Metabolic and ventilatory response pattern to arm elevation in patients with COPD and healthy age-matched subjects

Abstract

M Me et ta ab bo ol li ic c a an nd d v ve en nt ti il la at to or ry y r re es sp po on ns se e p pa at tt te er rn n t to o a ar rm m e el le ev va at ti io on n i in n p pa at ti ie en nt ts s w wi it th h C CO OP PD D a an nd d h he ea al lt th hy y a ag ge e--m ma at tc ch he ed d s su ub bj je ec ct ts s Each subject consecutively performed three types of arm elevation for 2 min, with 3 min rest periods in between. Breath-by-breath metabolic and ventilatory parameters and heart rate (HR) were registered during a 3 min baseline period and throughout the measurement period.Adjusted for significantly greater baseline test results in COPD patients, it was found that AE (arm elevation including recovery) tended to be more demanding with respect to metabolic and ventilatory response for patients with COPD than for the age-matched healthy subjects. Arm elevation resulted in an increase in oxygen consumption (V ' 'O 2 ) (COPD 12%; healthy 6%), carbon dioxide elimination V ' 'CO 2 (COPD 15%; healthy 10%), minute ventilation V ' 'E (COPD 13%; healthy 7%) and heart rate (COPD 2%; healthy 5%). A pronounced difference was found in the pattern of metabolic and ventilatory response to arm elevation, i.e. there was an earlier but sluggish V ' 'O 2 onset in COPD patients, whereas the healthy subjects demonstrated a sudden peak approximately 30 s after arm elevations. Mutual comparison of the three different types of arm elevation demonstrated a comparable response pattern.Knowledge of the specific response to arm elevations in COPD patients seems essential for interpretation of arm elevation tests in upper extremity rehabilitation programmes. Eur Respir J., 1995Respir J., , 8, 1345Respir J., -1351 Patients with severe chronic obstructive pulmonary disease (COPD) often complain of dyspnoea during activities of daily living, such as combing their hair, brushing their teeth or shaving [1][2][3]. These activities mainly involve (unsupported) movements of arm and shoulder muscles.Several factors may contribute to impairment of unsupported arm activities in COPD patients, such as a dual activity of shoulder muscles in breathing as well as movement [4,5], and peripheral [6] and respiratory [7] skeletal muscle weakness.In order to examine the possible limitations of (unsupported) arm activities in patients with COPD, other investigators have studied the metabolic and ventilatory requirements of simple arm elevation. In all studies, arm elevation resulted in a significant increase in metabolic and ventilatory requirements [3,4,5,8]. Possible differences in metabolic and ventilatory response pattern following arm elevation between COPD patients and healthy persons, however, have not yet been specified. Furthermore, it may be hypothesized that the response pattern depends on the type of arm elevation due to different muscle recruitment.In this study, the metabolic and ventilatory requirements of three basic arm elevations were compared between COPD patients and healthy age-matched control subjects. Material and methods Study popula...

Characteristics of daily arm activities in patients with COPD

“…Furthermore, differences in trapezius muscle effort between groups increased with arm elevation. This can be explained by previous findings showing that arm elevation in COPD patients is associated with changes in lung volumes and loss of vital capacity [9][10][11][12][13][14][15][16].…”

“…Patients with COPD experience a relatively high metabolic load and dyspnoea during the performance of self-paced domestic arm ADL compared to healthy control subjects [6]. Moreover, arm elevation in patients with COPD has been associated with loss of vital capacity [9][10][11][12][13][14][15][16]. Therefore, arm activities, especially when involving arm elevation, are demanding for accessory inspiratory muscles, such as the trapezius muscle [17].…”

Exercise training in chronic obstructive pulmonary disease

“…In brief, arm training has been studied because patients with moderate to severe COPD, particularly those with mechanical disadvantage of the diaphragm due to lung hyperinflation, have difficulty performing ADLs that involve the use of the upperlimbs. Also, arm elevation is associated with high metabolic and ventilatory demand [160][161][162], and activities involving the arms can lead to irregular, shallow, or dyssynchronous breathing [163,164]. Celli et al have postulated that an altered breathing pattern may result from de-recruitment of accessory respiratory muscles from their work as muscles of inspiration to contribute to arm activity [164,165].…”

Relationship of muscle strength with activities of daily living and quality of life in individuals with chronic obstructive pulmonary disease

“…al., (23), activities such as hair combing, brushing teeth or shaving involve shoulder muscles without support and upper limbs, and many of these muscles are still part of the accessory muscles of respiration. Relationship of muscle strength with activities of daily living and quality of life in individuals with chronic obstructive pulmonary disease 85…”