ORIGINAL RESEARCH 77 www.journals.viamedica.pl Address for correspondence: Mohammad Ali Zohal, Qazvin University of Medical Science Qazvin, Iran, e-mail: Mzohal@qums.ac.ir DOI: 10.5603/ARM.2019.0013 Received: 26.11.2018 Copyright © 2019 PTChP ISSN 2451–4934 Leili Yekefallah 1 , Mohammad Ali Zohal 2 , Ommolbanin Keshavarzsarkar 2 , Ameneh Barikani 2 , Maryam Gheraati 2 1 Faculty of Nursing & Midwifery, Qazvin University of Medical Science Qazvin, Iran 2 Qazvin University of Medical Science Qazvin, Iran Comparing the effects of upper limb and breathing exercises on six-minute walking distance among patients with chronic obstructive pulmonary disease: a three-group randomized controlled clinical trial The authors declare no financial disclosure Abstract Introduction: Physical exercise can improve patient outcomes and reduce hospitalization and mortality rates among subjects with chronic obstructive pulmonary disease. This study aimed to compare the effects of upper limb and breathing exercises on six-minute walking distance among these patients. Material and methods: This three-group randomized controlled clinical trial was conducted in 2017–2018 in Velayat hospital, Qazvin, Iran. Seventy-fve patients were purposively selected from the outpatient lung clinic of the hospital and randomly allo- cated to either the 25-patient groups of upper limb exercise, breathing exercise, or control. The patients in the frst group were performing upper limb exercises thrice weekly for one month in the study setting. Their counterparts in the second group were doing pursed-lip and diaphragmatic breathing exercises four times daily for one month at their homes. However, the patients in the control group received no exercise intervention. Six-minute walk test was performed by each participant both before and after the study intervention. The SPSS for Windows program (v. 23.0) was used to analyze the data via the Chi-square test, the paired-sample t test, and the one-way analysis of variance. Results: Before the intervention, the groups did not signifcantly differ from each other respecting six-minute walking distance. During the study, walking distance in the control group did not change signifcantly, while it remarkably increased in both the upper limb exercise and the breathing exercise groups (p < 0.05). After the intervention, walking distance in the upper limb exercise group was signifcantly greater than the breathing exercise group (p < 0.05) and the control group (p < 0.05); however, the difference between the breathing exercise and the control groups was not statistically signifcant (p > 0.05). Conclusion: Upper limb exercise is more effective than breathing exercise in increasing walking distance among patients with chronic obstructive pulmonary disease. Therefore, upper limb exercise can be used as a safe, simple, and inexpensive rehabili- tation technique for these patients. Key words: chronic obstructive pulmonary disease, upper limb exercise, breathing exercise, six-minute walk test Adv Respir Med. 2019; 87: 77–82 Introduction Chronic obstructive pulmonary disease (COPD) is a respiratory disorder which is asso- ciated with an ongoing limitation of airfow [1]. The underlying cause of COPD is a chronic in- fammation in the lung and airways in response to poisonous particles and gases [2]. During physical activity, COPD-associated limitation in the airfow is exacerbated and the resultant dyspnea prevents