The degree of arm elevation impacts the endurance and cardiopulmonary adaptations of COPD patients performing upper-limb exercise

a cross-over study

Mara Paneroni, Carla Simonelli, Pierantonio Laveneziana, Massimiliano Gobbo, Manuela Saleri, Luca Bianchi, Michele Vitacca

Research output: Contribution to journalArticle

Abstract

BACKGROUND: In Chronic Obstructive Pulmonary Disease (COPD), upper limb exercise is widely recommended. However, how the degree of shoulder flexion may influence the exercise response is unknown.

AIM: We compared metabolic, ventilatory and symptomatic responses during constant-load supported and unsupported exercise performed at 80° and 120° arm elevation.

DESIGN: Randomized cross-over study.

SETTING: Pulmonary Pathophysiology Service in an Italian Respiratory Rehabilitative Division, in-patients were enrolled.

METHODS: Twelve patients with moderate-to-severe COPD (FEV1 51%, BMI 26.7 ± 6.3 Kg/m2) performed 4 symptom-limited constant-load tests at 70% of their individual maximal workload: 2 supported and 2 unsupported, respectively at 80° and 120° of glenohumeral joint flexion, executed in a random order.

RESULTS: Time to exhaustion (Tlim), evaluated by Kaplan-Maier curve, was shorter at 120° than 80° arm elevation in both supported (360 vs.. 486 seconds, p=0.031) and unsupported exercise (210 vs.. 375 seconds, p=0.005). No difference in dynamic hyperinflation was found between 80° and 120° elevation, even at the peak of exercise and at iso-ventilation. When normalized to Tlim, 120° arm elevation had a significantly higher metabolic cost, heart rate, minute ventilation and dyspnea/fatigue symptoms compared to 80° elevation, both in unsupported and supported conditions.

CONCLUSIONS: A larger shoulder flexion shortens per se exercise endurance due to the increased metabolic, ventilatory and cardiac response, without worsening dynamic hyperinflation.

CLINICAL REHABILITATION IMPACT: Arm position should be considered when prescribing individual exercise training and may be adjusted to modulate the workload.

Original languageEnglish
Pages (from-to)690-697
Number of pages8
JournalEuropean Journal of Physical and Rehabilitation Medicine
Volume54
Issue number5
DOIs
Publication statusPublished - Oct 2018

Fingerprint

Upper Extremity
Cross-Over Studies
Chronic Obstructive Pulmonary Disease
Arm
Exercise
Workload
Ventilation
Shoulder Joint
Dyspnea
Fatigue
Rehabilitation
Heart Rate
Costs and Cost Analysis
Lung

Keywords

  • Aged
  • Arm/physiology
  • Cross-Over Studies
  • Dyspnea/etiology
  • Exercise Therapy/methods
  • Exercise Tolerance
  • Female
  • Humans
  • Male
  • Muscle Strength
  • Pulmonary Disease, Chronic Obstructive/physiopathology
  • Quality of Life

Cite this

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title = "The degree of arm elevation impacts the endurance and cardiopulmonary adaptations of COPD patients performing upper-limb exercise: a cross-over study",
abstract = "BACKGROUND: In Chronic Obstructive Pulmonary Disease (COPD), upper limb exercise is widely recommended. However, how the degree of shoulder flexion may influence the exercise response is unknown.AIM: We compared metabolic, ventilatory and symptomatic responses during constant-load supported and unsupported exercise performed at 80° and 120° arm elevation.DESIGN: Randomized cross-over study.SETTING: Pulmonary Pathophysiology Service in an Italian Respiratory Rehabilitative Division, in-patients were enrolled.METHODS: Twelve patients with moderate-to-severe COPD (FEV1 51{\%}, BMI 26.7 ± 6.3 Kg/m2) performed 4 symptom-limited constant-load tests at 70{\%} of their individual maximal workload: 2 supported and 2 unsupported, respectively at 80° and 120° of glenohumeral joint flexion, executed in a random order.RESULTS: Time to exhaustion (Tlim), evaluated by Kaplan-Maier curve, was shorter at 120° than 80° arm elevation in both supported (360 vs.. 486 seconds, p=0.031) and unsupported exercise (210 vs.. 375 seconds, p=0.005). No difference in dynamic hyperinflation was found between 80° and 120° elevation, even at the peak of exercise and at iso-ventilation. When normalized to Tlim, 120° arm elevation had a significantly higher metabolic cost, heart rate, minute ventilation and dyspnea/fatigue symptoms compared to 80° elevation, both in unsupported and supported conditions.CONCLUSIONS: A larger shoulder flexion shortens per se exercise endurance due to the increased metabolic, ventilatory and cardiac response, without worsening dynamic hyperinflation.CLINICAL REHABILITATION IMPACT: Arm position should be considered when prescribing individual exercise training and may be adjusted to modulate the workload.",
keywords = "Aged, Arm/physiology, Cross-Over Studies, Dyspnea/etiology, Exercise Therapy/methods, Exercise Tolerance, Female, Humans, Male, Muscle Strength, Pulmonary Disease, Chronic Obstructive/physiopathology, Quality of Life",
author = "Mara Paneroni and Carla Simonelli and Pierantonio Laveneziana and Massimiliano Gobbo and Manuela Saleri and Luca Bianchi and Michele Vitacca",
year = "2018",
month = "10",
doi = "10.23736/S1973-9087.18.04962-6",
language = "English",
volume = "54",
pages = "690--697",
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TY - JOUR

