Upper Arm Exercises Improve Vigor in COPD Patients

Karla Gale, MS

August 28, 2009

August 28, 2009 — The benefits of exercises to strengthen muscles in the upper arms, shoulders, and chest of patients with chronic obstructive pulmonary disease (COPD) extend beyond the upper extremities, results of a clinical trial indicate.

Unsupported upper extremity exercises "may ameliorate the patients' general exercise capacity and autonomy, over and above standard pulmonary rehabilitation," physical therapist Stefania Costi and associates in Italy report in the August issue of Chest.

The current guideline on pulmonary rehabilitation for COPD patients advocates exercise training targeted at the muscles of the upper extremities in COPD patients. The theoretical rationale for this advice involves the dual role of upper extremity muscles that sustain the upper girdle while also acting as accessory respiratory muscles.

However, Dr. Costi, from the University of Modena and Reggio Emilia, and her team found that the quality of previous clinical trials has been so poor that there are no reliable data to support this type of training.

They therefore conducted their own randomized trial among patients with stable COPD who had been referred for inpatient pulmonary rehabilitation, to study the effects of 15 sessions of unsupported upper extremity exercise training. Twenty-five patients each (mean age 69 years) were randomly assigned to regular rehabilitation or rehabilitation plus the upper extremity training. All patients completed the trial.

The training consisted of five movements while holding dumbbells to activate the pectoralis, deltoids, triceps brachii, trapezius, and biceps brachii.

The primary outcome was change in the 6-minute ring test, in which the total number of rings moved were counted and change in physiologic measures — heart rate, pulse oximetry, respiratory rate, perceived dyspnea and arm fatigue — were monitored. Secondary outcomes were an activities of daily living field test, the 6-minute walking test, and scales to assess the extent and effect of breathlessness on daily activities.

Evaluations carried out at the end of the study period indicated that patients in the intervention group improved significantly in the changes in the number of rings moved in the 6-minute ring test (+25 vs +5), number of shuttles achieved in the activities of daily living (+4.0 vs +0.3), as well as reduced perception of arm fatigue (–0.74 vs –0.08).

The intervention was also associated with significantly greater improvement in the number of meters walked in 6 minutes (+74 vs + 24), and in the dyspnea score (–1.04 vs –0.48).

At a 6-month follow-up, the intervention group maintained the greater improvement in the 6-minute ring test and in the degree of dyspnea experienced during daily activities.

Besides corroborating the efficacy of unsupported upper extremity exercise testing in improving exercise capacity, "this trial provides new and relevant data regarding the benefits of this specific training on clinically important outcomes, such as the ability to perform activities of daily living that involve the upper extremities and the fatigue related to those activities," Costi and associates conclude.

Unexpected was the improvement of general exercise capacity, the authors add, surpassing the minimal clinically important difference for patients with COPD.

Chest. 2009;136:387-395.

Reuters Health Information 2009. © 2009 Reuters Ltd.

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