title: Does unsupported upper limb exercise training improve symptoms and quality of life for patients with chronic obstructive pulmonary disease?
abstract: OBJECTIVE
  Many patients with chronic obstructive pulmonary disease (COPD) report dyspnea and fatigue when performing upper limb activities. Unsupported upper limb training has been shown to improve upper limb endurance, but its effects on symptoms and quality of life have not been examined. The aim of this study was to compare the effects of upper limb and lower limb training with lower limb training alone on exercise capacity, symptoms, and quality of life with COPD.
  
  
  METHODS
  For this study, 38 patients with moderate to severe COPD were randomly allocated to unsupported upper limb endurance training or to a control group that completed a sham training task. All the patients underwent lower limb endurance training. The 6-minute walk test, the Incremental Unsupported Upper Limb Exercise Test, and the Chronic Respiratory Disease Questionnaire (CRQ) were completed before training and then 6 weeks afterward. Both patients and assessors were blinded to group allocation.
  
  
  RESULTS
  All the patients reported symptoms associated with upper limb activities on the initial CRQ. Both groups showed significant improvements in all domains of the CRQ and in the 6-minute walk test after training. Only the upper limb training group showed improvement in upper limb endurance time (57 +/- 75 vs 2 +/- 58 seconds; P = .02). There were no significant differences between the groups for 6-minute walk test or any domain of the CRQ.
  
  
  CONCLUSIONS
  Unsupported upper limb training for patients COPD improves upper limb exercise capacity, but has no additional effect on symptoms or quality of life, as compared with leg training alone. This type of upper limb training may not adequately address the complex interaction between respiratory mechanics and upper limb function.
authors.affiliation: Department of Physiotherapy, Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia 3004. a.holland@alfred.org.au
authors.forename: Anne E
authors.initials: AE
authors.lastname: Holland
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Hill
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Nehez
authors.forename: George
authors.initials: G
authors.lastname: Ntoumenopoulos
mesh_terms: D000368:Aged; D004311:Double-Blind Method; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000534:rehabilitation*; D011788:Quality of Life; D015656:Respiratory Mechanics; D034941:Upper Extremity