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Meta-Analysis
. 2016 Dec 8:11:3121-3136.
doi: 10.2147/COPD.S121263. eCollection 2016.

Exercise training alone or with the addition of activity counseling improves physical activity levels in COPD: a systematic review and meta-analysis of randomized controlled trials

Aroub Lahham  1 , Christine F McDonald  2 , Anne E Holland  3
Affiliations
Meta-Analysis

Exercise training alone or with the addition of activity counseling improves physical activity levels in COPD: a systematic review and meta-analysis of randomized controlled trials

Aroub Lahham et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Background: Physical inactivity is associated with poor outcomes in COPD, and as a result, interventions to improve physical activity (PA) are a current research focus. However, many trials have been small and inconclusive.

Objective: The aim of this systematic review and meta-analysis was to study the effects of randomized controlled trials (RCTs) targeting PA in COPD.

Methods: Databases (Physiotherapy Evidence Database [PEDro], Embase, MEDLINE, CINAHL and the Cochrane Central Register for Controlled Trials) were searched using the following keywords: "COPD", "intervention" and "physical activity" from inception to May 20, 2016; published RCTs that aimed to increase PA in individuals with COPD were included. The PEDro scale was used to rate study quality. Standardized mean differences (effect sizes, ESs) with 95% confidence intervals (CIs) were determined. Effects of included interventions were also measured according to the minimal important difference (MID) in daily steps for COPD (599 daily steps).

Results: A total of 37 RCTs with 4,314 participants (mean forced expiratory volume in one second (FEV1) % predicted 50.5 [SD=10.4]) were identified. Interventions including exercise training (ET; n=3 studies, 103 participants) significantly increased PA levels in COPD compared to standard care (ES [95% CI]; 0.84 [0.44-1.25]). The addition of activity counseling to pulmonary rehabilitation (PR; n=4 studies, 140 participants) showed important effects on PA levels compared to PR alone (0.47 [0.02-0.92]), achieving significant increases that exceeded the MID for daily steps in COPD (mean difference [95% CI], 1,452 daily steps [549-2,356]). Reporting of methodological quality was poor in most included RCTs.

Conclusion: Interventions that included ET and PA counseling during PR were effective strategies to improve PA in COPD.

Keywords: chronic obstructive; interventions; physical activity; pulmonary disease.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
PRISMA flow diagram for database search and study selection process. Abbreviations: PA, physical activity; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RCT, randomized controlled trial.
Figure 2
Figure 2
Studies comparing PA interventions versus usual care. Abbreviations: CI, confidence interval; ET, exercise training; IV, independent variable; PA, physical activity; SMD, standardized mean difference.
Figure 3
Figure 3
Studies comparing PA counseling added to PR versus PR (short-term effect). Abbreviations: CI, confidence interval; IV, independent variable; PA, physical activity; PR, pulmonary rehabilitation; SMD, standardized mean difference.
Figure 4
Figure 4
Studies comparing PA counseling added to PR versus PR (long-term effect). Abbreviations: CI, confidence interval; IV, independent variable; PA, physical activity; PR, pulmonary rehabilitation; SMD, standardized mean difference.
Figure 5
Figure 5
Comparison between differences in daily steps achieved by PA interventions according to the MID of daily steps in COPD. Abbreviations: ET, exercise training; MID, minimal important difference; NNIV, nocturnal noninvasive ventilation; PA, physical activity; PR, pulmonary rehabilitation.
See this image and copyright information in PMC

References

    1. Pitta F, Troosters T, Probst VS, Spruit MA, Decramer M, Gosselink R. Physical activity and hospitalization for exacerbation of COPD. Chest. 2006;129(3):536–544. - PubMed
    1. Waschki B, Kirsten A, Holz O, et al. Physical activity is the strongest predictor of all-cause mortality in patients with COPD: a prospective cohort study. Chest. 2011;140(2):331–342. - PubMed
    1. Vorrink SN, Kort HS, Troosters T, Lammers J-WJ. Level of daily physical activity in individuals with COPD compared with healthy controls. Respir Res. 2011;12(1):1–8. - PMC - PubMed
    1. Pitta F, Troosters T, Spruit MA, Probst VS, Decramer M, Gosselink R. Characteristics of physical activities in daily life in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005;171(9):972–977. - PubMed
    1. Esteban C, Quintana JM, Aburto M, et al. Impact of changes in physical activity on health-related quality of life among patients with COPD. Eur Respir J. 2010;36(2):292–300. - PubMed

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