Upper limb exercise training and activities of daily living in patients with COPD: a systematic review of randomized controlled trials

Karagiannis, Christos; Savva, Christos; Mamais, Ioannis; Adamide, Tonia; Georgiou, Andreas; Xanthos, Theodoros

doi:10.36416/1806-3756/e20190370

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Brasil

Jornal Brasileiro de Pneumologia

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Brasil

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REVIEW ARTICLE • J. bras. pneumol. 46 (06) • 2020 • https://doi.org/10.36416/1806-3756/e20190370 copy

Upper limb exercise training and activities of daily living in patients with COPD: a systematic review of randomized controlled trials

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To investigate the efficacy of upper limb exercise training (ULExT) in improving the performance of activities of daily living (ADL) that involve the upper limbs (UL) in patients with COPD.

Methods:

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used in this systematic review. PubMed and EBSCOhost databases were searched to identify randomized controlled trials involving adults with COPD who underwent ULExT, compared with those who underwent other types of exercise or no exercise, in order to assess the performance of ADL that involve the UL. The methodological quality of the selected studies was assessed using the Physiotherapy Evidence Database scale.

Results:

Five studies, with a total sample of 173 subjects, met the inclusion criteria. The results of the selected studies showed that ULExT is safe and can significantly improve the performance of ADL that involve the UL in patients with COPD. However, there were inconsistencies in the results, especially regarding the perception of symptoms during ADL. The small number of studies included and their methodological quality do not allow for firm conclusions.

Conclusions:

The findings of this review revealed that ULExT is a safe therapeutic approach and can improve the performance of ADL that involve the UL in patients with COPD, but the results are unclear. Further investigation through well-designed randomized trials is warranted to determine the effectiveness of ULExT in improving the performance of ADL that involve the UL in patients with COPD.

Keywords:
Upper extremity; Pulmonary disease, chronic obstructive; Activities of daily living, Exercise therapy

Author	Criterion
Author	1	2	3	4	5	6	7	8	9	10	11	Total score
Ries et al.¹⁹19 Ries AL, Ellis B, Hawkins RW. Upper extremity exercise training in chronic obstructive pulmonary disease. Chest. 1988;93(4):688-692. https://doi.org/10.1378/chest.93.4.688 https://doi.org/10.1378/chest.93.4.688...	0	1	0	1	0	0	0	0	0	1	1	4
Marrara et al.²⁰20 Marrara KT, Marino DM, de Held PA, de Oliveira Junior AD, Jamami M, Di Lorenzo VA. Different physical therapy interventions on daily physical activities in chronic obstructive pulmonary disease. Respir Med. 2008;102(4):505-511. https://doi.org/10.1016/j.rmed.2007.12.004 https://doi.org/10.1016/j.rmed.2007.12.0...	0	1	0	1	0	0	0	0	0	1	1	4
Costi et al.²¹21 Costi S, Crisafulli E, Degli Antoni F, Beneventi C, Fabbri LM, Clini EM. Effects of unsupported upper extremity exercise training in patients with COPD: a randomized clinical trial. Chest. 2009;136(2):387-395. https://doi.org/10.1378/chest.09-0165 https://doi.org/10.1378/chest.09-0165...	1	1	1	1	0	0	1	1	1	1	1	8
Janaudis-Ferreira et al.²²22 Janaudis-Ferreira T, Hill K, Goldstein RS, Robles-Ribeiro P, Beauchamp MK, Dolmage TE, et al. Resistance arm training in patients with COPD: A Randomized Controlled Trial. Chest. 2011;139(1):151-158. https://doi.org/10.1378/chest.10-1292 https://doi.org/10.1378/chest.10-1292...	1	1	1	1	1	0	1	1	1	1	1	9
Calik-Kutukcu et al.²³23 Calik-Kutukcu E, Arikan H, Saglam M, Vardar-Yagli N, Oksuz C, Inal-Ince D, et al. Arm strength training improves activities of daily living and occupational performance in patients with COPD. Clin Respir J. 2017;11(6):820-832. https://doi.org/10.1111/crj.12422 https://doi.org/10.1111/crj.12422...	1	1	1	1	0	0	1	1	0	1	1	7

