C hronic obstructive pulmonary disease (COPD) is characterized by dyspnea, fatigue, exercise intolerance, poor quality of life, and high rates of morbidity and mortality. 1 In addition, peripheral muscle weakness 2 and inability to perform activities of daily living (ADL) with the upper limbs (UL) are common findings among patients with COPD. 3 Pulmonary rehabilitation (PR) programs are offered worldwide for the management of COPD and exercise training is a core component of PR. 4 Evidence suggests that exercise training can improve muscle function in patients with COPD, 2,5 and can drive improvements of oxidative 6 and exercise capacity, 4,5,7 and reduce ventilatory requirements and dyspnea. 8 Although similar beneficial effects have also been reported in patients with COPD for resistance and endurance training, 9 the specifics and the relative contribution of the upper limb exercise training (ULET) in PR of these patients remain unclear. 5 Findings from previous systematic reviews evaluating ULET in patients with COPD were inconsistent with respect to the translation of UL functional improvements reported to outcome measures such as health-related quality of life (HRQL), dyspnea, and ADL. [10][11][12][13] Recent evidence from a systematic review and meta-analysis indicates no effect in dyspnea and HRQL when endurance ULET was compared with resistance ULET, or when ULET combined with lower limb exercise training was compared with lower limb training alone. 3 Recent PR guidelines included endurance and resistance exercise for developing cardiorespiratory function, musculoskeletal fitness, and HRQL. 5,14 Upper limb exercise training has also been recommended given the evidence for improvements in UL function 5 ; however, the effectiveness of ULET in ADL of patients with COPD, as well as the optimal type of ULET, has yet to be determined due to the limited evidence comparing the effectiveness of different UL training interventions. 3 Given the lack of evidence from studies combining endurance and resistance ULET on patient-relevant outcomes, the main objective of the present study was to evaluate the effects of a rehabilitation program including resistance ULET with and without the addition of endurance ULET on ADL, HRQL, peripheral muscle strength, dyspnea, and fatigue perception in patients with COPD.
METHODSPatients with stable COPD were referred for a PR program at Nicosia General Hospital. Consecutive patients were approached over a period of 18 mo (December 2017 to June 2019). Patients were included if they had: (1) diagnosis of