Effects of unsupported upper extremity exercise training in patients with COPD: a randomized clinical trial.
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 <or= 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.


BACKGROUND
ClinicalTrials.gov Identifier: NCT00825032.
Costi
Stefania
S
Crisafulli
Ernesto
E
Degli Antoni
Francesca
F
Beneventi
Claudio
C
Fabbri
Leonardo M
LM
Clini
Enrico M
EM
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D004417:Dyspnea / Q000503:physiopathology; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000534:rehabilitation*; D012129:Respiratory Function Tests; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D034941:Upper Extremity