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      The 6-minute pegboard and ring test is correlated with upper extremity activity of daily living in chronic obstructive pulmonary disease

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          Abstract

          Background

          Upper-extremity exercise is for pulmonary rehabilitation. The 6-minute pegboard and ring test (6PBRT) was developed to evaluate arm exercise capacity in patients with chronic obstructive pulmonary disease (COPD). The purpose of this study was to characterize the 6PBRT and evaluate its relationship with upper-extremity activities of daily living (ADLs) in COPD patients.

          Methods

          Twenty outpatients with mild to very severe COPD underwent the 6PBRT and spirometry, and their maximal inspiratory and expiratory pressures and grip strength were measured. For the 6PBRT, subjects were asked to move as many rings as possible in 6 minutes, and the score was the number of moved rings during the 6-minute period. Upper-extremity ADLs were evaluated with the upper extremity activities subdomain of the modified Pulmonary Functional Status and Dyspnea Questionnaire. Upper-extremity ADLs were also measured objectively by using a wrist accelerometer every day for 1 week.

          Results

          There was a positive correlation between 6PBRT score and inspiratory capacity ( r = 0.71, P , 0.001), inspiratory capacity/total lung capacity predicted ( r = 0.68, P , 0.01), and forced vial capacity ( r = 0.57, P , 0.01). There was also a positive correlation between 6PBRT score and accelerometer count ( r = 0.54, P , 0.05) and a negative correlation between 6PBRT score and arm activity score (ρ = −0.49, P , 0.05).

          Conclusion

          The 6PBRT may be a predictive test to maintain and improve upper-extremity ADL during pulmonary rehabilitation in patients with COPD.

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          Most cited references 13

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          The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population.

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            • Record: found
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            Dyssynchronous breathing during arm but not leg exercise in patients with chronic airflow obstruction.

             J Rassulo,  B Celli,  B Make (1986)
            Some patients with chronic airflow obstruction experience dyspnea with mild arm exercise but not with more-intense leg exercise. To investigate why these patients have limited endurance during arm exertion, we studied ventilatory responses to exercise with unsupported arms in 12 patients with chronic airflow obstruction (mean [+/- SD] forced expiratory volume in one second, 0.68 +/- 0.28 liters). Unloaded leg cycling was also studied for comparison. In the five patients who had the most severe airflow obstruction, arm exercise was limited by dyspnea after 3.3 +/- 0.7 minutes, and dyssynchronous thoracoabdominal breathing developed. In the other seven patients, arm exercise was limited by the sensation of muscle fatigue after 6.1 +/- 2.0 minutes (P less than 0.05), and dyssynchronous breathing did not occur. None of the 12 patients had dyssynchronous breathing during unloaded leg cycling. Maximal transdiaphragmatic pressure, a measure of diaphragmatic fatigue, declined similarly after arm and leg exercise in both groups. During unsupported arm work, the accessory muscles of inspiration help position the torso and arms. We hypothesize that the extra demand placed on these muscles during arm exertion leads to early fatigue, an increased load on the diaphragm, and dyssynchronous thoracoabdominal inspirations. This sequence may contribute to dyspnea and limited endurance during upper-extremity exercise.
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              Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based guidelines. ACCP/AACVPR Pulmonary Rehabilitation Guidelines Panel. American College of Chest Physicians. American Association of Cardiovascular and Pulmonary Rehabilitation.

              (1997)
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                Author and article information

                Journal
                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
                1176-9106
                1178-2005
                2013
                2013
                23 July 2013
                : 8
                : 347-351
                Affiliations
                [1 ]Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Tottori University, Yonago, Japan;
                [2 ]Department of Regional Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
                [3 ]Department of Rehabilitation Medicine, Yoka Hospital, Yabu, Japan
                Author notes
                Correspondence: Kenichi Takeda, Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Tottori University, 86 Nishimachi, Yonago, 683-0862, Japan, Tel +81 859 38 6537,.Fax +81 859 38 6539, Email kentake724@ 123456gmail.com
                Article
                copd-8-347
                10.2147/COPD.S45081
                3726300
                23901268
                © 2013 Takeda et al, publisher and licensee Dove Medical Press Ltd

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                Categories
                Original Research

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