UPPER LIMBS EXERCISE TRAINING AND MUSCLE STRENGTH IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE. A SYSTEMATIC REVIEW

C. Karagiannis¹, C. Savva¹, V. Korakakis², P. Rentzias¹, G. Ploutarchou¹, T. Adamide³, A. Georgiou³, T. Xanthos⁴

Background: Chronic obstructive pulmonary disease is a respiratory disease characterized by chronic inflammation in the airway and lung parenchyma. However, it progressively becomes a multisystem disease, affecting other systems such as the musculoskeletal system. Pathophysiological changes in musculoskeletal system are associated with morphological and structural alterations of peripheral muscles, such as muscle weakness. Muscle weakness of the upper limbs is associated with reduced muscle mass and increased hyperinflation, dyspnea, morbidity, and mortality. Evidence suggests that exercise could improve muscle strength; however, upper limb exercise training is not reported in recent guidelines for pulmonary rehabilitation.

Purpose: The purpose of this systematic review was to investigate the effectiveness of upper limb exercise training, in muscle strength of patients with chronic obstructive pulmonary disease.

Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for this systematic review. PubMed, CINAHL Plus and Sports Discus were searched from inception to July 2020. We included randomized controlled trials of adults with stable chronic obstructive pulmonary disease assessing the effectiveness in muscle strength of upper limb exercise training, compared with other types of exercise, such as lower limb or respiratory exercises, as well as with no exercise. The methodological quality of each study was assessed using PEDro Scale.

Results: Twenty-one studies, with a total sample of 730 patients, met the inclusion criteria. Most of the studies were of moderate quality, with a quality score ranging between three to nine (out of 10) on the PEDro Scale. The majority of the studies (20/21) included resistance training of the upper limbs; however, other exercise parameters, such as frequency, intensity and time of intervention were differed among studies. In addition, strength assessment method and assessed muscle group varied among studies. Most common assessment methods were 1 repetition maximum, isometric, and isokinetic muscle strength. Muscle strength assessment usually included elbow flexors, shoulder flexors and abductors, chest muscles (pectoralis major), latissimus dorsi and handgrip muscles. Consistent results from the majority of the studies suggest significant within- and between-group strength improvements in favour of upper limb resistance training, at least in one of the muscle groups evaluated.

Conclusion(s): The results of this review showed that upper limb resistance training could improve upper limb muscle strength in patients with chronic obstructive pulmonary disease. Heterogeneity in training parameters did not allow for recommendations regarding the most effective strengthening program.

Implications: According to the results of the current review upper limb resistance training can significantly improve upper limb muscle strength. It is recommended that upper limb resistance training should be part of an individualized comprehensive pulmonary rehabilitation program in patients with chronic obstructive pulmonary disease.

Funding, acknowledgements: None

Keywords: Chronic Obstructive Pulmonary Disease, Upper limbs, Muscle strength

Topic: Cardiorespiratory

Did this work require ethics approval? No

Institution: n/a

Committee: n/a

Reason: It was a systematic review