Kronik Obstrüktif Akciğer Hastalarında Üst Ekstremite Kas Kuvveti Eğitiminin Solunum ve Periferal Kas Kuvveti, Günlük Yaşam Aktiviteleri ve Yaşam Kalitesi Üzerine Etkileri

Abstract

Further studies investigating the impact of arm strength training on functional performance in daily life and health-related quality of life are needed in patients with chronic obstructive pulmonary disease (COPD). Therefore, this study was planned as a prospective and randomized controlled trial to investigate the effects of upper extremity muscle strength training on respiratory and peripheral muscle strength, activities of daily living (ADL) and quality of life in patients with COPD. Fourty two clinically stable patients with COPD were included in the study. These patients were randomly assigned into two groups. Upper extremity muscle strength training was given at 40-50 % of one repetition maximum, 3 sets/session, 3 days/week with 8-12 repetetions loading for total 23 sessions (8 weeks). The breathing exercises were given as a home program to applied as 7 days of the week for 8 weeks in training and control groups. Before and after treatment, pulmonary function was evaluated using spirometry, respiratory muscle strength was evaluated using mouth pressure device, peripheral muscle strength was evaluated using hand-held and Jamar dynamometers, arm exercise capacity was evaluated using arm ergometer test. The ADL were determined using Glittre ADL test and ADL simulation tests, London Chest ADL Scale (LCADL), Milliken ADL Scale (MAS), Nottingham Extended ADL Scale (NEADLS) and Canadian Occupational Performance Measurement (COPM). Quality of life was assessed using St George's Respiratory Questionnaire (SGRQ) and COPD Assessment Test (CAT). As a result of the study, statistically significant increases were detected in elbow extensors, shoulder horizontal adductors, hand grip strength, Jamar hand grip strength and %Jamar hand grip strength values, peak workload in arm ergometer and the number of cycles in ADL simulation test in training group (p<0.05). Significant decreases were found in dyspnea and arm fatigue perception changes during arm exercise test and heart rate and dyspnea changes during Glittre ADL test in training group after treatment (p<0.05). A significant reduction in LCADL-physical subdimension score and significant increases in MAS-house cleaning and laundry integrated score, MAS-other activities integrated score, NEADLS-mobility score, COPM-performance and COPM-satisfaction scores were found in the training group after treatment (p<0.05). There was not any change except a significant reduction in heart rate change during Glittre ADL test, significant increases in the number of cycles in ADL simulation test and MAS-other activities current ability level score in control group after treatment (p<0.05). In conclusion, upper extremity muscle strength training is a reliable and feasible method in clinical practice in patients with COPD. Upper extremity muscle strength training increases upper extremity peripheral muscle strength, arm exercise capacity and performance in ADL and the patients' satisfaction regarding the performance in this activities, decreases dyspnea and arm fatigue perception during supported arm exercises and dyspnea perception during ADL in patients with COPD.