Upper-Body Resistance Training and Self-Efficacy Enhancement in COPD

PURPOSE: Loss of skeletal muscle strength is commonly seen with chronic obstructive pulmonary disease (COPD). The study aim was to determine the effects of comprehensive upper-body resistance training (8 different lifts) and a self-efficacy enhancing intervention in COPD with respect to muscle strength, symptoms, functional status and exercise adherence. METHODS: This randomized trial had 3 groups: upper-body resistance training with an intervention to enhance self-efficacy (UBR + SE), upper-body resistance training and health education (UBR + HE), gentle chair exercises and health education (CE + HE). Subjects performed 16 weeks of supervised training, then 12 months of long-term maintenance at home. Outcomes were: muscle strength, dyspnea, functional status, self-efficacy, and adherence. RESULTS: Sixty-four subjects completed 16 wks of training: age 71 ± 8 yr, fat-free mass index 19 ± 3 kg/m(2), forced expiratory volume in one second 58 ± 18 percent predicted. The UBR + SE intervention produced a 46% increase in strength compared to a 36% increase in the UBR + HE group (P = 0.054). The combined UBR + SE and UBR + HE groups produced a 41% increase in strength compared to an 11% increase in the CE+HE (P < 0.001). The combined UBR groups also demonstrated increases in lean arm mass (P = 0.003) and a trend toward decreased dyspnea (P = 0.053). There were no group differences in attrition, attendance and training progression. Fifty subjects completed long-term maintenance and the UBR + SE and UBR + HE groups retained some gains in muscle strength, 24% and 21% respectively, and the CE + HE group lost 3% of muscle strength from baseline. CONCLUSION: The study provides strong evidence that comprehensive resistance training increased strength and lean arm mass and that strength can be partially maintained through a simple home program using hand weights. It provides limited evidence that upper-body resistance training improved dyspnea and that the exercise-specific self-efficacy enhancing intervention was beneficial.