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Short-term Efficacy of Upper-Extremity Exercise Training in Patients With Chronic Airway Obstruction: A Systematic Review

S Costi, PT, MSc, is Physical Therapist, Section of Respiratory Disease, Department of Oncology, Haematology, and Respiratory Disease, University of Modena and Reggio Emilia, Via del Pozzo 74, 41100 Modena, Italy.
M Di Bari, MD, is Doctor, Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatrics, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
P Pillastrini, PT, MSc, is Physical Therapist, Department of Neurological Sciences, Occupational Medicine Unit, S Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
R D'Amico, PhD, is Statistician, Section of Respiratory Disease, Department of Oncology, Haematology, and Respiratory Disease, University of Modena and Reggio Emilia.
E Crisafulli, MD, is Doctor, Department of Pulmonary Rehabilitation, Ospedale Villa Pineta, Pavullo, Modena, Italy.
C Arletti, PT, BSc, Physical Therapist, Anni Azzurri, Ducale 1, 2, 3, Modena, Italy.
LM Fabbri, MD, is Doctor, Section of Respiratory Disease, Department of Oncology, Haematology, and Respiratory Disease, University of Modena and Reggio Emilia.
EM Clini, MD, FCCP, is Doctor, Section of Respiratory Disease, Department of Oncology, Haematology, and Respiratory Disease, University of Modena and Reggio Emilia, and Department of Pulmonary Rehabilitation, Ospedale Villa Pineta.

stefania.costi{at}unimore.it

Background, Objectives, and Measurements: Patients with chronic airway obstruction (CAO) frequently experience dyspnea and fatigue during activities performed by accessory muscles of ventilation, which competitively participate in arm elevation. This systematic review of randomized controlled trials (RCTs) concerning patients with CAO addresses the effects of upper-extremity exercise training (UEET), added to lower-extremity training or comprehensive pulmonary rehabilitation, on the following patient-centered outcomes: exercise capacity, symptoms, ability to perform daily activities, and health-related quality of life.

Methods: Studies were retrieved using comprehensive database and hand-search strategies. Two independent reviewers determined study eligibility based on inclusion criteria. A detailed description of treatments was mandatory. Reviewers rated study quality and extracted information on study methods, design, intervention, and results.

Results: Forty publications were evaluated. Four RCTs met the inclusion criteria but had serious methodological limitations, which introduce possible biases that reduce their internal validity. The outcomes measured were heterogeneous, and the results were inconsistent regarding maximal exercise capacity, dyspnea, and health-related quality of life. No effect of UEET was demonstrated for measures of arm fatigue.

Limitations and Conclusions: The limited methodological quality of the studies retrieved prevented us from performing a meta-analysis, the results of which could be misleading. This systematic review shows that there is limited evidence examining UEET and that the evidence available is of poor quality. Therefore, a recommendation for the inclusion or exclusion of UEET in pulmonary rehabilitation programs for individuals with CAO is not possible. Further research is needed to definitively ascertain the effects of this training modality on patient-centered outcomes.

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				S. Costi, E. Crisafulli, F. D. Antoni, C. Beneventi, L. M. Fabbri, and E. M. Clini Effects of Unsupported Upper Extremity Exercise Training in Patients With COPD: A Randomized Clinical Trial Chest, August 1, 2009; 136(2): 387 - 395. [Abstract] [Full Text] [PDF]