title: Arm exercise training in patients with chronic obstructive pulmonary disease: a systematic review.
abstract: OBJECTIVE
  Patients with chronic obstructive pulmonary disease (COPD) often report intolerable dyspnea when they use their arms for simple activities of daily living. Although arm exercise training is recommended in the guidelines for pulmonary rehabilitation (PR), there is limited information regarding its impact. Therefore, we undertook a systematic review of studies that have investigated the effects of an arm training program (ATP) on symptoms, exercise capacity, and health-related quality of life.
  
  
  METHODS
  A search of electronic databases (MEDLINE, CINAHL, EMBASE, Physiotherapy Evidence Database (PEDro), and the Cochrane Library of clinical trials) was complemented by screening the reference lists of pertinent articles to identify appropriate studies. We accepted randomized controlled trials that were written in English, performed in human subjects with COPD, and investigated the effects of an ATP in patients with COPD. Included studies were reviewed by 2 independent investigators who assigned a score out of 10, using the PEDro scale for assessment of study quality.
  
  
  RESULTS
  Of 98 reports, 5 met the study criteria. The mean PEDro score was 6.2 (SD = 1.3). The results of the studies indicate that ATP improves arm exercise capacity, but its effect on dyspnea, arm fatigue, and health-related quality of life is unclear.
  
  
  CONCLUSIONS
  There is evidence to support the use of ATP to improve arm exercise capacity. Larger trials with standardized training methodology and outcomes are required to better understand the optimal training regimen for patients with COPD.
authors.affiliation: Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.
authors.forename: Tania
authors.initials: T
authors.lastname: Janaudis-Ferreira
authors.forename: Kylie
authors.initials: K
authors.lastname: Hill
authors.forename: Roger
authors.initials: R
authors.lastname: Goldstein
authors.forename: Karin
authors.initials: K
authors.lastname: Wadell
authors.forename: Dina
authors.initials: D
authors.lastname: Brooks
mesh_terms: D001132:Arm / Q000502:physiology*; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation*; D016896:Treatment Outcome