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Strategies for exercise assessment and training in patients with chronic obstructive pulmonary disease
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Rationale: Chronic obstructive pulmonary disease (COPD) is not only a common lung disease but is a major cause of morbidity and mortality worldwide. Pulmonary rehabilitation (PR) helps optimize function and independence by increasing exercise capacity, reducing symptoms and improving health related quality of life (HRQL). Exercise training is certainly a key component of the PR programs; however, many of its aspects still need to be better defined such as optimal exercise assessment and training modality for these patients. The general purpose of this thesis was to generate new knowledge that could contribute to new strategies for exercise assessment and training in patients with COPD.

Methods and results: This thesis is comprised of four independent studies. Thigh muscle strength, endurance and fatigue were compared between 42 patients with moderate to severe COPD and 53 healthy controls (Study I). Impaired thigh muscle strength and endurance in patients with COPD was found, except for muscle strength in knee extension in male patients. Female patients had higher fatigue index than female controls while no difference was found between male patients and controls. The six-minute walk test (6MWD) performed on a non-motorized treadmill (6MWD-T) was compared with the 6MWD performed in a corridor (6MWD-C) in 16 healthy elderly subjects (Study II). They performed twelve tests (six 6MWD-C and six 6MWD-T) on two different days in a randomized order. An average discrepancy was found between the two methods with the subjects walking a shorter distance on the non-motorized treadmill. However, the results showed good test-retest reliability between days and test repetitions. A systematic review (Study III) was done of studies that investigated the effects of an arm training program in patients with COPD. The findings of this review indicated that there is evidence that an arm training program improves arm exercise capacity, but its effects on dyspnea, arm fatigue and healthy-related quality of life is unclear. Finally, a two-armed randomized controlled trial examined the effects of an arm training program on arm function, arm exercise capacity, muscle strength, symptoms and HRQL in patients with COPD (Study IV). The groups were randomized to arm training or sham. Compared with the changes observed in the control group, the magnitude of change in the intervention group was greater for arm function, arm exercise capacity and muscle strength. There was no difference between groups in HRQL or symptoms.

Conclusions: Upper extremity resistance training improves arm exercise capacity, arm function and muscle strength in patients with COPD. Training and assessment of upper and lower limb muscles should be included into PR programs. The 6MWD performed on a non-motorized treadmill may offer an alternative option to the standard 6MWD when a 30-meter corridor is not available.

Place, publisher, year, edition, pages
Umea: Umeå university , 2010. , 69 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1360
Keyword [en]
COPD, exercise, assessment, muscle strength, arm function
National Category
Physiotherapy
Research subject
Lung Medicine
Identifiers
URN: urn:nbn:se:umu:diva-35565ISBN: 978-91-7459-050-0 (print)OAI: oai:DiVA.org:umu-35565DiVA: diva2:345134
Public defence
2010-09-15, Aulan, Vårdvetarhuset, Umea, 13:00 (English)
Opponent
Supervisors
Available from: 2010-08-26 Created: 2010-08-23 Last updated: 2011-04-15Bibliographically approved
List of papers
1. Thigh muscle strength and endurance in patients with COPD compared with healthy controls.
Open this publication in new window or tab >>Thigh muscle strength and endurance in patients with COPD compared with healthy controls.
2006 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 100, no 8, 1451-1457 p.Article in journal (Refereed) Published
Keyword
Activities of Daily Living, Aged, Female, Humans, Male, Middle Aged, Muscle Contraction/physiology, Muscle Fatigue/*physiology, Muscle Strength/*physiology, Pulmonary Disease; Chronic Obstructive/*physiopathology, Sex Factors, Sweden, Thigh
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-7082 (URN)10.1016/j.rmed.2005.11.001 (DOI)16337114 (PubMedID)
Available from: 2008-01-03 Created: 2008-01-03 Last updated: 2017-12-14Bibliographically approved
2. Comparison of the 6-minute walk distance test performed on a non-motorised treadmill and in a corridor in healthy elderly subjects
Open this publication in new window or tab >>Comparison of the 6-minute walk distance test performed on a non-motorised treadmill and in a corridor in healthy elderly subjects
2010 (English)In: Physiotherapy, ISSN 0031-9406, E-ISSN 1873-1465, Vol. 96, no 3, 234-239 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To compare the 6-minute walk distance (6MWD) test performed on a non-motorised treadmill (6MWD-T) with the 6MWD test performed in a corridor (6MWD-C) in healthy elderly subjects.

