title: Arm training reduces the VO2 and VE cost of unsupported arm exercise and elevation in chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Patients with severe chronic obstructive pulmonary disease (COPD) may develop dyspnea with minimal arm activity, thoracoabdominal dyssynchrony with unsupported arm exercise (UAEX) and increased oxygen uptake (VO2), and minute ventilation (VE) with simple unsupported arm elevation (UAE) and UAEX. We investigated whether unsupported arm training, as the only form of exercise, could decrease the VO2 and VE cost (percentage increase from resting baseline) associated with unsupported arm elevation and exercise, respectively.
  
  
  METHODS
  Twenty-six patients with severe COPD were randomized to 21-24 sessions of unsupported arm (ARMT) or low-intensity resistive breathing (RBT) training as the only form of exercise. Patients were studied before and after training using a metabolic cart and esophageal and gastric pressures to evaluate metabolic and respiratory muscle function.
  
  
  RESULTS
  After ARMT, the VO2 (58% vs 38% increase, P < 0.05) and VE (41% v. 21% increase, P < 0.05) cost for UAEX at exercise isotime decreased and endurance time increased. Similarly the VO2 (25% vs 18% increase, P < 0.05) cost decreased and VE no longer increased in response to 2 minutes of UAE after ARMT. The RBT group showed no such change. No improvement in ventilatory load or respiratory muscle function could be identified to explain the physiologic changes observed. After ARMT, mean inspiratory flow (VT/TL), a measure of central respiratory drive, was reduced during UAEX and the expected increase during UAE did not occur.
  
  
  CONCLUSIONS
  We conclude that arm training reduces the VO2 and VE cost of UAE and UAEX, possibly through improved synchronization and coordination of accessory muscle action during unsupported arm activity.
authors.affiliation: Pulmonary and Critical Care Division, New England Medical Center, Washington St, Boston, MA 02111, USA.
authors.forename: S K
authors.initials: SK
authors.lastname: Epstein
authors.forename: B R
authors.initials: BR
authors.lastname: Celli
authors.forename: F J
authors.initials: FJ
authors.lastname: Martinez
authors.forename: J I
authors.initials: JI
authors.lastname: Couser
authors.forename: J
authors.initials: J
authors.lastname: Roa
authors.forename: M
authors.initials: M
authors.lastname: Pollock
authors.forename: J O
authors.initials: JO
authors.lastname: Benditt
mesh_terms: D000368:Aged; D001132:Arm; D001945:Breathing Exercises; D004417:Dyspnea / Q000209:etiology*; D004734:Energy Metabolism; D005081:Exercise Therapy; D017079:Exercise Tolerance; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000150:complications / Q000378:metabolism* / Q000503:physiopathology / Q000534:rehabilitation*; D008297:Male; D010101:Oxygen Consumption; D014797:Vital Capacity