T1 - The degree of arm elevation impacts the endurance and cardiopulmonary adaptations of COPD patients performing upper-limb exercise

T2 - a cross-over study

AU - Paneroni, Mara

AU - Simonelli, Carla

AU - Laveneziana, Pierantonio

AU - Gobbo, Massimiliano

AU - Saleri, Manuela

AU - Bianchi, Luca

AU - Vitacca, Michele

PY - 2018/10

Y1 - 2018/10

N2 - BACKGROUND: In Chronic Obstructive Pulmonary Disease (COPD), upper limb exercise is widely recommended. However, how the degree of shoulder flexion may influence the exercise response is unknown.AIM: We compared metabolic, ventilatory and symptomatic responses during constant-load supported and unsupported exercise performed at 80° and 120° arm elevation.DESIGN: Randomized cross-over study.SETTING: Pulmonary Pathophysiology Service in an Italian Respiratory Rehabilitative Division, in-patients were enrolled.METHODS: Twelve patients with moderate-to-severe COPD (FEV1 51%, BMI 26.7 ± 6.3 Kg/m2) performed 4 symptom-limited constant-load tests at 70% of their individual maximal workload: 2 supported and 2 unsupported, respectively at 80° and 120° of glenohumeral joint flexion, executed in a random order.RESULTS: Time to exhaustion (Tlim), evaluated by Kaplan-Maier curve, was shorter at 120° than 80° arm elevation in both supported (360 vs.. 486 seconds, p=0.031) and unsupported exercise (210 vs.. 375 seconds, p=0.005). No difference in dynamic hyperinflation was found between 80° and 120° elevation, even at the peak of exercise and at iso-ventilation. When normalized to Tlim, 120° arm elevation had a significantly higher metabolic cost, heart rate, minute ventilation and dyspnea/fatigue symptoms compared to 80° elevation, both in unsupported and supported conditions.CONCLUSIONS: A larger shoulder flexion shortens per se exercise endurance due to the increased metabolic, ventilatory and cardiac response, without worsening dynamic hyperinflation.CLINICAL REHABILITATION IMPACT: Arm position should be considered when prescribing individual exercise training and may be adjusted to modulate the workload.

AB - BACKGROUND: In Chronic Obstructive Pulmonary Disease (COPD), upper limb exercise is widely recommended. However, how the degree of shoulder flexion may influence the exercise response is unknown.AIM: We compared metabolic, ventilatory and symptomatic responses during constant-load supported and unsupported exercise performed at 80° and 120° arm elevation.DESIGN: Randomized cross-over study.SETTING: Pulmonary Pathophysiology Service in an Italian Respiratory Rehabilitative Division, in-patients were enrolled.METHODS: Twelve patients with moderate-to-severe COPD (FEV1 51%, BMI 26.7 ± 6.3 Kg/m2) performed 4 symptom-limited constant-load tests at 70% of their individual maximal workload: 2 supported and 2 unsupported, respectively at 80° and 120° of glenohumeral joint flexion, executed in a random order.RESULTS: Time to exhaustion (Tlim), evaluated by Kaplan-Maier curve, was shorter at 120° than 80° arm elevation in both supported (360 vs.. 486 seconds, p=0.031) and unsupported exercise (210 vs.. 375 seconds, p=0.005). No difference in dynamic hyperinflation was found between 80° and 120° elevation, even at the peak of exercise and at iso-ventilation. When normalized to Tlim, 120° arm elevation had a significantly higher metabolic cost, heart rate, minute ventilation and dyspnea/fatigue symptoms compared to 80° elevation, both in unsupported and supported conditions.CONCLUSIONS: A larger shoulder flexion shortens per se exercise endurance due to the increased metabolic, ventilatory and cardiac response, without worsening dynamic hyperinflation.CLINICAL REHABILITATION IMPACT: Arm position should be considered when prescribing individual exercise training and may be adjusted to modulate the workload.

KW - Aged

KW - Arm/physiology

KW - Cross-Over Studies

KW - Dyspnea/etiology

KW - Exercise Therapy/methods

KW - Exercise Tolerance

KW - Female

KW - Humans

KW - Male

KW - Muscle Strength

KW - Pulmonary Disease, Chronic Obstructive/physiopathology

KW - Quality of Life

U2 - 10.23736/S1973-9087.18.04962-6

DO - 10.23736/S1973-9087.18.04962-6

M3 - Article

VL - 54

SP - 690

EP - 697

JO - European Journal of Physical and Rehabilitation Medicine

JF - European Journal of Physical and Rehabilitation Medicine

SN - 1973-9087

IS - 5

ER -