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A New Unsupported Upper Limb Exercise Test for Patients With Chronic Obstructive Pulmonary Disease

Takahashi, Tetsuya PT, MSc; Jenkins, Sue C. PT, PhD; Strauss, Geoffrey R. MPE; Watson, Carol P. PT; Lake, Fiona R. MD

Journal of Cardiopulmonary Rehabilitation: November/December 2003 - Volume 23 - Issue 6 - pp 430-437
Pulmonary Rehabilitation

PURPOSE: This study aimed to develop a new unsupported upper limb exercise test (UULEX) for patients with chronic obstructive pulmonary disease (COPD).

METHODS: The reproducibility of the UULEX was assessed in nine patients with COPD who performed the test on three occasions. A comparison of the UULEX and a supported incremental upper limb exercise test (SULEX) using an arm ergometer also was performed with 18 patients who had COPD.

RESULTS: There were no significant differences in the maximum values for each cardiorespiratory variable and sensation of dyspnea between the three repetitions of the UULEX, and all the variables showed high reproducibility. During the supported test, maximum values for the cardiorespiratory variables were significantly higher, but the ratio of minute ventilation to carbon dioxide output was lower than during the unsupported exercise test. There were significant correlations for cardiorespiratory responses, arm muscle fatigue, and sensation of dyspnea between the two tests.

CONCLUSIONS: The findings suggest that the new UULEX test is a reproducible and acceptable exercise test for patients with COPD that can be used as a simple method to evaluate upper limb function in these patients. Further studies are required to determine the external validity of the test and its sensitivity to interventions such as pulmonary rehabilitation.

Breathlessness during routine daily tasks involving unsupported upper limb activities is a common and serious problem for patients with chronic obstructive pulmonary disease (COPD). This problem often leads to avoidance of upper limb activities. As a result, patients become increasingly disabled because they are no longer able to cope with simple activities of daily living. Currently, there is no standard method available to test the upper limb function of patients with COPD, although arm exercise tests using a cycle ergometer often are used. Such tests, however, are not the most appropriate for assessing disability during upper limb activities of patients with COPD because arm cycling movements bear little semblance to arm use during activities of daily living.

A number of studies have determined the cardiorespiratory responses during unsupported upper limb exercise for both normal subjects and patients with COPD. In all these studies, unsupported upper limb exercise consisted of simple arm elevation, which resulted in a measurable cardiorespiratory response in both groups. However, the unsupported upper limb exercises studied were not incremental and required substantial static muscle contraction for maintenance of the upper limbs at 90° of shoulder flexion 1–4 or shoulder abduction, 5 or above 90° of shoulder flexion in the performance of small-amplitude (10 cm) vertical movements of the upper limbs. 6–9 These exercises also imposed a single constant workload. A standardized unsupported upper limb exercise test that mimics daily activities is essential for evaluating the effects of different therapies, including pulmonary rehabilitation, and may be useful in the assessment of patients because the upper limbs are used in a wide variety of daily tasks.

The aim was to develop a simple unsupported incremental upper limb exercise test (UULEX) that could be used in the assessment of patients with COPD and in studies investigating the effectiveness of therapies. The specific objectives were to examine the within-patient reproducibility of the UULEX, and to compare the UULEX and a supported upper limb exercise test (SULEX) among patients with COPD.

From the School of Physiotherapy, Curtin University of Technology (Mr Takahashi, Dr Jenkins, Mr Strauss); the Physiotherapy Department, Sir Charles Gairdner Hospital (Dr Jenkins); the Physiotherapy Department, Royal Perth Hospital (Ms Watson); the School of Medicine and Pharmacology, University of Western Australia and Department of Respiratory Medicine, Royal Perth Hospital, Perth, Australia (Dr Lake).

Address correspondence to: Tetsuya Takahashi, Kou 3-12, Kameizumi, Maebashi-shi, Gunma, 371-0004, Japan (e-mail:

© 2003 Lippincott Williams & Wilkins, Inc.