Effects of unsupported upper extremity training in patients with chronic airway obstruction: a randomized clinical trial.

Introduction: Recent guidelines on pulmonary rehabilitation (PR) recommend upper extremity exercise training (UEET) in patients with chronic obstructive pulmonary disease (COPD). However, literature still questions the effectiveness of systematic UEET in this population.Objective: We aimed to verify the effects of unsupported UEET on functional exercise capacity, ability to perform activities of daily living (ADL) and symptoms perceived during activities involving upper extremity in COPD patients.Methods: We conducted a randomized trial comparing the effects of unsupported UEET plus PR (Intervention) to those of PR alone (Control). Change in 6-minute ring test (6MRT) was the primary outcome; ADL field test (4 shuttle stations), dyspnea score as assessed by Medical Research Council (MRC) scale, London Chest Activity of Daily Living scale (LCADL), and 6-minute walked distance (6MWT) served as secondary outcomes of the study . Results: Fifty COPD patients were consecutively randomized into the two groups and completed the study. At the end of rehabilitation period, 6MRT specifically improved in Intervention (p<0.001) but not in Control group; number of rings moved at 6MRT, shuttles completed at the ADL field test, 6MWT and MRC significantly and greatly changed (p<0.01) in Intervention as compared with Control group. At 6-month follow-up, rings moved at 6MRT (p=0.039) and LCADL (p=0.001) were still significantly better in Intervention as compared with Control group.Conclusion: Our trial corroborates the effectiveness of unsupported UEET in specifically improving functional exercise capacity of COPD patients. Moreover, it also provides evidence that this training modality may ameliorate and maintain the patients’ autonomy over and above standard PR.