Efficacy of unsupervised exercise in adults with obstructive lung disease: a systematic review and meta-analysis

Abstract

IntroductionThe benefits of unsupervised exercise programmes in obstructive lung disease are unclear. The aim of this systematic review was to synthesise evidence regarding the efficacy of unsupervised exercise versus non-exercise-based usual care in patients with obstructive lung disease.MethodsElectronic databases (MEDLINE, CINAHL, Embase, Allied and Complementary Medicine Database, Web of Science, Cochrane Central Register of Controlled Trials and Physiotherapy Evidence Database) and trial registers (ClinicalTrials.gov, Current Controlled Trials, UK Clinical Trials Gateway and WHO International Clinical Trials Registry Platform) were searched from inception to April 2020 for randomised trials comparing unsupervised exercise programmes with non-exercise-based usual care in adults with chronic obstructive pulmonary disease (COPD), non-cystic fibrosis bronchiectasis or asthma. Primary outcomes were exercise capacity, quality of life, mortality, exacerbations and respiratory cause hospitalisations.ResultsSixteen trials (13 COPD, 2 asthma, 1 chronic bronchitis: 1184 patients) met the inclusion criteria. Only data on COPD populations were available for meta-analysis. Unsupervised exercise resulted in a statistically but not clinically significant improvement in the 6-Minute Walk Test (n=5, MD=22.0 m, 95% CI 4.4 to 39.6 m, p=0.01). However, unsupervised exercise did lead to statistically significant and clinically meaningful improvements in St. George’s Respiratory Questionnaire (n=4, MD=−11.8 points, 95% CI −21.2 to −2.3 points, p=0.01) and Chronic Respiratory Disease Questionnaire domains (dyspnoea: n=4, MD=0.5 points, 95% CI 0.1 to 0.8 points, p<0.01; fatigue: n=4, MD=0.7 points, 95% CI 0.4 to 1.0 points, p<0.01; emotion: n=4, MD=0.5 points, 95% CI 0.2 to 0.7 points, p<0.01; mastery: unable to perform meta-analysis) compared with non-exercise-based usual care.DiscussionThis review demonstrates clinical benefits of unsupervised exercise interventions on health-related quality of life in patients with COPD. High-quality randomised trials are needed to examine the effectiveness of prescription methods.

Quality of life profile three months or more after the end of adjuvant radiotherapy used for the treatment of head and neck cancer in a High Complexity Oncology Care Center

“…A implementação de treinamento de resistência geral tem fornecido bons resultados, especialmente no desempenho motor, na percepção de fadiga além de beneficiar claramente os resultados obtidos em escalas de avaliação da capacidade funcional como por exemplo o ECOG Performance Status podendo ser determinante para a realização ou continuidade do tratamento [34][35][36] . Porém, pacientes que apresentam caquexia oncológica podem recusar o as condutas propostas em um típico programa de reabilitação, como forma de evitar o aumento a sensação/manifestação de fadiga.…”

Review of the British Thoracic Society Winter Meeting 23 November 2022 23–25 November 2022

“…Digital interventions have shown some promise at increasing completion rates,49 however, improvements in important outcomes such as walking capacity are less convincing. Two systematic reviews have demonstrated broadly equivalent results in unsupervised exercise training and home based PR for those with COPD 50 51. However, all interventions should consider the key components of PR 52…”

The severe asthma–obesity conundrum: Consequences for exertional dyspnoea and exercise tolerance in men and women

“…The reasons are multiple and interconnected, involving genetic, biological, behavioural, economic and social factors 3 . Regardless of the underlying mechanisms, asthma and obesity conflate to increase the burden of exertional dyspnoea and decrease exercise tolerance, two important determinants of poor quality of life in chronic respiratory diseases 5 …”

“…3 Regardless of the underlying mechanisms, asthma and obesity conflate to increase the burden of exertional dyspnoea and decrease exercise tolerance, two important determinants of poor quality of life in chronic respiratory diseases. 5 In a recent publication in Respirology, Pitzner-Fabricius and co-workers 6 analysed the results of a cross-sectional study that involved a sub-population of asthmatics who might be particularly susceptible to the deleterious physiological and sensory consequences of obesity 7 : those with severe asthma. 8 The authors found that amongst a comprehensive array of clinical and biological factors only asthma symptoms of daily life and increased body mass index (BMI) were associated with poor exercise tolerance as indicated by a low 6-min walking distance (6-MWD).…”