【COPD英文精品課件】Upper-extremity-training-in-COPD

1、Upper extremity training in COPDTania Janaudis-Ferreira, BScPT, MSc, PhD Post Doctoral Research Fellow West Park Healthcare Centre, Toronto and Department of Physical Therapy, University of Toronto.Conflict of interestI have no conflict of interest to declareObjectives of this session To understand

2、the impact of upper extremity dysfunction on dyspnea in COPDTo understand the role of upper extremity training as part of COPD rehabilitation and to get acquainted with different types of arm trainingTo understand how to measure arm exercise capacity in patients with COPDBackgroundAirflow limitation

3、Lung hyperinflationSystemic inflammationPeripheral muscle dysfunctionImpairments are encountered during hurried walking, stair climbing and simple activities of daily living (ADL)Dyspneaand exercise intoleranceImpairments during arm activities:Dyspnea and arm fatigueArm fatigue:Muscle strengthDyspne

4、a Overhead arm activity FRC hyperinflationWorsens respiratory muscle mechanics burden on diaphragm worsening its force-generating capacity sensation of dyspneaDuring unsupported arm activity unable to use accessory musclesWhat we knowSystematic reviewsCosti et al. and Janaudis-Ferreira et al. (2009)

5、:Upper extremity training increases arm exercise capacity Effect on other clinical outcomes are unclear - Methodological shortcomingsACCP/AACVPR guidelinesRecommend the inclusion of upper-extremity training in PR The best type of arm training is unknown due to lack of randomized controlled trialsJan

6、audis-Ferreira et al. 2009Characteristics of the arm training programs Supported and unsupported exercises:Cycle ergometer (Ries et al. and Lake et al.)Dowel lifts (Epstein et al. and Holland et al.)Hand weights (Ries et al. and Bauldoff et al.)Ball against wall (Lake et al.)Passing bean bags (Lake

7、et al.)Pulling ropes (Lake et al.)Moving rings (Lake et al.)Latest ResearchRecent RCTsAddressed the methodological shortcomings of the previous studiesIncluded a comprehensive upper extremity resistance training with standardized training protocol/progressionIncluded measures of HRQL and symptoms du

8、ring ADL and arm testsCosti et al.: demonstrated improvements in arm function and ADLObjectiveEvaluate the effect of a 6-week program of unsupported upper extremity resistance training for patients with COPD on dyspnea during ADL, arm function, arm exercise capacity, muscle strength and HRQL. Traini

9、ng characteristicsTraining duration: -3 days/week (during 6 weeks)-total of 18 sessionsMuscle groups: pectoralis, latissimus, deltoids, rhomboids, biceps, triceps Initial load: 10-12 RMControl group: sham (upper limb flexibility and stretching exercises)CHEST PRESSPectoralis major, deltoids medial,

10、tricepsPEC-DEC BUTTERFLYPectoralis major, middle deltoidsSEATED ROWRhomboids, Latissumus, biceps, trapezius, deltoidsLAT PULL DOWNLatissimus dorsi, deltoids , rhomboids, biceps, erector spinaeARM CURL BicepsTRICEPS PRESS DOWNTricepsFront arm raisesAnterior deltoidsShoulder PressMiddle deltoidsTraini

11、ng ProtocolLarger muscles before smaller musclesInitial loads 10 -12 repetition Start with 1x12 for 4 sessions then 2x12 for the rest Loads were increased if they could manage more than 12 repetitions for both sets on two consecutive sessions Rest 1-3 minutes between setsPatients rate dyspnea and ar

12、m fatigue (BORG), before and afterOutcome measuresDyspnea during ADL (CRDQ)Health-related quality of life (CRDQ)Arm exercise capacity (UULEX)Arm function (6PBRT)Arm fatigue and dyspnea during arm exercise tests (Borg scale)Peripheral muscle force (hand-held dynamometer)EquipmentsZhan et al. 2006Taka

13、hashi et al. 2003UULEX6PBRTMicrofet 2Significant findingsImprovements in arm function, arm exercise capacity and arm muscle strengthNo between-group differences in HRQL or dyspnea during ADLPossible mechanisms responsible for an increase in arm exercise capacityImproved aerobic capacity Desensitizat

14、ion or tolerance to symptomsIncrease force-generating capacity Improved muscular coordinationdecrease in dyspneaSummary of the resultsResistance arm training program improved arm function, arm exercise capacity and muscle strengthPatients achieved superior performance during tests of arm exercise ca

15、pacity without any significant increase in dyspnea or arm fatigueEvidences for arm endurance training?No study specifically examined the effects of arm endurance training in COPDAssessmentHow should we measure arm exercise capacity in COPD? A systematic review.Tania Janaudis-Ferreira1,2, Marla K. Be

16、auchamp1, Roger Goldstein1,2,3, Dina Brooks1,21Respiratory Medicine, West Park Healthcare Centre, Toronto, Canada 2Dept of Physical Therapy and 3Medicine, University of Toronto, Canada.Results41 articles were included in the reviewFive categories of arm exercise tests were identified: (1) arm ergome

17、try (Peak ex. capacity, endurance)(2) ring shifts (Function, endurance)(3) dowel or arm lifts (Peak ex. capacity, endurance, function)(4) diagonal movement using PNF (Peak ex. capacity)(5) ADL-based test (Function)Only 4 studies assessed measurement properties of arm exercise tests (6PBRT, UULEX, Gr

18、ocery Shelving Task (GST) and an overhead task)ResultsType of testConstruct ValidityTest-retest reliabilityResponsivenessInterpretabilityArm ergometryNoNoSomeNoRing ShiftsYes: 6PBRT and OHTYesSomeNoDowel liftsYes:UULEXYesSomeNoPNFNoNoNoNoADL testYes:GSTYesYesNo Evidence for the measurement properties of the arm exercise testsConclusionsThe choice of the test should depend on the target construct being measur