Limb training

The endurance training discussed above is mostly carried out using walking, treadmill, and cycling exercises. Strength training of the lower limbs is an attractive approach, because peripheral muscle weakness contributes to exercise limitation in patients with COPD [21,22]. Two studies have investigated this issue. Simpson et al. showed that specific strength training improved muscle function by 16-40%, depending on the specific muscle that was trained [23]. They also found an increased endurance capacity and an improved quality of life. Clark et al. showed that a programme of low-intensity leg and arm exercises leads to an improved walking distance and demonstrated a physiological training response by showing a reduced ventilatory equivalent for oxygen and carbon dioxide [24].

Upper limb training is now generally recommended as part of the rehabilitation programme [1]. The beneficial effects of this training are reflected in reduced metabolic and ventilatory requirements, leading to an increase in endurance capacity in arm exercises [49,50]. However, there is no conclusive evidence that upper limb training is beneficial in addition to exercise training in improving functional status.

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