Open Access Maced J Med Sci. 2020 May 15; 8(B):479-483. 479 Scientifc Foundation SPIROSKI, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. 2020 May 15; 8(B):479-483. https://doi.org/10.3889/oamjms.2020.3890 eISSN: 1857-9655 Category: B - Clinical Sciences Section: Pulmonology The Impact of Short-term Combination of Limb Training and Pursed-lip Breathing in Chronic Obstructive Pulmonary Disease Amira Permatasari Tarigan 1 *, Fannie Rizki Ananda 1 , Pandiaman Pandia 1 , Trisno Susilo 2 , Maryaningsih Maryaningsih 2 , Anggriani Anggriani 2 1 Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia; 2 Division of Cardiorespiration, Faculty of Physiotherapy, STIKES Siti Hajar, Medan, Indonesia Abstract AIM: The aim of this study is to determine the impact of short-term combination of upper and lower limb training on lung functions, functional capacity, and quality of life in stable chronic obstructive pulmonary disease (COPD). METHODS: This quasi-experimental study held in 2017 and included 20 participants diagnosed with COPD (forced expiratory volume in 1 second/forced volume capacity [FEV 1 /FVC] ≤70%). Combination of limb training with pursed- lip breathing held twice a week for 8 weeks. Lung functions, functional capacity, dyspnea scale, and quality of life were measured before, 1 month, and 2 months after training. RESULTS: In this study, there was a signifcant improvement of FVC after 2 months after training (p-value: 0.04), but not in FEV 1 . There was a signifcant improvement of CAT (p-value: 0.00) and modifed medical research council (p-value: 0.04) after 1 month of training. There was a signifcant improvement of 6-min walking test mean after 2 months of training (p-value: 0.00). CONCLUSIONS: Short-term combination of limb training and pursed-lip breathing impacted positively on FVC, functional capacity, dyspnea scale, and quality of life in patients with COPD, but not in FEV 1 . Edited by: Ksenija Bogoeva-Kostovska Citation: Tarigan AP, Ananda FR, Pandia P, Susilo T, Maryaningsih M, Anggriani A. The Impact of Short-term Combination of Limb Training and Pursed-lip Breathing in Chronic Obstructive Pulmonary Disease. Open Access Maced J Med Sci. 2020 May 15; 8(B):479-483. https://doi.org/10.3889/oamjms.2020.3890 Keywords: Pulmonary rehabilitation; Lung functions; Functional capacity; Quality of life, Stable chronic obstructive pulmonary disease *Correspondence: Amira Permatasari Tarigan, Dr. Mansyur 1 Dalam Road No. 4, Medan, North Sumatera, Indonesia. Mobile: 081221211941. E-mail: amira@usu.ac.id Received: 13-Oct-2019 Revision: 07-Mar-2020 Accepted: 07-Mar-2020 Copyright: © 2020 Amira Permatasari Tarigan, Fannie Rizki Ananda, Pandiaman Pandia, Trisno Susilo, Maryaningsih Maryaningsih, Anggriani Anggriani Funding: Investigation was fnancially supported by the Directorate of Research and Development Ministry of Research, Technology, and Higher Education, Republic of Indonesia, Budget Year of 2018 Competing Interests: The authors have declared that no competing interests exist Open Access: This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial 4.0 International License (CC BY-NC 4.0) Introduction Chronic obstructive pulmonary disease (COPD) begins a challenging disease in physicians to control the incidence and progression [1]. It is usually under- diagnosed in the early stage, so the majority of patients usually ask for help after having signifcant impairment in daily life, particularly in Asia-Pacifc region [2]. This make COPD burden in Asia is greater than in developed Western countries, measured by high mortality rate, years of life lost, and years that had spent with the disability [3]. Pulmonary rehabilitation (PR) has a signifcant role in the treatment of COPD (GOLD, 2018) [1]. Most studies showed signifcant improvement of lung functions, exercise capacity, and muscle strength lead to decrease dyspnea scale and improve quality of life in COPD after a short period of PR [4], [5]. A combination of PR and pharmacological treatment provides a better outcome in exercise capacity, health-related quality of life, and mental health rather than pharmacological alone [6], [7]. These facts made PR was considered to be part of comprehensive treatment in patients with the global initiative of lung disease (GOLD) criteria B, C, and D in GOLD consensus in 2018 [1]. However, another study showed that in mild obstruction severity in COPD, PR also gives a positive impact in improving exercise capacity and quality of life patients with COPD [8]. Exercise-related PR consists of a few type of training include endurance, strength, upper limb training, and breathing training [1]. A combination of endurance and strength training can give a better outcome in patients with COPD [9]. From a study in India, upper limb training can synchronize and coordinate accessory muscles during respiration so it can decrease the thoracoabdominal desynchronized in COPD patients. Later, it reduced dyspnea and increase lung function in moderate to severe COPD [10]. This is line with a study that showed signifcant improvement of lung function, functional capacity, and quality of life in patients with COPD [11]. In another study, lower limb exercise proved to increase lung functions, lower limb strength, and exercise performance lead to signifcantly improve quality of life in patients with COPD after regular limb training [12]. This is in line with another study in Indonesia that showed a signifcant improvement of