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

Abstract

BackgroundPhysical 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.ObjectiveThe aim of this systematic review and meta-analysis was to study the effects of randomized controlled trials (RCTs) targeting PA in COPD.MethodsDatabases (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).ResultsA 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.ConclusionInterventions that included ET and PA counseling during PR were effective strategies to improve PA in COPD.

Use of pedometers as a tool to promote daily physical activity levels in patients with COPD: a systematic review and meta-analysis

“…However, significant heterogeneity (I 2 =81%) may have affected the overall analysis of those studies. The increase in steps per day reported as a result of pedometer physical activity promotion seems much larger than those from other methods including exercise training as part of pulmonary rehabilitation, health monitoring, long-term oxygen therapy or neuromuscular electrical stimulation [12,17].…”

“…The final search of the literature took place on 18 January, 2019. Pre-piloted literature searches prior to the final search strategy were conducted based on two previously published systematic reviews on a related topic [1,17]. The full search strategy can be found in table 1.…”

The feasibility of early pulmonary rehabilitation and activity after COPD exacerbations: external pilot randomised controlled trial, qualitative case study and exploratory economic evaluation

“…34,[36][37][38][39][40] The British Thoracic Society (BTS) guidelines 34 recommend, at a minimum, twice-weekly supervised sessions over 6-12 weeks commencing within 1 month of hospital discharge. PR aims to restore the patient to the highest possible level of independent function through increased physical activity and the provision of education about their disease, different treatment options and coping strategies.…”

Predictors of adherence to exercise interventions during and after cancer treatment: A systematic review

“…However, behavioral factors are more crucial in predicting exercise adherence in unsupervised exercise compared to supervised interventions. 47Awareness of the importance of physical exercise not only in cancer treatment but also in other chronic diseases, such as chronic obstructive pulmonary disease and diabetes, has increased over the past years 72,73. Consequently, the number of RCTs investigating exercise interventions during and after cancer treatment has increased.…”