Effect of upper limb, lower limb and combined training on exercise performance, quality of life and survival in COPD

BackgroundBecause there are differences between the upper limb (UL) and lower limb (LL) muscles in terms of the morphological and functional adaptations in COPD patients, specific protocols for strength training and endurance should be developed and tested for the corresponding muscle groups.AimTo elucidate the potential effects of unsupported UL and/or LL exercise training in patients with COPD. The 6-min walking distance (6-MWD), unsupported upper limb endurance (UULE) time, St. George’s Respiratory questionnaire (SGRQ), BODE index and pulmonary function tests are used as outcome measures.MethodsA prospective, randomized controlled study of patients with COPD. Patients were randomly assigned to one of 4 groups, group A received UL training, group B received LL training, group C received both UL and LL training and group D received no training (controls). Patients in group A, B, and C underwent exercise training 3 times weekly for 8 weeks. The outcome measures were carried out at study entry and after 8 weeks.Results78 patients completed the study: 20 patients in group A, 21 in group B, 19 in group C and 18 in group D. Upper limb training significantly increased UULE time without affecting 6-MWD while LL training significantly increased 6-MWD without changing UULE time. Combined UL and LL training significantly increased both UULE time and 6-MWD. Significant reductions in the scores of SGRQ and BODE index were observed in groups A, B and C but not group D (control). No changes were found in pulmonary function in all groups at the end of the study.ConclusionIn patients with COPD, combined UL and LL training significantly enhanced the exercise tolerance and quality of life and reduced the risk of death (BODE index) without any change in the pulmonary function.