title: Exercises using the upper limbs hyperinflate COPD patients more than exercises using the lower limbs at the same metabolic demand.
abstract: BACKGROUND
  Lower and upper body exercise are mandatory constituents of a rehabilitation programme for patients with COPD. However, it is not known how much these exercises may induce pulmonary dynamic hyperinflation (DH).
  
  
  OBJECTIVE
  To evaluate the DH in patients with COPD exercising the upper and lower parts of the body at the same metabolic demand.
  
  
  METHODS
  Sixteen patients aged 63 +/- 13 years and with a FEV1 of 1.5 +/- 0.7 L (41 +/- 11% pred) were studied. Patients initially performed a maximal exercise test with the arms using the diagonal movement technique. The lower limbs were exercised on a treadmill at the same metabolic demand.
  
  
  RESULTS
  Inspiratory capacity decreased 222 +/- 158 ml (9.8%) after the upper body exercise (p < 0.0001) and 148 +/- 161 ml (7%) after exercise with the lower body (p = 0.0028) and a difference between the two groups was found (p < 0.05). There was no difference between resting IC before upper and lower limbs exercises (p = 0.8); increase in minute ventilation and in pulmonary ventilation in percentage of maximum voluntary ventilation and reduction of expiratory time were larger in the upper limbs exercise (p < 0.05). Dyspnea as measured by the Borg Scale was higher in the upper body (3.9 +/- 2.2) than in the lower body (2.3 +/- 1.3) at the end of the exercise (p = 0.033). Pulmonary ventilation and inspiratory capacity were correlated (p = 0.0001; r = 0.82).
  
  
  CONCLUSIONS
  Exercise with the upper part of the body causes more DH and dyspnea than exercise with the lower part of the body at the same metabolic demand.
authors.affiliation: Pulmonary Rehabilitation Center of Federal University of São Paulo (Unifesp), Brazil.
authors.forename: E F
authors.initials: EF
authors.lastname: Porto
authors.forename: A A M
authors.initials: AA
authors.lastname: Castro
authors.forename: M
authors.initials: M
authors.lastname: Velloso
authors.forename: O
authors.initials: O
authors.lastname: Nascimento
authors.forename: F
authors.initials: F
authors.lastname: Dal Maso
authors.forename: J R
authors.initials: JR
authors.lastname: Jardim
mesh_terms: D000704:Analysis of Variance; D004417:Dyspnea / Q000503:physiopathology; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D035002:Lower Extremity / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology* / Q000534:rehabilitation*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology*