***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This study poses two questions : 1 ) is there an abnormality in isokinetic skeletal muscle strength and endurance in mild chronic obstructive pulmonary disease ( COPD ) ? and 2 ) what is the effect of a r and omized , controlled , 12 week hospital outpatient weight training programme in terms of skeletal muscle function and exercise tolerance ? Upper and lower limb isokinetic maximum and sustained muscle function were compared in 43 COPD patients ( age 49+/-11 yrs ) , mean forced expiratory volume in one second ( FEV1 ) 77+/-23 % pred and 52 healthy , sedentary subjects ( age 51 ( 10 ) yrs ) , mean FEV1 109+/-16 % pred . The 43 COPD patients were r and omly allocated into training ( n=26 ) and control ( n=17 ) groups . Isokinetic and isotonic muscle function , whole body endurance , maximal exercise capacity and lung function were measured . The COPD patients had reduced isokinetic muscle function ( with the exception of sustained upper limb strength ) as compared with healthy sedentary subjects . Muscle function improved after weight training in the COPD patients . Whole body endurance during treadmill walking also improved with no change in maximal oxygen consumption . A deficit in skeletal muscle function can be identified in patients with mild chronic obstructive pulmonary disease which can not be explained by factors such as hypoxaemia and malnutrition . Intervention with weight training is effective in countering this deficit which the authors conclude is probably due to muscle deconditioning PURPOSE To determine ( 1 ) the relationship among three common upper-limb tests for patients with chronic obstructive pulmonary disease ( COPD ):  unsupported upper limb exercise test ( UULEX ) , 6-minute pegboard and ring test ( 6PBRT ) , and a muscle-strength test using a h and -held dynamometer ; and ( 2 ) the responsiveness of these three tests to changes after pulmonary rehabilitation that included a resistance arm-training programme . METHODS The study was a secondary analysis of a r and omized controlled trial ( RCT ) . The UULEX and the 6PBRT were used to measure peak arm exercise capacity and arm function , respectively . A h and held dynamometer was used to measure elbow and shoulder flexion force . We analyzed baseline data for all participants in the RCT , as well as baseline and post-PR data for those who completed 6-week follow-up testing . RESULTS 36 patients with COPD ( mean forced expiratory volume in 1 second [FEV1]=35 % [ SD 15 % ] predicted ; age 66 [ 9 ] y ) participated , of whom 13 completed an arm-training programme . The correlations among the test results ranged from 0.41 to 0.81 ( p<0.0001 ) . St and ardized response means were 1.0 for muscle force of elbow flexion , 1.2 for shoulder flexion , and 1.8 for the 6PBRT and UULEX . CONCLUSIONS Although the three tests ( UULEX , 6PBRT , and muscle-strength test using a h and -held dynamometer ) are intended to measure different constructs , they were moderately to highly correlated with one another . The 6PBRT , UULEX , and muscle-strength test were demonstrated to be responsive to the resistance arm-training programme Objectives : To study the effect of unsupported upper limb and lower limb exercise training and their combined influence on the exercise performance and health-related quality of life in COPD patients . Material s and Methods : Thirty patients were r and omly assigned to one of the three groups , through block r and omization . Of the three groups , group A received upper limb training , group B received lower limb training , and group C received both upper and lower limb training . Patients in group A , B , and C underwent exercise training five times a week for four weeks . The outcome measures used in the study were unsupported upper limb endurance test ( UULEX ) , Six-Minute Walk Test ( 6-MWT ) , and a Chronic Respiratory Question naire . Statistical analysis was performed with analysis of variance , Wilcoxon scale , and a Kruskal Wallis one way ANOVA test , and a P value of .05 was used in the study . Conclusion : The combined upper limb and lower limb training group showed a significant improvement in the exercise performance and health-related quality of life Purpose Loss of skeletal muscle strength is commonly seen with chronic obstructive pulmonary disease ( COPD ) . The study aim was to determine the effects of comprehensive upper-body resistance training ( 8 different lifts ) and a self-efficacy enhancing intervention in COPD with respect to muscle strength , symptoms , functional status and exercise adherence . Methods This r and omized trial had 3 groups : upper-body resistance training with an intervention to enhance self-efficacy ( UBR + SE ) , upper-body resistance training and health education ( UBR + HE ) , gentle chair exercises and health education ( CE + HE ) . Subjects performed 16 weeks of supervised training , then 12 months of long-term maintenance at home . Outcomes were : muscle strength , dyspnea , functional status , self-efficacy , and adherence . Results Sixty-four subjects completed 16 wks of training : age 71 ± 8 yr , fat-free mass index 19 ± 3 kg/m2 , forced expiratory volume in one second 58 ± 18 percent predicted .  The UBR + SE intervention produced a 46 % increase in strength compared to a 36 % increase in the UBR + HE group ( P = 0.054 ) . The combined UBR + SE and UBR + HE groups produced a 41 % increase in strength compared to an 11 % increase in the CE+HE ( P < 0.001 ) . The combined UBR groups also demonstrated increases in lean arm mass ( P = 0.003 ) and a trend toward decreased dyspnea ( P = 0.053 ) . There were no group differences in attrition , attendance and training progression . Fifty subjects completed long-term maintenance and the UBR + SE and UBR + HE groups retained some gains in muscle strength , 24 % and 21 % respectively , and the CE + HE group lost 3 % of muscle strength from baseline . Conclusion The study provides strong evidence that comprehensive resistance training increased strength and lean arm mass and that strength can be partially maintained through a simple home program using h and weights . It provides limited evidence that upper-body resistance training improved dyspnea and that the exercise-specific self-efficacy enhancing intervention was beneficial This r and omized , controlled study investigated the physiological effects of a specially design ed 12 week programme of isolated conditioning of peripheral skeletal muscle groups . The programme required minimal infrastructure in order to allow continued rehabilitation at home after familiarization within hospital . Forty eight patients , aged 40 - 72 yrs with chronic obstructive pulmonary disease ( COPD ) ( mean ( SD ) forced expiratory volume in one second ( FEV1 ) 61 (27)% of predicted normal ) were r and omly allocated into training ( n = 32 ) and control ( n = 16 ) groups . Physiological assessment s were performed before and after the 12 week study period , and included peripheral muscle endurance and strength , whole body endurance , maximal exercise capacity ( maximum oxygen consumption ( V'O2,max ) ) and lung function . The training group showed significant improvement in a variety of measures of upper and lower peripheral muscle performance , with no additional breathlessness . Whole body endurance measured by free arm treadmill walking increased by 6,372 ( 3,932 - 8,812 ) 3 ( p < 0.001 ) . Symptom-limited maximal V'O2 was unchanged . However , the training group showed a reduction in ventilatory equivalents for oxygen and carbon dioxide , both at peak exercise and at equivalent work rate ( Wmax ) . In summary , low intensity isolated peripheral muscle conditioning is well-tolerated , simple and easy to perform at home . The various physiological benefits should enable patients across the range of severity of chronic obstructive pulmonary disease to improve daily functioning BACKGROUND The study aim ed to evaluate the effect of upper extremity resistance training for patients with COPD on dyspnea during activity of daily living ( ADL ) , arm function , arm exercise capacity , muscle strength , and health-related quality of life ( HRQL ) . METHODS Patients were r and omly assigned to an intervention or control group . The intervention group underwent arm resistance training . The control group performed a sham . Both groups exercised three times a week for 6 weeks . Dyspnea during ADL and HRQL were measured using the Chronic Respiratory Disease Question naire ( CRDQ ) . Arm function and exercise capacity were measured using the 6-min pegboard and ring test ( 6PBRT ) and the unsupported upper limb exercise test ( UULEX ) , respectively . Muscle strength for the biceps , triceps , and anterior and middle deltoids was obtained using an isometric dynamometer . RESULTS Thirty-six patients with COPD ( 66 ± 9 years ) participated in the study . Compared with the control group , the magnitude of change in the intervention group was greater for the 6PBRT ( P = .03 ) , UULEX ( P = .01 ) , elbow flexion force ( P = .01 ) , elbow extension force ( P = .02 ) , shoulder flexion force ( P = .029 ) , and shoulder abduction force ( P = .01 ) . There was no between-group difference in dyspnea during ADL , HRQL , or symptoms during the 6PBRT or UULEX ( all P values > .08 ) . CONCLUSIONS Resistance-based arm training  improved arm function , arm exercise capacity , and muscle strength  in patients with COPD .  No improvement in dyspnea during ADL , HRQL , or symptoms was demonstrated BACKGROUND Current guidelines on pulmonary rehabilitation ( PR ) recommend upper extremity exercise training ( UEET ) in patients with COPD . However , the literature still questions the effectiveness of systematic UEET in this population . We studied the effects of 15 sessions of unsupported UEET on functional exercise capacity , the ability to perform activities of daily living ( ADL ) , and symptoms perceived during activities involving arms in patients with COPD . METHODS We conducted a r and omized trial that consisted of 3 weeks of inpatient PR , comparing the short-term effects of unsupported UEET plus PR ( intervention group ) to those of PR alone ( control group ) . A change in the 6-min ring test ( 6MRT ) was the primary outcome ; the ADL field test ( four shuttle stations ) , the dyspnea score as assessed by the Medical Research Council scale , the London Chest Activity of Daily Living scale ( LCADL ) , and the distance walked in 6 min served as secondary outcomes of the study . At the 6-month follow-up , we repeated the 6MRT and the LCADL . RESULTS Fifty patients with COPD were r and omly assigned to the two groups and completed the study . At the end of the study period , patients in the intervention group improved in the 6MRT and ADL field test compared with those patients in the control group ( p = 0.018 and p = 0.010 , respectively ) with reduced perception of fatigue ( p < or= 0.006 ) . At the 6-month follow-up , 6MRT ( p = 0.001 ) and LCADL ( p = 0.039 ) scores were still significantly better in the intervention group compared with the control group . CONCLUSIONS Our trial corroborates the effectiveness of unsupported UEET in specifically improving functional exercise capacity of patients with COPD . Moreover , it also provides evidence that this training modality may ameliorate and maintain the patients ' autonomy over and above st and ard PR . TRIAL REGISTRATION Clinical Trials.gov Identifier : NCT00825032 Abstract Objective : This comparison study examined strength and functional fitness ( FF ) outcomes between 2 single-set resistance training ( SSRT ) studies of differing intensity progressions ( rapid progression [ RP ] versus delayed progression [ DP ] ) among elderly pulmonary rehabilitation ( PR ) patients to determine if there is a threshold effect for training intensity . Methods : Twenty PR patients participating in identical hospital-based PR programs , which met twice a week for 8 weeks , were r and omly assigned to SSRT programs  , which differed in intensity progression ( RP : n = 10 , mean age = 71.0 ± 3.7 years ; DP : n = 10 , mean age = 65.4 ± 7.8 years ) . The SSRT consisted of 1 set of 8 to 15 repetitions of 5 exercises . For both studies , training loads were determined equally . Load increases in the RP study consisted of 5 % to 10 % immediately following a session where 10 repetitions were completed . Load increases for the DP study consisted of 3 to 5 lbs following 2 consecutive sessions wherein 12 repetitions were completed . Results of the primary outcomes data from both SSRT studies were compared to determine the presence of a threshold effect for intensity progression . The outcomes evaluated in both studies were upper and lower body strength and various FF measures . Repeated measures controlling for age , pulmonary function , and body mass index ( BMI ) were used to assess the presence of significant differences . To determine statistical significance , alpha was set at p < 0.05 . Results : Rapid progression result ed in greater increases in upper body strength ( chest press ; P = 0.021 ) and FF ( arm curl test , p = 0.001 ; lift and reach test , P = 0.003 ) than DP . Conclusions : Rapid progression of training intensity in a SSRT involving elderly PR patients appears superior to delayed progression The effects of endurance training on exercise capacity and health-related quality of life ( HRQL ) in chronic obstructive pulmonary disease ( COPD ) patients have been studied thoroughly , while resistance training has been rarely evaluated . This 
    Output:
    
Only one study , in which endurance upper limb training was compared to resistance upper limb training , reported on HRQoL and showed no between-group differences ( St George 's Respiratory Question naire MD 2.0 points , 95 % CI -9 to 12 ; one study on 20 people).Positive findings were shown for the effects of upper limb training on the secondary outcome of unsupported endurance upper limb exercise capacity .
Evidence from this review indicates that some form of upper limb exercise training when compared to no upper limb training or a sham intervention improves dyspnoea but not HRQoL in people with COPD .
The limited number of studies comparing different upper limb training interventions precludes conclusions being made about the optimal upper limb training programme for people with COPD , although endurance upper limb training using unsupported upper limb exercises does have a large effect on unsupported endurance upper limb capacity .