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Arm Exercise and Hyperinflation in Patients With COPD^*

Effect of Arm Training

^* From Fondazione Don C. Gnocchi, IRCCS, Pozzolatico, Florence, Italy.

Correspondence to: Giorgio Scano, MD, Section of Pulmonary Rehabilitation, Fondazione Don C. Gnocchi IRCCS, Via Imprunetana 124, 50020 Pozzolatico, Firenze, Italy; e-mail: uopneumo.pozzolatico{at}dongnocchi.it

Background: Unlike studies on leg exercise, reports on the regulation of dynamic hyperinflation during arm exercise are scanty. We ascertained the following in patients with COPD: (1) whether and to what extent upper-limb exercise results in dynamic hyperinflation, and (2) the mechanism whereby an arm-training program (ATP) reduces arm effort and dyspnea.

Patients: Twelve patients with moderate-to-severe COPD were tested during incremental, symptom-limited arm exercise after a nonintervention control period (pre-ATP) and after ATP.

Methods: Exercise testing (1-min increments of 5 W) was performed using an arm ergometer. Oxygen uptake (O₂), carbon dioxide output, minute ventilation (E), tidal volume, and respiratory rate (RR) were measured continuously during the tests. Inspiratory capacity (IC), exercise dyspnea, and arm effort using a Borg scale were assessed at each step of exercise.

Results: Arm exercise resulted in a significant decrease in IC and significant positive relationships of IC with an increase in O₂ and exercise dyspnea and arm effort. The results of ATP were as follows: (1) a significant increase in exercise capacity (p < 0.001); (2) no change in the relationships of exercise dyspnea and arm effort with E and IC, and of IC with O₂; (3) at a standardized work rate, E, exercise dyspnea, and arm effort significantly decreased, while the decrease in IC was significantly less (p < 0.01) than before the ATP; the decrease in E was accomplished primarily by a decrease in RR; and (4) at standardized E, exercise dyspnea and arm effort decreased significantly.

Conclusions: Arm exercise results in the association of dynamic hyperinflation, exercise dyspnea, and arm effort in COPD patients. An ATP increases arm endurance, modulates dynamic hyperinflation, and reduces symptoms.

Key Words: arm training • COPD • dynamic hyperinflation • dyspnea

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