Chest
Volume 93, Issue 4, April 1988, Pages 688-692
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Upper Extremity Exercise Training in Chronic Obstructive Pulmonary Disease

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Many patients with chronic obstructive pulmonary disease (COPD) report greater limitation for activities involving the upper extremities than the lower extremities. Exercise training has generally emphasized lower-extremity exercise. We designed and evaluated two simple, practical, and widely applicable upper-extremity training programs in 45 patients with COPD participating concurrently in a comprehensive, multidisciplinary pulmonary rehabilitation program. Patients were randomly assigned to one of the following three groups: (1) gravity-resistance (GR) upper-extremity training; (2) modified proprioceptive neuromuscular facilitation (PNF) upper-extremity training; or (3) no upper-extremity training (control). Patients were evaluated before and after at least six weeks of uninterrupted training. Twenty-eight patients completed the study. Compared to controls, both GR and PNF patients demonstrated improved performance on tests specific to the training performed (upper-extremity performance test, maximal level and endurance on isokinetic arm cycle). There were no significant changes on isotonic arm cycle, ventilatory muscle endurance, or simulated activities of daily-living tests. Ratings of perceived breathlessness and fatigue decreased significantly in all groups for several tests. We conclude that specific upper-extremity training may be beneficial in the rehabilitation of patients with COPD and warrants further investigation.

Section snippets

Subjects

Forty-five subjects were recruited from participants in the University of California at San Diego ¢UCSD) Pulmonary Rehabilitation Program. This is a comprehensive multidisciplinary program for patients with stable COPD and includes education, instruction in techniques of physical and respiratory therapy, exercise training, and psychosocial support. Subjects were assigned randomly to one of three groups: two groups using upper-extremity exercise; and a control group with no upper-extremity

Patients and Baseline Results

For the 45 patients initially enrolled in the study, there were no significant differences between groups for any of the baseline measurements.

Twenty-eight of the 45 patients completed the study, including the requirement of at least six weeks of uninterrupted training. There were 11 control subjects, eight GR trainers, and nine PNF trainers. Seventeen patients did not complete the study for the following reasons: interfering medical problems in ten; nonmedical problems in six; and

DISCUSSION

The results of this study indicate that upper-extremity training resulted in improved upper-extremity performance for these patients with COPD; however, upper-extremity training did not result in improved performance for tests unrelated to training, including arm cycle ergometry, ventilatory muscle endurance, and simulated ADL testing. Nevertheless, many patients reported subjective improvement in their ability to perform daily activities involving the upper extremities.

Studies of exercise

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    Supported in part by the Easter Seal Research Foundation of the National Easter Seal Society and National Institutes of Health grant RR00827 from the Division of Research Resources for the Clinical Research Center.

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