Effects of Unsupported Upper Extremity Exercise Training in Patients With COPD: A Randomized Clinical Trial

doi:10.1378/chest.09-0165

Chest

Volume 136, Issue 2, August 2009, Pages 387-395

https://doi.org/10.1378/chest.09-0165 Get rights and content

Background

Current guidelines on pulmonary rehabilitation (PR) recommend upper extremity exercise training (UEET) in patients with COPD. However, the literature still questions the effectiveness of systematic UEET in this population. We studied the effects of 15 sessions of unsupported UEET on functional exercise capacity, the ability to perform activities of daily living (ADL), and symptoms perceived during activities involving arms in patients with COPD.

Methods

We conducted a randomized trial that consisted of 3 weeks of inpatient PR, comparing the short-term effects of unsupported UEET plus PR (intervention group) to those of PR alone (control group). A change in the 6-min ring test (6MRT) was the primary outcome; the ADL field test (four shuttle stations), the dyspnea score as assessed by the Medical Research Council scale, the London Chest Activity of Daily Living scale (LCADL), and the distance walked in 6 min served as secondary outcomes of the study. At the 6-month follow-up, we repeated the 6MRT and the LCADL.

Results

Fifty patients with COPD were randomly assigned to the two groups and completed the study. At the end of the study period, patients in the intervention group improved in the 6MRT and ADL field test compared with those patients in the control group (p = 0.018 and p = 0.010, respectively) with reduced perception of fatigue (p ≤ 0.006). At the 6-month follow-up, 6MRT (p = 0.001) and LCADL (p = 0.039) scores were still significantly better in the intervention group compared with the control group.

Conclusions

Our trial corroborates the effectiveness of unsupported UEET in specifically improving functional exercise capacity of patients with COPD. Moreover, it also provides evidence that this training modality may ameliorate and maintain the patients' autonomy over and above standard PR.

Trial registration

ClinicalTrials.gov Identifier: NCT00825032

Section snippets

Population

We recruited inpatients with stable COPD who were referred for the inpatient PR program at the regional center of Villa Pineta Hospital, Pavullo, Italy. Patients were asked to participate in the study if they fulfilled the following criteria: diagnosis of COPD confirmed by clinical examination and a pulmonary function test; a degree of COPD severity equal to or above grade 2 (moderate) on the basis of the Global Initiative for Chronic Obstructive Pulmonary Disease classification²¹; clinical

Results

From March to September 2007, 350 patients were referred to the PR hospital program. One hundred fifty-five of them were eligible for the study protocol. Fifty of them (17 female patients) fulfilled all the inclusion/exclusion criteria and were then recruited. All the patients completed the treatment period and data were collected from all of them at Tend. After 6 months, we collected data from 46 patients (23 in each group) since 4 patients did not attend follow-up because of logistical

Discussion

This study corroborates the efficacy of unsupported UEET, over and above standard PR, in improving the exercise capacity of the UEs in patients with COPD. Moreover, this trial provides new and relevant data regarding the benefits of this specific training on clinically important outcomes, such as the ability to perform ADL that involve the UEs and the fatigue related to these activities. Interestingly enough, the benefits demonstrated in exercise capacity and in dyspnea during daily activities

Conclusions

This randomized trial underscores the true efficacy of unsupported UEET in improving the specific functional exercise capacity of the UEs in patients with COPD. It also adds evidence that this training modality may ameliorate the patients' general exercise capacity and autonomy, over and above standard PR.

Acknowledgments

Author contributions: Ms. Costi has made substantial contributions to conception and design, and interpretation of data; she has drafted the submitted article and revised it critically for important intellectual content. Dr. Crisafulli has made substantial contributions to conception and design, acquisition of data, and analysis and interpretation of data. Ms. Degli Antoni has made substantial contributions to the acquisition, analysis, and interpretation of data. Mr. Beneventi has made

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Cited by (76)

