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COPD – Increased strength

Evidence Summary (Updated 2022)
There are a few interventional studies that shows increased muscle strength after an exercise programme as evidenced by increased hand-grip strength(1), 1-repetition-max leg press(2) and isometric quadriceps strength(3) increases.
Recent review found 2 large systematic reviews that strengthened this evidence. A 30 RCT systematic review investigating the effects of endurance exercise, resistance exercise, and combined aerobic and resistance exercise. Pooled meta-analysis observed improvement in muscle strength and exercise capacity compared to non-exercising controls. Subgroup analysis showed that resistance exercise significantly improved muscle strength (SMD = 0.6, 95% CI 0.35–0.84, I2 = 61%), but only isotonic strength improved with exercise interventions (SMD = 0.89, 95% CI 0.51–1.26, I2 = 71%).(4)
3 RCT studies (n= 145) showed a higher knee extensor strength after elastic resistance training vs no-exercise controls (SMD = 0.52, 95% CI = 0.09 to 0.95, I2 = 40%: low certainty). 2 other studies (n = 98) showed improved shoulder flexor strength with elastic resistance training (SMD = 0.35, 95% CI = −0.05 to 0.75, I2 = 0%; low certainty). Versus conventional exercise control: the experimental group presented similar effects for muscle strength, functional exercise capacity, HRQoL, and dyspnoea.(5)
A 23 RCT (n= 690) SR and MA on the effects of resistance traininghowed, through a 4 study MA, a significant quadricep muscle strength improvement (SMD 2.9, 95% CI 1.1; 4.7, I2 = 91%, p = 0.002). with a larger MA showing significant improvement in walking ability and performance as well.(6 )
However, this a 3 study meta-analysis found no significant improvement in peripheral muscle strength following land and water training vs usual care (“routine nursing”) (ULMS, P = .34, LLMS, P = .98). There was also no significant improvement in peripheral muscle strength in the water vs land group (ULMS [SMD: 0.05 {–0.33, 0.44}, P = .79] and LLMS [SMD: 0.31, 95% CI {–0.13, 0.75}, P = .17])(7)(8)

Quality of Evidence
Grade B – Moderate quality.

Strength of recommendation
Grade 1 – Strong recommendation.

Growing evidence and a number of systematic reviews with meta-analyses shows that strength is improved in COPD patients. Resistance exercise should be advised, and this is in line with the CMO recommendations.


  1. Garcia-Aymerich J, Serra I, Gómez FP, Farrero E, Balcells E, Rodríguez DA, et al. Physical activity and clinical and functional status in COPD. Chest [Internet]. 2009 Jul 1 [cited 2022 Oct 6];136(1):62–70. Available from:
  2. Amin S, Abrazado M, Quinn M, Storer TW, Tseng CH, Cooper CB. A controlled study of community-based exercise training in patients with moderate COPD. BMC Pulm Med [Internet]. 2014 Aug 4 [cited 2022 Oct 4];14(1):1–8. Available from: /1471-2466-14-125
  3. Kawagoshi A, Kiyokawa N, Sugawara K, Takahashi H, Sakata S, Satake M, et al. Effects of low-intensity exercise and home-based pulmonary rehabilitation with pedometer feedback on physical activity in elderly patients with chronic obstructive pulmonary disease. Respir Med [Internet]. 2015 [cited 2022 Oct 6];109(3):364–71. Available from:
  4. Li P, Li J, Wang Y, Xia J, Liu X. Effects of Exercise Intervention on Peripheral Skeletal Muscle in Stable Patients With COPD: A Systematic Review and Meta-Analysis. Front Med [Internet]. 2021 Nov 18 [cited 2022 Oct 6];8. Available from:
  5. de Lima FF, Cavalheri V, Silva BSA, Grigoletto I, Uzeloto JS, Ramos D, et al. Elastic Resistance Training Produces Benefits Similar to Conventional Resistance Training in People With Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis. Phys Ther [Internet]. 2020 Nov 1 [cited 2022 Oct 5];100(11):1891–905. Available from:
  6. Ferté JB, Boyer FC, Taiar R, Pineau C, Barbe C, Rapin A. Impact of resistance training on the 6-minute walk test in individuals with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Ann Phys Rehabil Med [Internet]. 2022 May 1 [cited 2022 Oct 6];65(3). Available from:
  7. Cai H, Chen J, Panagodage Perera NK, Liang X. Effects of Herbal Mouthwashes on Plaque and Inflammation Control for Patients with Gingivitis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Evidence-based Complement Altern Med. 2020;2020.
  8. Chen H, Li P, Li N, Wang Z, Wu W, Wang J. Rehabilitation effects of land and water-based aerobic exercise on lung function, dyspnea, and exercise capacity in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Medicine (Baltimore) [Internet]. 2021 Aug 20 [cited 2022 Oct 5];100(33). Available from: