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. 2024 Sep 12;22(1):389.
doi: 10.1186/s12916-024-03605-7.

Efficacy of respiratory support therapies during pulmonary rehabilitation exercise training in chronic obstructive pulmonary disease patients: a systematic review and network meta-analysis

Xinrong Chen  1 , Ling Xu  1 , Shuqin Li  2 , Cui Yang  1 , Xiaoling Wu  3 , Mei Feng  4 , Ying Wu  5 , Jing Zhu  1
Affiliations

Efficacy of respiratory support therapies during pulmonary rehabilitation exercise training in chronic obstructive pulmonary disease patients: a systematic review and network meta-analysis

Xinrong Chen et al. BMC Med. .

Abstract

Background: Exercise training is fundamental in pulmonary rehabilitation (PR), but patients with chronic obstructive pulmonary disease (COPD) often struggle with exercise intolerance. Respiratory support during exercise in COPD patients may be a beneficial adjunct therapy. In this study, the effect of different respiratory support therapy during pulmonary rehabilitation exercise training in COPD patients was assessed through a network meta-analysis.

Methods: Five databases were searched to obtain randomized controlled trials involving different respiratory support therapies during PR exercise training in COPD patients. The Cochrane Handbook tool was employed to assess the risk bias of included studies. Network meta-analysis was performed using the STATA software. The study protocol was registered at PROSPERO (CRD42023491139).

Results: A total of 35 studies involving 1321 patients and 6 different interventions were included. Network meta-analysis showed that noninvasive positive pressure ventilation (NPPV) is superior in improving exercise capacity (6-Minute Walk Test distance, peak work rate, endurance time), dyspnea, and physiological change (peak VO2, tidal volume, minute ventilation and lactate level) in stable COPD patients who were at GOLD stage III or IV during PR exercise training. The final surface under the cumulative ranking curve value indicated that NPPV therapy achieved the best assistive rehabilitation effect.

Conclusions: The obtained results indicate that NPPV is most powerful in assisting exercise in severe COPD patients under stable condition. Researchers should focus more on the safety, feasibility, and personalization of interventions. Furthermore, there is a need for additional high-quality trials to assess the consistency of evidence across various respiratory support approaches.

Trial registration: The study was registered at PROSPERO (CRD42023491139).

Keywords: Chronic obstructive pulmonary disease; Network meta-analysis; Pulmonary rehabilitation; Respiratory support therapy.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Network structure of the primary outcomes. A Exercise capacity: 6 Minute Walk Test—distance. B Exercise capacity: peak work rate. C Exercise capacity: endurance time. D Physiological change: peak VO2
Fig. 3
Fig. 3
Network structure of the secondary outcomes. A Dyspnea (Borg score). B Physiological change: tidal volume. C Physiological change: minute ventilation. D Physiological change: lactate level. E Quality of life
See this image and copyright information in PMC

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