Physiological and Symptomatic Responses to Arm versus Leg Activities in People with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

Assessment and indicators of kinematic behavior and perceived fatigability

OBJECTIVE

The objective of this study was to investigate the relationship between upper limb kinetics and perceived fatigability in elderly individuals during an upper limb position sustained isometric task.

METHODS

A total of 31 elderly participants, 16 men (72.94±4.49 years) and 15 women (72.27±6.05 years), performed a upper limb position sustained isometric task. Upper-limb acceleration was measured using an inertial measurement unit. Perceived fatigability was measured using the Borg CR10 scale.

RESULTS

Higher mean acceleration in the x-axis throughout the activity was associated with higher final perceived fatigability scores. Moderate correlations were observed between perceived fatigability variation and mean acceleration cutoffs in all axes during the second half of the activity. In women, significant correlations were found between all perceived fatigability cutoffs and mean acceleration in the y- and x-axes. However, in men, the relationships between perceived fatigability variation and mean acceleration were more extensive and stronger.

CONCLUSION

The acceleration pattern of the upper limb is linked to perceived fatigability scores and variation, with differences between sexes. Monitoring upper limb acceleration using a single inertial measurement unit can be a useful and straightforward method for identifying individuals who may be at risk of experiencing high perceived fatigability or task failure.

Upper-limb interval versus constant-load exercise in patients with COPD: a physiological crossover study

Objective

Upper-limb exercise is recommended for patients with COPD, albeit there are limited data concerning the optimal modality to implement. We compared interval (INT-EX) to continuous (CONT-EX) upper-limb exercise in terms of exercise tolerance, ventilatory and metabolic responses when both conditions were sustained at an equivalent work rate.

Methods

26 stable COPD patients undertook three upper-limb exercise sessions to initially establish peak work rate (PWR) via an incremental exercise test and subsequently two equivalent work rate tests to the limit tolerance in balanced order: 1) INT-EX consisting of 30-s work at 100% PWR interspersed with 30-s work at 40% of PWR; and 2) CONT-EX at 70% PWR.

Results

20 patients (76.9%) had longer tolerance during INT-EX, while six out of 26 (23.1%) exhibited longer tolerance during CONT-EX. The average endurance time was 434.1±184.7 and 315.7±128.7 s for INT-EX and CONT-EX, respectively. During INT-EX at isotime (i.e. when work completed was the same between INT-EX and CONT-EX), the majority of patients manifested lower oxygen uptake, minute ventilation, pulmonary hyperinflation, heart rate, symptoms and higher CO2 blood concentration. Patients with longer INT-EX had a lower comorbidity score (Cumulative Illness Rating Scale: 1.58±0.30 versus 1.88±0.29, p=0.0395) and better-preserved lung function (forced vital capacity 84.7±15.31% versus 67.67±20.56%, p=0.0367; forced expiratory volume in 1 s 57.15±14.59 versus 44.67±12.99% predicted, p=0.0725) compared to patients with longer CONT-EX.

Conclusion

INT-EX is more sustainable than CONT-EX for the majority of COPD patients with moderate obstruction, leading to lower dynamic hyperinflation and symptoms at isotime. Further studies need to define the benefits of its application during pulmonary rehabilitation.

Upper-Limb Kinematic Behavior and Performance Fatigability of Elderly Participants Performing an Isometric Task: A Quasi-Experimental Study

Upper-limb position-sustained tasks (ULPSIT) are involved in several activities of daily living and are associated with high metabolic and ventilatory demand and fatigue. In older people, this can be critical to the performance of daily living activities, even in the absence of a disability.

OBJECTIVES

To understand the ULPSIT effects on upper-limb (UL) kinetics and performance fatigability in the elderly.

METHODS

Thirty-one (31) elderly participants (72.61 ± 5.23 years) performed an ULPSIT. The UL average acceleration (AA) and performance fatigability were measured using an inertial measurement unit (IMU) and time-to-task failure (TTF).

RESULTS

The findings showed significant changes in AA in the X- and Z-axes (p < 0.05). AA differences in women started earlier in the baseline cutoff in the X-axis, and in men, started earlier between cutoffs in the Z-axis. TTF was positively related to AA in men until 60% TTF.

CONCLUSIONS

ULPSIT produced changes in AA behavior, indicative of movement of the UL in the sagittal plane. AA behavior is sex related and suggests higher performance fatigability in women. Performance fatigability was positively related to AA only in men, where movement adjustments occurred in an early phase, though with increased activity time.

Physiological responses and adaptations to exercise training in people with or without chronic obstructive pulmonary disease: protocol for a systematic review and meta-analysis

INTRODUCTION

Exercise training is a cornerstone in managing chronic obstructive pulmonary disease (COPD), leading to several physiological adaptations including, but not limited to, structural and muscular alterations, increased exercise capacity and improved cognitive function. Still, it is not uncommon that the acute physiological response to an exercise session and the extent of chronic adaptations to exercise training are altered compared with people without COPD. To date, potential differences in acute physiological responses and chronic adaptations in people with or without COPD are not fully understood, and results from individual studies are contradictory. Therefore, the current study aims to synthesise and compare the acute physiological responses and chronic adaptations to exercise training in people with COPD compared with people without COPD.

METHODS AND ANALYSES

A systematic review of randomised controlled trials (RCTs), non-randomised studies of interventions (NRSIs) and cross-sectional studies (CSSs) will be conducted. A comprehensive search strategy will identify relevant studies from MEDLINE, Scopus, CINAHL, SPORTDiscus, CENTRAL and Cochrane Airways Trials Register databases. Studies including adults with and without COPD will be considered. Outcomes will include cardiorespiratory, muscular and cognitive function, intramuscular adaptations, lung volumes and cardiometabolic responses. The protocol is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols and the Cochrane Methodological Expectations of Cochrane Intervention Reviews. Risk of bias assessment will be conducted using Cochrane Risk-of-Bias 2 Tool (for RCTs), Risk-of-Bias in Non-Randomised Studies Tool (for NRSIs) and Downs and Black checklist (for CSS). Meta-analyses will be conducted when appropriate, supplemented with a systematic synthesis without meta-analysis.

ETHICS AND DISSEMINATION

As this study is a systematic review, ethical approval is not required. The final review results will be submitted for publication in a peer-reviewed journal and presented at international conferences.

PROSPERO REGISTRATION NUMBER

CRD42022307577.