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. 2024 Oct 9;33(174):240027.
doi: 10.1183/16000617.0027-2024. Print 2024 Oct.

The effect of graded exercise therapy on fatigue in people with serious respiratory illness: a systematic review

Angela T Burge  1   2 , Adelle M Gadowski  2 , Lorena Romero  3 , Guido Vagheggini  4   5 , Anna Spathis  6 , Natasha E Smallwood  2   7 , Magnus Ekström  8 , Anne E Holland  9   2   7   10
Affiliations

The effect of graded exercise therapy on fatigue in people with serious respiratory illness: a systematic review

Angela T Burge et al. Eur Respir Rev. .

Abstract

Background: In adults with serious respiratory illness, fatigue is prevalent and under-recognised, with few treatment options. The aim of this review was to assess the impact of graded exercise therapy (GET) on fatigue in adults with serious respiratory illness.

Methods: Electronic databases were searched to identify randomised controlled trials (RCTs) testing GET (involving incremental increases in exercise from an established baseline) in adults with serious respiratory illness. The primary outcome was fatigue and secondary outcomes were health-related quality of life (HRQoL) and adverse events. Two authors independently screened for inclusion, evaluated risk of bias and extracted data.

Results: 76 RCTs were included with 3309 participants, most with a diagnosis of COPD or asthma. Reductions in fatigue measured by the Chronic Respiratory Disease Questionnaire fatigue domain score were demonstrated following GET consisting of aerobic with/without resistance training (mean difference (MD) 0.53 points, 95% CI 0.41-0.65, 11 RCTs, 624 participants) and GET using resistance training alone (MD 0.58 points, 95% CI 0.21-0.96, two RCTs, 82 participants) compared with usual care. Although the mean effect exceeded the minimal important difference, the lower end of the confidence intervals did not always exceed this threshold so the clinical significance could not be confirmed. GET consistently improved HRQoL in people with a range of chronic respiratory diseases on multiple HRQoL measures. No serious adverse events related to GET were reported.

Conclusion: GET may improve fatigue alongside consistent improvements in HRQoL in people with serious respiratory illness. These findings support the use of GET in the care of people with serious respiratory illness.

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Conflict of interest statement

Conflicts of interest: L. Romero declares funding from the European Respiratory Society to design search strategies for this review. A.E. Holland declares authorship on four of the systematic reviews included in this study. A.E. Holland declares no other conflicts of interest. All other authors have nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Preferred reporting items for systematic reviews and meta-analyses flow of studies through the systematic review.
FIGURE 2
FIGURE 2
Risk of bias graph: judgements about each risk of bias item presented as percentages across all included studies.
FIGURE 3
FIGURE 3
Forest plot: fatigue (Chronic Respiratory Disease Questionnaire (CRQ) fatigue domain score) for graded exercise therapy (GET) versus usual care at end of intervention (8–12 weeks). a) CRQ fatigue domain score. b) CRQ fatigue domain score in participants with COPD. c) CRQ fatigue domain score in participants with interstitial lung disease. IV: inverse variance.
FIGURE 4
FIGURE 4
Forest plot: health-related quality of life (St George's Respiratory Questionnaire (SGRQ) total, symptoms, activity and impact domain scores) for graded exercise therapy (GET) versus usual care at end of intervention (6–12 weeks). a) SGRQ total score. b) SGRQ symptoms domain score. c) SGRQ activity domain score. d) SGRQ impact domain score. IV: inverse variance.
FIGURE 4
FIGURE 4
Continued.
FIGURE 5
FIGURE 5
Forest plot: number of participants with exacerbations during the intervention period for graded exercise therapy (GET) versus usual care. a) Participants with COPD. b) Participants with asthma. c) Participants with interstitial lung disease. M-H: Mantel–Haenszel.
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Comment in

References

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