Effect of different forms of upper limb muscle training on dyspnea in chronic obstructive pulmonary disease: a...

Patients with chronic obstructive pulmonary disease (COPD) often report an increase in dyspnea during activities involving the upper limbs. For this reason, pulmonary rehabilitation guidelines recommend upper limb training for these patients. However, the most effective training methods are unclear.

This study aimed to assess the relative effectiveness of upper limb endurance training vs force training in patients with COPD during pulmonary rehabilitation.

In a randomised, open-label, monocentric controlled trial, the included patients were allocated to either upper limb force training (Force group) or endurance training (Endurance group). Evaluations were performed at baseline and after 4 weeks. The primary outcome was dyspnea, measured using the London Chest Activity of Daily Living questionnaire. Secondary outcomes included dyspnea, assessed using the MMRC Dyspnea Scale and Dyspnea-12 questionnaire; upper limb exercise capacity, measured using the 6-min peg board and ring test; maximal voluntary strength of the deltoid, biceps, and triceps brachii; quality of life, anxiety, and depression. All analyses were performed on an intention-to-treat basis.

280 patients (FEV1[%]: force group: 45.9[19.2]; endurance group: 46.0[17.7]) were included. Dyspnea decreased in both groups. There was no difference in the improvement in dyspnea between both groups, and the minimum important difference of -3 points was not within the 95 % confidence interval (95% CI, -1.0 to 2.1). A significantly greater increase in biceps strength was found in the force group, N.m, 3.3 (6.3) vs 1.5 (6.2), (95% CI, 0.3 - 3.4), P < 0.017. A higher proportion of patients in the force group were unable to reach the required intensity because they found the program too difficult.

We found no significant difference between upper limb force training and upper limb endurance training in terms of changes in dyspnea, arm exercise capacity, quality of life, anxiety, or depression. We therefore suggest incorporating upper limb endurance training during pulmonary rehabilitation.

ClinicalTrials.gov (NCT03611036).