Arm exercise training in chronic obstructive pulmonary disease: an umbrella review of systematic reviews and meta-analyses

Due to systemic inflammation, long-term oxygen therapy, corticosteroids, and symptoms, skeletal muscle dysfunctions or myopathies are observed in patients with chronic obstructive pulmonary disease (COPD). To manage the extrapulmonary features of COPD, arm exercise training has gained increasing attention as a component of pulmonary rehabilitation. However, there is no consensus regarding the level of evidence for arm exercises.

This umbrella review is aimed at synthesizing the findings about arm exercise training in patients with COPD.

This umbrella review was registered at PROSPERO (CRD420251230948). Six databases were screened from inception to May 2026 and results were imported into Rayyan AI tool for detailed screening. Systematic reviews and meta-analysis that investigated arm exercise were included. The AMSTAR-2 tool was used for methodological quality. The GRADE framework was used to determine the certainty of evidence for the findings.The overlap among primary studies was assessed using the corrected covered area.Results:A total of 1,835 patients with COPD were included in eight studies (5 meta-analyses and 3 systematic reviews). The methodological quality of the reviews was rated as high in one review, moderate in two reviews, low in three reviews, and critically low in two reviews.Arm exercises improved dyspnea with moderate certainty evidence and arm exercise capacity and muscle strength with low-certainty evidence. Moreover, the effects of arm exercise training on fatigue were inconsistent with low certainty, and quality of life and activities of daily living were inconsistent with very low certainty.

Arm exercise training may improve dyspnea and may enhance arm exercise capacity and muscle strength. However, confidence in these findings is limited by methodological weaknesses of the included reviews, overlap among primary studies, and heterogeneity in exercise interventions and outcome measures.It may be considered as an adjunct to pulmonary rehabilitation to improve these outcomes.