Effects of Unsupported Upper Extremity Exercise Training in Patients With COPD: A Randomized Clinical Trial

摘要

Background: Current guidelines on pulmonary rehabilitation (PR) recommend upper extremitynexercise training (UEET) in patients with COPD. However, the literature still questions theneffectiveness of systematic UEET in this population. We studied the effects of 15 sessions ofnunsupported UEET on functional exercise capacity, the ability to perform activities of daily livingn(ADL), and symptoms perceived during activities involving arms in patients with COPD.nMethods: We conducted a randomized trial that consisted of 3 weeks of inpatient PR, comparing thenshort-term effects of unsupported UEET plus PR (intervention group) to those of PR alone (controlngroup). A change in the 6-min ring test (6MRT) was the primary outcome; the ADL field test (fournshuttle stations), the dyspnea score as assessed by the Medical Research Council scale, the LondonnChest Activity of Daily Living scale (LCADL), and the distance walked in 6 min served as secondarynoutcomes of the study. At the 6-month follow-up, we repeated the 6MRT and the LCADL.nResults: Fifty patients with COPD were randomly assigned to the two groups and completed thenstudy. At the end of the study period, patients in the intervention group improved in the 6MRT andnADL field test compared with those patients in the control group (p u0001 0.018 and p u0001 0.010,nrespectively) with reduced perception of fatigue (p < 0.006). At the 6-month follow-up, 6MRTn(p u0001 0.001) and LCADL (p u0001 0.039) scores were still significantly better in the intervention groupncompared with the control group.nConclusions: Our trial corroborates the effectiveness of unsupported UEET in specifically improvingnfunctional exercise capacity of patients with COPD. Moreover, it also provides evidence that thisntraining modality may ameliorate and maintain the patients’ autonomy over and above standard PR.nTrial registration: ClinicalTrials.gov Identifier: NCT00825032 (CHEST 2009; 136:387–395)