Effect of Strength Versus Strength and Endurance Upper Limb Exercise Training in Patients With Chronic Obstructive Pulmonary Disease

Abstract

C hronic obstructive pulmonary disease (COPD) is characterized by dyspnea, fatigue, exercise intolerance, poor quality of life, and high rates of morbidity and mortality. 1 In addition, peripheral muscle weakness 2 and inability to perform activities of daily living (ADL) with the upper limbs (UL) are common findings among patients with COPD. 3 Pulmonary rehabilitation (PR) programs are offered worldwide for the management of COPD and exercise training is a core component of PR. 4 Evidence suggests that exercise training can improve muscle function in patients with COPD, 2,5 and can drive improvements of oxidative 6 and exercise capacity, 4,5,7 and reduce ventilatory requirements and dyspnea. 8 Although similar beneficial effects have also been reported in patients with COPD for resistance and endurance training, 9 the specifics and the relative contribution of the upper limb exercise training (ULET) in PR of these patients remain unclear. 5 Findings from previous systematic reviews evaluating ULET in patients with COPD were inconsistent with respect to the translation of UL functional improvements reported to outcome measures such as health-related quality of life (HRQL), dyspnea, and ADL. [10][11][12][13] Recent evidence from a systematic review and meta-analysis indicates no effect in dyspnea and HRQL when endurance ULET was compared with resistance ULET, or when ULET combined with lower limb exercise training was compared with lower limb training alone. 3 Recent PR guidelines included endurance and resistance exercise for developing cardiorespiratory function, musculoskeletal fitness, and HRQL. 5,14 Upper limb exercise training has also been recommended given the evidence for improvements in UL function 5 ; however, the effectiveness of ULET in ADL of patients with COPD, as well as the optimal type of ULET, has yet to be determined due to the limited evidence comparing the effectiveness of different UL training interventions. 3 Given the lack of evidence from studies combining endurance and resistance ULET on patient-relevant outcomes, the main objective of the present study was to evaluate the effects of a rehabilitation program including resistance ULET with and without the addition of endurance ULET on ADL, HRQL, peripheral muscle strength, dyspnea, and fatigue perception in patients with COPD. METHODSPatients with stable COPD were referred for a PR program at Nicosia General Hospital. Consecutive patients were approached over a period of 18 mo (December 2017 to June 2019). Patients were included if they had: (1) diagnosis of

Effect of Endurance Training in COPD Patients Undergoing Pulmonary Rehabilitation: A Meta-Analysis

“…They observed reduced heart rate and serum lactate levels but comparable quality of life in patients receiving ET. Furthermore, strength training with upper limb ET has also been demonstrated to significantly improve the quality of life and muscle strength than strength training alone [ 25 ]. However, both methods have similar effects in reducing CAT scores.…”

“…In conclusion, ET can improve patients' motor function and reduce dyspnea. ET might be incorporated as an important part of lung rehabilitation training [19,20,[22][23][24][25][26][27][28][29][30][31][32][33]. Heterogeneity: Chi 2 = 5.11, df = 3 (P = 0.16); I 2 = 41% Test for overall effect: Z = 9.88 (P < 0.00001)…”

“…Literature. A total of 2361 articles were retrieved, among which 14 RCTs with a total of 816 patients with COPD were finally included [19,20,[22][23][24][25][26][27][28][29][30][31][32][33]. The screening process is shown in Figure 1.…”

The effects of upper limb exercise training on upper limb muscle strength in people with chronic obstructive pulmonary disease: a systematic review and meta-analysis of randomized controlled trials

“…Nine studies (283 patients) compared UL and LL training with different types of UL exercise with significant variability in the exercise and the exercise programs (Supplementary Table 2). 9,43,45,50,[54][55][56][57][58] Four studies compared training with elastic resistance to weight machines; 50,54,56,57 two studies compared endurance training with combined endurance and resistance training; 43,45 one study compared resistance training and diagonal movements with diagonal movements only, 55 and two studies compared resistance with endurance training 9 and resistance with combined training. 58 Very low certainty evidence indicates a nonsignificant difference between elastic resistance exercise and weight machines training in all muscle groups at the short-term follow-up (Figure 6 and Table 3).…”

“…9,43,45,50,[54][55][56][57][58] Four studies compared training with elastic resistance to weight machines; 50,54,56,57 two studies compared endurance training with combined endurance and resistance training; 43,45 one study compared resistance training and diagonal movements with diagonal movements only, 55 and two studies compared resistance with endurance training 9 and resistance with combined training. 58 Very low certainty evidence indicates a nonsignificant difference between elastic resistance exercise and weight machines training in all muscle groups at the short-term follow-up (Figure 6 and Table 3). In sensitivity analysis (Supplementary Figures 20 and 21 and Supplementary Table 3) by removing heterogeneous studies, 56,57 results did not change.…”