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Selon les sociétés savantes, il est recommandé d’inclure un renforcement des membres supérieurs à un programme de réhabilitation respiratoire. Cependant, les modalités de l’entraînement des membres supérieurs ne sont pas définies. L’objectif de cette étude est de comparer les effets de l’entraînement en Force (F) versus en Endurance (E), sur la dyspnée chez des patients atteints BPCO, en réhabilitation respiratoire.
Étude pilote, prospective, randomisée incluant des patients BPCO hospitalisés dans le service réhabilitation respiratoire du CH Morlaix pour 4 semaines. Le groupe (F) a bénéficié d’un entraînement des membres supérieurs en force et le groupe (E) d’un entraînement des membres supérieurs en endurance, 5 jours par semaine. Les effets du mode entraînement a été évalué sur la dyspnée, la force d’abduction d’épaule et la capacité à l’exercice des membres supérieurs.
Dix patients ont été inclus dans cette étude. Les patients du groupe (F) ont davantage diminué leur dyspnée au questionnaire LCADL (−5,5 [–7,5–1,8] vs 0,5 [–5,3–4,3]) et amélioré leur force d’abduction (Droite : 48 [–92–96] ; Gauche : 21 [–110–74] vs Droite : 10,5 [–38–76,8] ; Gauche : 4,5 [–34–53,5]) comparativement au groupe (E), sans différence significative entre les 2 groupes. L’amélioration de la capacité à l’exercice des membres supérieurs était supérieure dans le groupe endurance (8,5 [–3,8–45,8] vs −2,5 [–15–29,5]), sans différence significative entre les 2 groupes.
L’entraînement en force des membres supérieurs semble plus bénéfique en termes de diminution de la dyspnée et d’amélioration de la force comparativement à un entraînement en endurance, durant un programme de réhabilitation respiratoire, dans la BPCO. Ces résultats doivent être confirmés par une étude de plus grande ampleur.
3.
According to the respiratory societies, it is recommended to include upper limbs muscle strengthening in pulmonary rehabilitation. However, the modalities are not defined. The objective of this study is to compare the effects of upper limb strength training (F) versus upper limb endurance training (E) on dyspnea in COPD patients undergoing pulmonary rehabilitation.
A prospective randomized pilot study included COPD patients admitted to the pulmonary rehabilitation unit of the Morlaix Hospital Centre for 4 weeks. Patients in group F underwent upper limb strength training and patients in group E upper limb endurance training, 5 days a week. The effects of the mode of training on dyspnea, shoulder abduction strength and upper limb exercise capacity were evaluated.
Ten patients were included in this study. Patients in group F showed greater decrease in dyspnea on the LCADL questionnaire (−5.5 [−7.5–1.8] vs. 0.5 [−5.3–4.3]) and greater improvement in abduction strength (right: 48 [–92–96]; left: 21 [–110–74] vs. right: 10.5 [−38–76.8]; left: 4.5 [−34–53.5]) than group E, although the difference between the 2 groups was not significant. Improvement in upper limb exercise capacity was greater in group E (8.5 [−3.8–45.8] vs. −2.5 [−15–29.5]), although the difference between the 2 groups was not significant.
Upper limb strength training seems more beneficial in decreasing dyspnea and increasing strength than upper limb endurance training in pulmonary rehabilitation for COPD patients. These results must be confirmed by a study of bigger sample size.
3.
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Chronic obstructive pulmonary disease (COPD) is a respiratory disorder responsible for a high mortality and disability. People older than 65 years are more commonly affected than younger people and tend to present with more symptoms and a greater level of disability. Non-pharmacological interventions play an important role in the management of all patients with COPD and this is particularly true in the elderly. Given the improvement in quality of life and risk of hospitalization, smoking cessation should be promoted to patients of all ages. Increased physical activity is associated with reduced respiratory symptoms. Tests such as the “Short Physical Performance Battery” can be useful in frailer older people with COPD, while walking tests such as the 6-minute walk test are used as an assessment before pulmonary rehabilitation. Increased physical activity should be combined with nutritional management. Screening for undernutrition by questionnaire, body mass index and albumin quantification is recommended in the elderly. In case of undernutrition, oral supplementation seems to reduce the risk of re-admission. All these measures must be included in an education program adapted to the elderly comorbidities (hearing loss, isolation…).
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Pulmonary rehabilitation (PR) is one of the key components in the management of patients with chronic respiratory disease. The goal of this guidance document is to provide rehabilitation team members with an update on the main interventions to be carried out within a PR programme, with special emphasis on the assessments that precede the start of the programme. An appropriate assessment will allow the interventions to be tailored to the patient's individual needs and will improve the overall efficiency of PR.
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Original ResearchCOPDEffects of Unsupported Upper Extremity Exercise Training in Patients With COPD: A Randomized Clinical Trial

Background

Methods

Results

Conclusions

Trial registration

Section snippets

Population

Results

Discussion

Conclusions

Acknowledgments

Original Research
COPD
Effects of Unsupported Upper Extremity Exercise Training in Patients With COPD: A Randomized Clinical Trial