Author	Participants (M/F), n	Severity of COPD	Study group (n)
Ries et al.¹⁹19 Ries AL, Ellis B, Hawkins RW. Upper extremity exercise training in chronic obstructive pulmonary disease. Chest. 1988;93(4):688-692. https://doi.org/10.1378/chest.93.4.688 https://doi.org/10.1378/chest.93.4.688...	28 (N/A)^a	Moderate to very severe	UAE + GR (8)
			UAE + PNF (9)
			Control (11)
Marrara et al.²⁰20 Marrara KT, Marino DM, de Held PA, de Oliveira Junior AD, Jamami M, Di Lorenzo VA. Different physical therapy interventions on daily physical activities in chronic obstructive pulmonary disease. Respir Med. 2008;102(4):505-511. https://doi.org/10.1016/j.rmed.2007.12.004 https://doi.org/10.1016/j.rmed.2007.12.0...	22 (22/0)	Moderate to severe	UAE (8)
			LE (8)
			Control (6)
Costi et al.²¹21 Costi S, Crisafulli E, Degli Antoni F, Beneventi C, Fabbri LM, Clini EM. Effects of unsupported upper extremity exercise training in patients with COPD: a randomized clinical trial. Chest. 2009;136(2):387-395. https://doi.org/10.1378/chest.09-0165 https://doi.org/10.1378/chest.09-0165...	50 (33/17)^a	Moderate to very severe	UAE (25)
	50 (33/17)^a	Moderate to very severe	Control (25)
Janaudis-Ferreira et al.²²22 Janaudis-Ferreira T, Hill K, Goldstein RS, Robles-Ribeiro P, Beauchamp MK, Dolmage TE, et al. Resistance arm training in patients with COPD: A Randomized Controlled Trial. Chest. 2011;139(1):151-158. https://doi.org/10.1378/chest.10-1292 https://doi.org/10.1378/chest.10-1292...	31 (N/A)	Moderate to very severe	ART (13)
	31 (N/A)	Moderate to very severe	Control (18)
Calik-Kutukcu et al.²³23 Calik-Kutukcu E, Arikan H, Saglam M, Vardar-Yagli N, Oksuz C, Inal-Ince D, et al. Arm strength training improves activities of daily living and occupational performance in patients with COPD. Clin Respir J. 2017;11(6):820-832. https://doi.org/10.1111/crj.12422 https://doi.org/10.1111/crj.12422...	42 (27/15)	Moderate to severe	ART (21)
	42 (27/15)	Moderate to severe	Control (21)

Author	Type of arm training	Intensity	Frequency	Duration	Additional interventions	Control group
Ries et al.¹⁹19 Ries AL, Ellis B, Hawkins RW. Upper extremity exercise training in chronic obstructive pulmonary disease. Chest. 1988;93(4):688-692. https://doi.org/10.1378/chest.93.4.688 https://doi.org/10.1378/chest.93.4.688...	Arm ergometry & resistance training (hand weights)	GR: 1-2 sets × 10 reps (1-5 lb) PNF: 3 sets × 4-10 reps (1-5 lb)	1-2 × day	6 weeks	Arm ergometry; PR	PR (no upper extremity training)
Marrara et al.²⁰20 Marrara KT, Marino DM, de Held PA, de Oliveira Junior AD, Jamami M, Di Lorenzo VA. Different physical therapy interventions on daily physical activities in chronic obstructive pulmonary disease. Respir Med. 2008;102(4):505-511. https://doi.org/10.1016/j.rmed.2007.12.004 https://doi.org/10.1016/j.rmed.2007.12.0...	Resistance training (free weights)	3 sets × 10 reps 1st: 50% 10 RM 2nd: 75% 10 RM 3rd: 100% 10 RM	3 × week	6 weeks	UL & LL stretching; bronchial hygiene	Respiratory exercises; bronchial hygiene; stretching
Costi et al.²¹21 Costi S, Crisafulli E, Degli Antoni F, Beneventi C, Fabbri LM, Clini EM. Effects of unsupported upper extremity exercise training in patients with COPD: a randomized clinical trial. Chest. 2009;136(2):387-395. https://doi.org/10.1378/chest.09-0165 https://doi.org/10.1378/chest.09-0165...	Resistance training (dumbbells)	3 sets × 10-15 reps 50% 1 RM	5 × week	3 weeks	PR; cycle ergometry; calisthenics; resistance exercise	PR; cycle ergometry; calisthenics; resistance exercise
Janaudis-Ferreira et al.²²22 Janaudis-Ferreira T, Hill K, Goldstein RS, Robles-Ribeiro P, Beauchamp MK, Dolmage TE, et al. Resistance arm training in patients with COPD: A Randomized Controlled Trial. Chest. 2011;139(1):151-158. https://doi.org/10.1378/chest.10-1292 https://doi.org/10.1378/chest.10-1292...	Resistance training (free weights)	Loads equivalent to 10-12 RM	3 × week	6 weeks	Walking; lower and upper extremity strength training; breathing exercises; self-management education	UL flexibility and stretching exercises
Calik-Kutukcu et al.²³23 Calik-Kutukcu E, Arikan H, Saglam M, Vardar-Yagli N, Oksuz C, Inal-Ince D, et al. Arm strength training improves activities of daily living and occupational performance in patients with COPD. Clin Respir J. 2017;11(6):820-832. https://doi.org/10.1111/crj.12422 https://doi.org/10.1111/crj.12422...	Resistance training (free weights)	3 sets × 8-12 reps 40-50% 1 RM	3 × week	8 weeks	Arm ergometry and stretching exercises for warm-up and cool down; breathing exercises	Breathing exercises