PARTICIPANTS: Sixteen healthy elderly individuals.

DESIGN: Participants performed three 6MWD-T tests and three 6MWD-C tests on two different days.

OUTCOME MEASURES: Distance walked was recorded in metres. Perceived exertion and leg fatigue were rated on the modified Borg scale before and after each test.

RESULTS: Using the Bland and Altman limits of agreement analysis method, the mean difference between the two methods was 153.3m (limits of agreement: 28 to 278). The mean difference between days 1 and 2 for the 6MWD-C test was -7.2m (limits of agreement: -45.4 to 30.8), and the mean difference between days 1 and 2 for the 6MWD-T test was -1.6m (limits of agreement: -64.0 to 60.7). The mean difference between the first and second repetitions of the 6MWD-C test was -5m (limits of agreement: -41 to 31), and the mean difference between the first and second repetitions of the 6MWD-T test was -17m (limits of agreement: -85 to 51).

CONCLUSIONS: The 6MWD-C and 6MWD-T tests are not interchangeable. However, the results showed good test-retest reliability between days and between test repetitions for both tests. Therefore, the 6MWD-T test may offer an alternative option to the 6MWD-C test when a 30-m corridor is not available. These findings may have implications for execution of the 6MWT-T test within cardiac and pulmonary rehabilitation.

National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-35569 (URN)10.1016/j.physio.2009.11.015 (DOI)000281889800008 ()20674656 (PubMedID)
Available from: 2010-08-24 Created: 2010-08-24 Last updated: 2017-12-12Bibliographically approved
3. Arm exercise training in patients with cronic obstructíve pulmonary disease: a systematic review
Open this publication in new window or tab >>Arm exercise training in patients with cronic obstructíve pulmonary disease: a systematic review
Show others...
2009 (English)In: Journal of cardiopulmonary rehabilitation and prevention, ISSN 1932-7501, Vol. 29, 277-283 p.Article in journal (Refereed) Published
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-29878 (URN)
Available from: 2009-11-25 Created: 2009-11-25 Last updated: 2011-04-15Bibliographically approved
4. Resistance arm training in patients with chronic obstructive pulmonary disease: a randomized controlled trial
Open this publication in new window or tab >>Resistance arm training in patients with chronic obstructive pulmonary disease: a randomized controlled trial
Show others...
2011 (English)In: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 139, no 1, 151-158 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The study aimed to evaluate the effect of upper extremity resistance training for patients with COPD on dyspnea during activity of daily living (ADL), arm function, arm exercise capacity, muscle strength and health related quality of life (HRQL)

METHODS: Patients were randomly assigned to an intervention or control group. The intervention group underwent arm resistance training. The control group performed a sham. Both groups exercised 3 times a week for 6 weeks. Dyspnea during ADL and HRQL were measured using the chronic respiratory disease questionnaire (CRDQ). Arm function and exercise capacity were measured using the 6-minute pegboard and ring test (6PBRT) and the unsupported upper limb exercise test (UULEX), respectively. Muscle strength for the biceps, triceps, anterior and middle deltoids was obtained using an isometric dynamometer.

RESULTS: Thirty-six patients with COPD (66 +/- 9 yrs) participated in the study. Compared with the control group, the magnitude of change in the intervention group was greater for the 6PBRT (p = 0.03), UULEX (p = 0.01) and elbow flexion force (p = 0.01); elbow extension force (p = 0.02), shoulder flexion force (p = 0.029) and shoulder abduction force (p = 0.01). There was no between-group difference in dyspnea during ADL, HRQL or symptoms during the 6PBRT or UULEX (all p values greater than 0.08).

CONCLUSIONS: Resistance based arm training improved arm function, arm exercise capacity and muscle strength in patients with COPD. No improvement in dyspnea during ADL, HRQL or symptoms was demonstrated.

Place, publisher, year, edition, pages
American College of Chest Physicians, 2011
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-35568 (URN)10.1378/chest.10-1292 (DOI)000286493400025 ()20724740 (PubMedID)
Available from: 2010-08-24 Created: 2010-08-24 Last updated: 2017-12-12Bibliographically approved

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