Effects of different exercise regimens on prognosis of patients with chronic obstructive pulmonary disease: a systematic reviews and meta-analysis

Abstract

Introduction: Skeletal muscle dysfunction is a significant factor contributing to exercise limitation in patients with chronic obstructive pulmonary disease (COPD). Although exercise training is often recommended to enhance patient outcomes, there continues to be ongoing debate regarding its exact effects.

Objective: The aim of this study is to evaluate the effectiveness of endurance exercise, strength training and combined exercise on cardiorespiratory fitness (including maximal oxygen uptake, maximal minute ventilation, and the 6-minute walk test), strength of lower limbs (measured by leg press), and quality of life (using the COPD Assessment Test) in patients with COPD. By conducting a systematic review and meta-analysis of randomized controlled trials (RCTs), our objective is to provide tailored training methods and intensity recommendations for patients with COPD in order to improve their quality of life.

Methods: The meta-analysis included 10 randomized controlled trials (RCTs) of exercise rehabilitation programs involving 180 patients with COPD that were retrieved from electronic databases (PubMed, Cochrane Library, and Embase). Two reviewers independently assessed the topical relevance, trial quality, and extracted data for the meta-analysis.

Results: Meta-analysis showed that primary outcomes representing exercise endurance were elevated under different exercise interventions compared to pre-test, such as maximal oxygen uptake (VO2max (ml/kg/min)) [SMD = 0.40, 95% CI (0.15, 0.64)] and the 6-min walk test (6MWT) [MD = 33.90, 95% CI (25.25, 42.55)], and primary outcomes representing strength also increased, such as leg press (1RM) [MD = 24.59, 95% CI (16.08, 33.11)], while secondary outcomes such as assessments of life such as the COPD Assessment Test (CAT) recovered [MD = 2.51, 95% CI (2.01, 3.00)], with all differences being statistically significant (p < 0.05). However, Maximum minute ventilation (VEmax (L)) [MD = 0.91, 95%CI (3.61, 5.43)] was not statistically significant (p > 0.05) when compared with the post-test data. The sensitivity test data were stable, and the results were reliable. We subgrouped the data from different types of exercise interventions and found that different types of exercise affected the experimental results.

Conclusion: Exercise interventions have a positive effect on the treatment of patients with COPD, significantly improving functional capacity, aerobic capacity, and exercise tolerance, but they should be individualized and developed according to the patient's condition to achieve the best therapeutic effect.

Keywords: chronic pulmonary obstruction; combined exercise; endurance exercise; meta-analysis; strength training.

Figure 1.

PRISMA flow chart.

Figure 2.

Risk of bias assessment for the RCTs included in the meta-analysis. (A) risk of bias summary; (B) Risk of bias graph. Symbols. (þ): low risk of bias; (?): unclear risk of bias; (–): high risk of bias.

Figure 3.

Effect of exercise intervention in individuals with COPD. (A) VO2 (ml/kg/min); (B) VEmax (L). (C) CAT; (D) 6MWT; (E) leg press (1RM).

Figure 3.

Effect of exercise intervention in individuals with COPD. (A) VO2 (ml/kg/min); (B) VEmax (L). (C) CAT; (D) 6MWT; (E) leg press (1RM).

Figure 3.

Effect of exercise intervention in individuals with COPD. (A) VO2 (ml/kg/min); (B) VEmax (L). (C) CAT; (D) 6MWT; (E) leg press (1RM).

Figure 4.

Funnel plot for publication bias test. (A) VO2 (ml/kg/min). (B) VEmax (L); (C) CAT; (D) 6MWT; (E) leg Press (1RM)

Figure 4.

Funnel plot for publication bias test. (A) VO2 (ml/kg/min). (B) VEmax (L); (C) CAT; (D) 6MWT; (E) leg Press (1RM)

Figure 4.

Funnel plot for publication bias test. (A) VO2 (ml/kg/min). (B) VEmax (L); (C) CAT; (D) 6MWT; (E) leg Press (1RM)