Upper arm exercise in COPD patients: From physiology to bed-side

Patients suffering from COPD often complain limited activity in everyday life due to the weakness of muscles of their upper limbs, which are also involved to sustain ventilatory function. Functional mechanisms and interactions involving activated muscles of the upper limbs may lead to ventilatory asynchronism, reduced mechanical efficacy of the arms, increased load on the ventilatory pump. To date, there is evidence that specifically training the upper limb muscles may prove rationale in COPD patients. Aim of the present review is, therefore, to update the knowledge of methods and results of upper limb training in these patients. In each section of the article, data on physiology of the upper limb muscles in healthy and COPD patients as well as the effectiveness of training programs are reviewed. Methods of evaluation and modality to deliver training are also included.