Chest
Volume 141, Issue 1, January 2012, Pages 111-120
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Original Research
COPD
How Should We Measure Arm Exercise Capacity in Patients With COPD?: A Systematic Review

https://doi.org/10.1378/chest.11-0475Get rights and content

Background

There are no recommendations on how to measure arm exercise capacity in individuals with COPD. The objectives of this study were (1) to synthesize the literature on measures of arm exercise capacity in individuals with COPD, (2) to describe the psychometric properties and the target construct of each measure, and (3) to make recommendations for clinical practice and research.

Methods

Studies conducted in patients with COPD that included a measure of arm exercise capacity were identified after searches of five electronic databases (PubMed, CINAHL, EMBASE, PEDro, and Cochrane Library) and reference lists of pertinent articles. One reviewer performed data extraction, and two assessed the quality of the studies that described measurement properties, using the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) checklist.

Results

Of 654 reports, 41 met the study criteria. Five types of arm exercise tests were identified: arm ergometry, ring shifts, dowel lifts, proprioceptive neuromuscular facilitation, and activities of daily living. Four studies assessed the measurement properties of the unsupported upper-limb exercise test (UULEX), the 6-min pegboard and ring test (6PBRT), a test involving weight shifts, and the grocery-shelving task (GST). Validity studies were of fair to good quality, whereas reliability studies were of poor quality.

Conclusions

Arm ergometry may be the best method for measuring peak supported arm exercise capacity and endurance. The UULEX, 6PBRT, and GST may better reflect activities of daily living and should be the tests of choice to measure peak unsupported arm exercise capacity (UULEX) and arm function (6PBRT and GST).

Section snippets

Search Strategy

Electronic searches were conducted of the PubMed, EMBASE, CINAHL, PEDro, and Cochrane Library databases, from the inception of these databases until December 2010. Key terms included “COPD,” “arm,” “upper extremity,” “upper limb,” “training,” “exercise,” “arm exercise capacity,” “arm endurance,” “arm function,” “arm exercise test,” and “assessment.” Hand searches were performed of the reference lists of all identified studies.

Inclusion Criteria

We considered studies of any design conducted with individuals with

Literature Search

The study selection process is illustrated in Figure 1. The electronic and hand searches identified 654 articles. After screening study titles and abstracts, 601 were considered to be unrelated to the study or were duplicate articles. Fifty-three remained for full-text analysis; of these, 12 articles were excluded, leaving a total of 41 articles for inclusion in this review. The reasons for exclusion are presented in Figure 1. Different categories of arm exercise tests were identified among the

Discussion

The findings of this systematic review of 41 articles revealed that there are five main types of arm exercise tests available for patients with COPD: arm ergometry, ring shifts, dowel or arm lifts, diagonal movement using PNF, and ADL-based tests. The choice of the test should depend on the target construct being measured and on the psychometric properties of the tests. See Table 4 for advantages and disadvantages of each test. Arm ergometry may be best for measuring peak arm exercise capacity

Conclusions

There are several tools available to measure arm exercise capacity in people with COPD. The choice of test should depend on the target construct being measured and on the known psychometric properties of the test. In addition, feasibility, patient tolerance, and ease of administration should be considered when choosing a specific test for a clinical or research purpose.

Although arm ergometry appears to be the best choice to measure supported peak arm exercise capacity and endurance in patients

Acknowledgments

Author contributions: Dr Brooks had full access to all of the data in the study and takes full responsibility for the integrity of all of the data and the accuracy of the data analysis, including and especially any adverse effects.

Dr Janaudis-Ferreira: made direct and substantial contribution to this work by participating in conceiving and designing the study, extracting the data, interpreting the data, writing the manuscript, and approving the final version of the manuscript.

Ms Beauchamp: made

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    Funding/Support: The authors have reported to CHEST that no funding was received for this study.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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