Understanding the Muscle-Brain Link Could Improve COPD Management: Dries Cops, MSc

There is a relationship between physical activity and mental processes with exercise training able to enhance cognitive function and brain structure in people living with chronic obstructive pulmonary disease (COPD), according to research presented today in a special Science Slam session at the European Respiratory Society Congress 2025 by Dries Cops, MSc, Hasselt University. His presentation, "From Muscle to Brain: Exploring the Secret Link in Individuals with Chronic Obstructive Pulmonary Disease," was part of a competition on how to deliver research in an entertaining way for a nonspecialist audience and also included presentations on asthma, cross-country skiing and coughing, and pulmonary rehab.

Here Cops explains associations he has found between quadriceps function, including muscle strength and power, and cognitive function (specifically executive function) and brain structure (eg, the hippocampus and dorsolateral prefrontal cortex) in patients who have COPD.

This transcript was lightly edited for clarity; captions were auto-generated.

Transcript

Can you describe the research you presented on the secret link between muscle and the brain in COPD?

I highlighted the associations between quadriceps function and also cognitive function and brain structure in individuals with COPD, where we found that both muscle strength and muscle power are associated with executive function—this is what we need to structure and plan our daily life—but also the size of specific brain areas, including the hippocampus and dorsolateral prefrontal cortex. How I nonscientifically communicated about this is by making the link with scuba diving, because the hippocampus is derived from the seahorse, which is a sea animal, so we went for scuba diving to see if we could find the link between the muscle and the brain in individuals with COPD.

How does this connection differ between individuals who have COPD and their healthy counterparts, and what are modifiable risk factors that contribute to these different health outcomes?

We see similar links in healthy individuals, where we see that quadriceps strength is associated with better cognitive function, but also those with larger muscle strength show reduced cognitive decline over time. There are indeed modifiable risk factors—including physical inactivity, smoking, nutritional status, and inflammatory status—that could negatively impact both the muscle and brain. This is an opportunity for rehabilitation and other strategies to improve both the muscle and brain in a similar fashion.

What methods or tools do you use to study muscle-brain connectivity in COPD, and what insights do they provide beyond traditional pulmonary assessments?

We know that cognitive function is currently overlooked in COPD research, but it is very prevalent that up to 6 out of 10 individuals with COPD experience mild cognitive impairment. To investigate this, we used the Montreal Cognitive Assessment, which is a commonly known screening tool to assess mild cognitive impairments. Moreover, the Trail Making Test part[s] A and B [were] administered to assess executive function, which we know is frequently impaired in individuals with COPD.

Lastly, for brain structure, we assessed it in a subset of individuals using magnetic resonance imaging. On the other hand, quadriceps function was assessed using measures of computerized dynamometry using a Biodex, but also the stair climbing power test and the timed sit-to-stand test to assess functional muscle power.

How might a better understanding of this pathway influence rehabilitation strategies or nonpharmacologic management approaches for COPD?

Currently, we don't know how to ultimately treat individuals with mild cognitive impairment and COPD—while we know that this increases both mortality and hospitalization risk—so if we now have found that there is a link between the muscle and brain, the future step would be to see if there's also a causal relationship, if improving muscle function can also improve cognitive function and brain structure, and therefore also identify potential rehabilitation strategies, including resistance training or exercise spinning to improve cognitive health in our patients.

Looking ahead, what are some key research questions or next steps you see as most critical for advancing this line of investigation?

Currently, we don't know which exercise intensity of aerobic training is most optimal to improve cognitive function. Therefore, we are currently exploring a trial if super maximal high-intensity interval training is superior compared to moderate-intensity continuous spinning to improve cognitive function. On the other hand, we don't know if we can improve brain structure and how we can optimally improve brain structure in our patients [with] COPD, while we know this is important to reduce the prevalence of mild cognitive impairments in dementia. I think a future step would be to implement resistance training and exercise training, or aerobic training, to improve cognitive function and brain structure in our patients.