition and muscle mass were greater in PRNS patients. Lean body mass depletion in COPD was associated with an impaired health status and higher mortality.[20, 21] It was also shown that muscle mass had strong impact on mortality in advanced COPD.[22] In a review of NS, it was suggested to examine whether it is possible for depleted COPD patients to gain weight and rebuild muscle mass with adequate nutrition.[23] Although body weight is a very simple and useful prognostic marker, it is insensitive for evaluating changes in body composition. Therefore, use of lean mass and CSA as outcome measures is more appropriate for evaluating the effectiveness of PR and NS as interventions. In our study, single slice muscle MRI was used for the objective measurement of CSA, a commonly used indicator of the muscle size.[24] Our results demonstrated greater increases in body weight (1.1?��?0.9?kg), BMI (0.2?��?1.4?kg/m2), FFMI (0.6?��?0.5?kg/m2) and mid-thigh CSA (2.5?��?4.1?cm2) with PRNS, than with PR alone. In PRNS, the changes in weight were attributable to an increase in lean mass as revealed by increases in body composition and particularly mid-thigh CSA. In COPD patients, muscle mass can be increased by strength training and additional NS that can overcome negative energy balance caused by exercise training. NS with exercise training may therefore be advantageous to improve body composition Vatalanib (PTK787) 2HCl and muscle mass. In agreement with our results, Sugawara et?al.[25] demonstrated better significant improvements on body weight (3.1?��?3.6?kg), FFMI (2.4?��?3.9?kg/m2) and quadriceps force (20.9?��?20.5?kg) throughout 12 weeks of low-intensity exercise combined with NS. Longer period of exercise training with NS might be the reason for better results in their study. In a recent review; the effects of androgenic anabolic steroids on muscle strength or exercise capacity were evaluated in advanced COPD patients.