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      The one repetition maximum test and the sit-to-stand test in the assessment of a specific pulmonary rehabilitation program on peripheral muscle strength in COPD patients

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          Individuals with COPD may present reduced peripheral muscle strength, leading to impaired mobility. Comprehensive pulmonary rehabilitation (PR) should include strength training, in particular to lower limbs. Furthermore, simple tools for the assessment of peripheral muscle performance are required.


          To assess the peripheral muscle performance of COPD patients by the sit-to-stand test (STST), as compared to the one-repetition maximum (1-RM), considered as the gold standard for assessing muscle strength in non-laboratory situations, and to evaluate the responsiveness of STST to a PR program.


          Sixty moderate-to-severe COPD inpatients were randomly included into either the specific strength training group or into the usual PR program group. Patients were assessed on a 30-second STST and 1-minute STST, 1-RM, and 6-minute walking test (6MWT), before and after PR. Bland–Altman plots were used to evaluate the agreement between 1-RM and STST.


          The two groups were not different at baseline. In all patients, 1-RM was significantly related to the 30-second STST ( r=0.48, P<0.001) and to 1-minute STST ( r=0.36, P=0.005). The 30-second STST was better tolerated in terms of the perceived fatigue ( P=0.002) and less time consuming ( P<0.001) test. In the specific strength training group significant improvements were observed in the 30-second STST ( P<0.001), 1-minute STST ( P=0.005), 1-RM ( P<0.001), and in the 6MWT ( P=0.001). In the usual PR program group, significant improvement was observed in the 30-second STST ( P=0.042) and in the 6MWT ( P=0.001).


          Our study shows that in stable moderate-to-severe inpatients with COPD, STST is a valid and reliable tool to assess peripheral muscle performance of lower limbs, and is sensitive to a specific PR program.

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          Most cited references 23

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          Statistical methods for assessing agreement between two methods of clinical measurement.

          In clinical measurement comparison of a new measurement technique with an established one is often needed to see whether they agree sufficiently for the new to replace the old. Such investigations are often analysed inappropriately, notably by using correlation coefficients. The use of correlation is misleading. An alternative approach, based on graphical techniques and simple calculations, is described, together with the relation between this analysis and the assessment of repeatability.
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            Sit-to-stand performance depends on sensation, speed, balance, and psychological status in addition to strength in older people.

            Sit-to-stand (STS) performance is often used as a measure of lower-limb strength in older people and those with significant weakness. However, the findings of recent studies suggest that performance in this test is also influenced by factors associated with balance and mobility. We conducted a study to determine whether sensorimotor, balance, and psychological factors in addition to lower-limb strength predict sit-to-stand performance in older people. Six hundred and sixty nine community-dwelling men and women aged 75-93 years (mean age 78.9, SD = 4.1) underwent quantitative tests of strength, vision, peripheral sensation, reaction time, balance, health status, and sit-to-stand performance. Many physiological and psychological factors were significantly associated with sit-to-stand times in univariate analyses. Multiple regression analysis revealed that visual contrast sensitivity, lower limb proprioception, peripheral tactile sensitivity, reaction time involving a foot-press response, sway with eyes open on a foam rubber mat, body weight, and scores on the Short-Form 12 Health Status Questionnaire pain, anxiety, and vitality scales in addition to knee extension, knee flexion, and ankle dorsiflexion strength were significant and independent predictors of STS performance. Of these measures, quadriceps strength had the highest beta weight, indicating it was the most important variable in explaining the variance in STS times. However, the remaining measures accounted for more than half the explained variance in STS times. The final regression model explained 34.9% of the variance in STS times (multiple R =.59). The findings indicate that, in community-dwelling older people, STS performance is influenced by multiple physiological and psychological processes and represents a particular transfer skill, rather than a proxy measure of lower limb strength.
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              Peripheral muscle weakness in patients with chronic obstructive pulmonary disease.

              Peripheral muscle weakness is commonly found in patients with chronic obstructive pulmonary disease (COPD) and may play a role in reducing exercise capacity. The purposes of this study were to evaluate, in patients with COPD: (1) the relationship between muscle strength and cross-sectional area (CSA), (2) the distribution of peripheral muscle weakness, and (3) the relationship between muscle strength and the severity of lung disease. Thirty-four patients with COPD and 16 normal subjects of similar age and body mass index were evaluated. Compared with normal subjects, the strength of three muscle groups (p < 0.05) and the right thigh muscle CSA, evaluated by computed tomography (83.4 +/- 16.4 versus 109.6 +/- 15.6 cm2, p < 0.0001), were reduced in COPD. The quadriceps strength/thigh muscle CSA ratio was similar for the two groups. The reduction in quadriceps strength was proportionally greater than that of the shoulder girdle muscles (p < 0.05). Similar observations were made whether or not patients had been exposed to systemic corticosteroids in the 6-mo period preceding the study, although there was a tendency for the quadriceps strength/thigh muscle CSA ratio to be lower in patients who had received corticosteroids. In COPD, quadriceps strength and muscle CSA correlated positively with the FEV1 expressed in percentage of predicted value (r = 0.55 and r = 0. 66, respectively, p < 0.0005). In summary, the strength/muscle cross-sectional area ratio was not different between the two groups, suggesting that weakness in COPD is due to muscle atrophy. In COPD, the distribution of peripheral muscle weakness and the correlation between quadriceps strength and the degree of airflow obstruction suggests that chronic inactivity and muscle deconditioning are important factors in the loss in muscle mass and strength.

                Author and article information

                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                11 November 2015
                : 10
                : 2423-2430
                [1 ]Division of Pneumology, IRCCS Rehabilitation Institute of Tradate, Salvatore Maugeri Foundation, Tradate, Italy
                [2 ]Division of Internal and Respiratory Medicine, Malcantonese Hospital, Giuseppe Rossi Foundation, Castelrotto, Switzerland
                [3 ]Respiratory Disease and Lung Function Unit, Department of Clinical and Experimental Medicine, University of Parma, Padiglione Rasori, Parma, Italy
                [4 ]Division of Pneumology, Department of Internal Medicine, Ospedale Civico, Lugano, Switzerland
                [5 ]Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
                Author notes
                Correspondence: Andrea Zanini, Divisione di Medicina Interna a Indirizzo Pneumologico, Ospedale Malcantonese, Fondazione Giuseppe Rossi, 6980 Castelrotto, Switzerland, Tel +41 91 611 3700, Fax +41 91 611 3701, Email azanini67@
                © 2015 Zanini et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Original Research

                Respiratory medicine

                copd, sit-to-stand test, strength training


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