Author	UL-related ADL simulation test	UL-related ADL questionnaires	Dyspnea during ADL	Fatigue during ADL	ULExT-related AE
Ries et al.¹⁹19 Ries AL, Ellis B, Hawkins RW. Upper extremity exercise training in chronic obstructive pulmonary disease. Chest. 1988;93(4):688-692. https://doi.org/10.1378/chest.93.4.688 https://doi.org/10.1378/chest.93.4.688...	Decrease in the time taken to complete the ADL test*		NS	NS	Back pain (n = 1)
Marrara et al.²⁰20 Marrara KT, Marino DM, de Held PA, de Oliveira Junior AD, Jamami M, Di Lorenzo VA. Different physical therapy interventions on daily physical activities in chronic obstructive pulmonary disease. Respir Med. 2008;102(4):505-511. https://doi.org/10.1016/j.rmed.2007.12.004 https://doi.org/10.1016/j.rmed.2007.12.0...	Decrease in V_E/MVV and in VO₂/VO₂max during blackboard erasing*		NS		No AE reported
Costi et al.²¹21 Costi S, Crisafulli E, Degli Antoni F, Beneventi C, Fabbri LM, Clini EM. Effects of unsupported upper extremity exercise training in patients with COPD: a randomized clinical trial. Chest. 2009;136(2):387-395. https://doi.org/10.1378/chest.09-0165 https://doi.org/10.1378/chest.09-0165...	Increased number of ADL cycles in 10 min*^†		Significant decrease*	Significant decrease*^†	No AE reported
Janaudis-Ferreira et al.²²22 Janaudis-Ferreira T, Hill K, Goldstein RS, Robles-Ribeiro P, Beauchamp MK, Dolmage TE, et al. Resistance arm training in patients with COPD: A Randomized Controlled Trial. Chest. 2011;139(1):151-158. https://doi.org/10.1378/chest.10-1292 https://doi.org/10.1378/chest.10-1292...		NS in modified DASH scores	Significant decrease*		Elbow pain (n = 1) Neck pain (n = 1) Severe dyspnea (n = 1)
Calik-Kutukcu et al.²³23 Calik-Kutukcu E, Arikan H, Saglam M, Vardar-Yagli N, Oksuz C, Inal-Ince D, et al. Arm strength training improves activities of daily living and occupational performance in patients with COPD. Clin Respir J. 2017;11(6):820-832. https://doi.org/10.1111/crj.12422 https://doi.org/10.1111/crj.12422...	Increase in the number of ADL cycles in 10 min Improvement in MAS housecleaning and laundry integrated scores* NS in the Glittre-ADL test	Improvement in MAS scores*	Significant decrease during the Glittre-ADL test*	NS	No AE reported

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[1] Correspondence to: Christos Karagiannis. 12 Isthmion Street, 3083, Limassol, Cyprus. Tel.: 357-2255-9562. E-mail: c.karayiannis@euc.ac.cy or xristos_fys@hotmail.com