Reference values for the Unsupported Upper Limb Exercise test in healthy adults in Brazil

Abstract

Objective: To establish reference values for the Unsupported Upper Limb EXercise (UULEX) test, which measures peak arm exercise capacity, in healthy adults in Brazil. Methods: This was a cross-sectional study, involving presumably healthy individuals ≥ 30 years of age who completed questionnaires and underwent spirometry. All of the individuals underwent two UULEX tests 30-min apart. The outcome measure was the maximum time (in min) to completion of the test. Results: We included 100 individuals between 30 and 80 years of age. The mean test completion time was 11.99 ± 1.90 min among the women and 12.89 ± 2.15 min among the men (p = 0.03). The test completion time showed statistically significant correlations with age (r = −0.48; p < 0.001), gender (r = 0.28; p = 0.004), body mass index (BMI, r = −0.20; p = 0.05), and height (r = 0.28; p = 0.005). Linear regression analysis showed that the predictors of UULEX completion time were age (p = 0.000), BMI (p = 0.003), and gender (p = 0.019), which collectively explained 30% of the total variability. The mean UULEX completion time was 6% lower for the women than for the men. Conclusions: The present study was able to establish reference values for the UULEX test in healthy adults in Brazil. The values were influenced by age, gender, and BMI.

Upper limbs: how physically limited is your patient?

“…(4) When arm activities are unsupported, there is a reduction in inspiratory capacity and thoracoabdominal asynchrony, consequently increasing ventilatory demand and oxygen uptake, thus worsening dyspnea. (5)(6)(7)(8) Although oxidative capacity is preserved and even increased in the deltoid muscles, which support the upper limbs, exercise tolerance is lower during activities performed with no upper limb support. (5) Therefore, the use of specific tests for upper limb assessment is crucial in patients who report some type of limitation in the performance of ADLs involving the upper limbs.…”

“…(6) However, due to the lack of normative values for the Brazilian population, there is a gap in the literature regarding the correct interpretation of this test. In the current issue of the JBP, Lima et al (7) have determined, for the first time, reference values for the UULEX test in healthy adults in Brazil. Their study involved a sample of 100 healthy Brazilian individuals over 30 years of age.…”

“…The regression model developed by the authors demonstrated that UULEX completion time was partly explained by the gender, age, and body mass index of the individuals, those variables collectively accounting for 30% of the variability in completion time. (7) Although the sample size was small and the adjusted coefficient of determination was low (r 2 = 0.30), a descriptive analysis of the performance of the individuals in the sample was carried out, providing normative values for men and women in each decade of life. In fact, those results will be very useful to assist in the interpretation of the UULEX test in young adults and elderly individuals in Brazil.…”

“…The following is a practical example of how to identify upper limb exercise limitation objectively in a population known to present with pulmonary and systemic impairment. Considering the new UULEX test normative values (7) , we will interpret the performance of COPD patients in the study that introduced the UULEX test. (8) In that study, 9 patients underwent the test.…”

“…The mean age of those patients was 62 years, and most were male. Therefore, we used the normative values obtained in the study conducted by Lima et al (7) for males in the 61-to 70-year age group; that is, a mean UULEX completion time of 13.05 min (95% CI: 9.00-15.00). Thus, using a simple rule of three, we determined that the patients with COPD in that study showed 61% of the predicted values.…”