Arm exercise and hyperinflation in patients with COPD - Effect of arm training

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 (Vo(2)), carbon dioxide output, minute ventilation (VE), 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 Vo(2) 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 VE and IC, and of IC with Vo(2); (3) at a standardized work rate, VE, 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 VE was accomplished primarily, by, a decrease in RR; and (4) at standardized VE, 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.