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Original Research: COPD |

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

Stefania Costi, MSPT; Ernesto Crisafulli, MD, FCCP; Francesca Degli Antoni, BSPT; Claudio Beneventi, BSPT; Leonardo M. Fabbri, MD, FCCP; Enrico M. Clini, MD, FCCP
Author and Funding Information

From the Department of Oncology, Haematology, and Respiratory Disease (Drs. Fabbri and Clini, and Ms. Costi), University of Modena, Modena, Italy; and the Department of Pulmonary Rehabilitation (Drs. Crisafulli and Clini, Ms. Degli Antoni, and Mr. Beneventi), Villa Pineta Hospital, Pavullo, Italy.

Stefania Costi, MS, PT, Department of Oncology, Haematology, and Respiratory Disease, University of Modena and Reggio Emilia, Via del Pozzo 74, 41100 Modena, Italy; e-mail: stefania.costi@unimore.it


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


© 2009 American College of Chest Physicians


Chest. 2009;136(2):387-395. doi:10.1378/chest.09-0165
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Background:  Current guidelines on pulmonary rehabilitation (PR) recommend upper extremity exercise training (UEET) in patients with COPD. However, the literature still questions the effectiveness of systematic UEET in this population. We studied the effects of 15 sessions of unsupported UEET on functional exercise capacity, the ability to perform activities of daily living (ADL), and symptoms perceived during activities involving arms in patients with COPD.

Methods:  We conducted a randomized trial that consisted of 3 weeks of inpatient PR, comparing the short-term effects of unsupported UEET plus PR (intervention group) to those of PR alone (control group). A change in the 6-min ring test (6MRT) was the primary outcome; the ADL field test (four shuttle stations), the dyspnea score as assessed by the Medical Research Council scale, the London Chest Activity of Daily Living scale (LCADL), and the distance walked in 6 min served as secondary outcomes of the study. At the 6-month follow-up, we repeated the 6MRT and the LCADL.

Results:  Fifty patients with COPD were randomly assigned to the two groups and completed the study. At the end of the study period, patients in the intervention group improved in the 6MRT and ADL field test compared with those patients in the control group (p = 0.018 and p = 0.010, respectively) with reduced perception of fatigue (p ≤ 0.006). At the 6-month follow-up, 6MRT (p = 0.001) and LCADL (p = 0.039) scores were still significantly better in the intervention group compared with the control group.

Conclusions:  Our trial corroborates the effectiveness of unsupported UEET in specifically improving functional exercise capacity of patients with COPD. Moreover, it also provides evidence that this training modality may ameliorate and maintain the patients' autonomy over and above standard PR.

Trial registration:  ClinicalTrials.gov Identifier: NCT00825032

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