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COPD – Increased strength

Evidence Summary

There are a few interventional studies that shows increased muscle strength after an exercise programme

Quality of Evidence

Grade B – moderate quality. Evidence comes from randomised controlled trials

Strength of recommendation

Grade 1 – strong recommendation. Clinical and patient consensus is that physical activity can improve muscle strength. On the basis of the existing evidence, clinical opinion is that all or most patients will be best served by following this piece of evidence. The vast majority of patients would choose to follow this evidence when given the choice

Conclusion

Strong recommendations can be applied to most patients in most circumstances and should be followed unless there are compelling reasons to do otherwise

  1. Garcia-Aymerich, J. 2009, Chest6

PEmax (% pred) Mean (SD) 60 (21) in quartile 1 (Q1) of energy expenditure in physical activity; 68 (25) in Q2; 67 (22) in Q3; 71 (23) in Q4; p for trend=0.004

Adjusted regression coefficient (95% CI): 7.4 (-0.44 to 15.2) for Q2 of energy expenditure in physical activity; 4.5 (-3.4 to 12.4) for Q3; 8.5 (0.6 to 16.4) for Q4; p for trend=0.081

PImax (% pred): Mean (SD) 61 (28) in quartile 1 (Q1) of energy expenditure in physical activity; 62 (17) in Q2; 68 (23) in Q3; 65 (23) in Q4; p for trend=0.169

Non-dominant handgrip (% pred) Mean (SD) 104 (29) in quartile 1 (Q1) of energy expenditure in physical activity; 105 (22) in Q2; 105 (29) in Q3; 102 (28) in Q4; p for trend=0.593

(Cross-sectional study, self-reported physical activity, 341 participants)

  1. Amin (BMC Pulm Med, 2014. 45)

Outcomes other than physical activity: –   Treadmill endurance, Muscle strength, Dyspnoea, Health status. intervention type for outcomes. 12 week supervised personal trainer for progressive strength and endurance vs unsupervised physical activity, on moderate COPD patients specific outcomes (i.e. p value and absolute change and size of study). 19 patients randomised to intervention or control. Muscle strength p<0.001. SGRQ score no significant change

  1. Kawagoshi (Respiratory Medicine, 2014)117

Intervention: Pulmonary rehabilitation +pedometer feedback vs pulmonary rehabilitation alone. Improvements in physical activity seen in pedometer feedback group was associated with significant improvements in MRC dyspnoea and quadriceps strength

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