Chest
Volume 136, Issue 5, November 2009, Pages 1269-1283
Journal home page for Chest

Original Research
COPD
Progressive Resistance Exercise Improves Muscle Strength and May Improve Elements of Performance of Daily Activities for People With COPD: A Systematic Review

https://doi.org/10.1378/chest.09-0029Get rights and content

Background

Skeletal muscle weakness and its impact on exercise tolerance in many people with COPD provide a rationale for the intervention of progressive resistance exercise during pulmonary rehabilitation. To optimize rehabilitation outcomes, clinicians prescribing resistance programs require up-to-date information on effectiveness, safety, and feasibility. Therefore, the review aimed to update the current evidence for progressive resistance exercise for people with COPD.

Methods

Using the keywords of “COPD” and “strength/resistance/weight training,” controlled trials relating to progressive resistance exercise for people with COPD were identified through electronic database searches and citation tracking. Data from the identified trials were extracted and assessed by two independent reviewers. Standardized mean differences (effect sizes) with 95% CIs were determined, and overall effects were calculated using metaanalysis.

Main results

Eighteen controlled trials (including 10 trials published in the last 5 years) demonstrated moderate effects for increases in muscle strength after short-term progressive resistance exercise. Despite effects favoring progressive resistance exercise for cycling tests when compared with no intervention, and daily tasks such as sit-to-stand and stair climbing, trials reporting these outcomes had a higher risk of bias.

Conclusions

Short-term progressive resistance exercise can lead to appreciable increases in muscle strength for people with COPD, which may carry over to the performance of some daily activities. Future research should place emphasis on activity and participation level outcomes, and focus on determining the longer term outcomes and optimal methods for maintaining outcomes in this population.

Section snippets

Materials and Methods

The methods used were based on those previously described in the original systematic review.9 However, a few alterations to the review methods, such as the exclusion of noncontrolled trials and review articles, were made and are described. In order to identify new trials of progressive resistance exercise for people with COPD, the original search strategy was applied, with the time period limited from March 2003 to May 2006 for an initial review update, and then May 2006 to April 2008. The

Results

Figure 1 demonstrates the search yield for trials included in the review. Four additional trials20, 21, 22, 23 from the March 2003 to May 2006 search period and six additional trials24, 25, 26, 27, 28, 29 from the May 2006 to April 2008 search period were included. Accounting for the exclusion of the single group trial included in the earlier review,30 there was a total of 18 included trials.

Discussion

The results from 18 controlled clinical trials20-29, 31, 32, 33, 34, 35, 36, 37, 38 in the systematic review update confirmed that progressive resistance exercise can lead to appreciable increases in arm and leg muscle strength for people with COPD. Given that muscle weakness is a common problem in this population,4, 41, 42 progressive resistance exercise represents a beneficial treatment for improving muscle strength. Moreover, improvements in muscle strength can be obtained when progressive

Conclusion

The inclusion of a large number of more recent trials in the updated systematic review provides clinicians with a more comprehensive understanding of progressive resistance exercise outcomes and factors influencing implementation within the rehabilitation setting. This review confirmed that progressive resistance exercise can produce increases in arm and leg muscle strength, and suggested that the performance of tasks such as stair climbing and rising from sitting may improve after progressive

Acknowledgments

Author contributions: Dr. O'Shea contributed to conception, design, data acquisition, data analysis and interpretation, and drafting of the manuscript. Dr. Taylor contributed to design, data analysis and interpretation, and revision of the manuscript for intellectual content. Dr. Paratz contributed to the design, data analysis and revision of the manuscript for intellectual content. All authors have approved the final version of the submitted manuscript.

Financial/nonfinancial disclosures: The

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