Pulmonary Rehabilitation Using Minimal Equipment for People With Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

Abstract

Objective Pulmonary rehabilitation programs that use minimal equipment for exercise training, rather than gymnasium equipment, would enable delivery of PR to a greater number of people with chronic obstructive pulmonary disease (COPD). The effectiveness of minimal equipment programmes in people with COPD is unclear. This systematic review and meta-analysis aimed to determine the effects of PR using minimal equipment for aerobic and/or resistance training in people with COPD. Methods Literature databases were searched up to September 2022 for randomized controlled trials (RCTs) comparing the effect of minimal equipment programs with usual care or with exercise equipment-based programs, for exercise capacity, health-related quality of life (HRQoL), and strength. Results Nineteen RCTs were included in the review and 14 RCTs were included in the meta-analyses, which reported low to moderate certainty of evidence. Compared with usual care, minimal equipment programs increased 6-minute walk distance (6MWD) by 85 m (95% CI = 37 to 132). No difference in 6MWD was observed between minimal equipment and exercise equipment-based programs (14 m, 95% CI = −27 to 56). Minimal equipment programs were more effective than usual care for improving HRQoL (standardized mean difference = 0.99; 95% CI = 0.31 to 1.67) and were not different from exercise equipment-based programs for improving upper limb strength (6 N; 95% CI = −2 to 13) or lower limb strength (20 N; 95% CI = −30 to 71). Conclusions In people with COPD, pulmonary rehabilitation programs using minimal equipment elicit clinically significant improvements in 6MWD and HRQoL and are comparable with exercise equipment-based programs for improving 6MWD and strength. Impact Pulmonary rehabilitation programs using minimal equipment may be a suitable alternative in settings where access to gymnasium equipment is limited. Delivery of pulmonary rehabilitation programs using minimal equipment may improve access to pulmonary rehabilitation worldwide, particularly in rural and remote areas and in developing countries.

Efficacy of Pulmonary Rehabilitation in Post-COVID-19: A Systematic Review and Meta-Analysis

“…Pulmonary rehabilitation (PR) is a very effective exercise-based therapeutic strategy to improve functional capacity, dyspnea, and health-related quality of life in patients with chronic obstructive disease [ 7 ].…”

The effects of adding a six-month Pilates exercise program to three months of traditional community-based pulmonary rehabilitation in individuals with COPD: A prospective cohort study

“…Indeed, similar improvements have been observed in patients with COPD following other types of structured exercise programs. [10][11][12][13][14][15] Moreover, the superior effect on the intervention group could also be (at least partially) attributed to the potential effect of additional exposure to exercise-based intervention. After the initial 3 months of traditional pulmonary rehabilitation, while the control group followed home-based exercises for 6 months, the intervention group received a structured Pilates-based exercise program twice week in addition to the home-base exercises.…”

“…9 A myriad of exercise-based programs -including aerobic exercise, resistance exercise, water-based exercise, Yoga and Tai Chi -have shown to be effective in patients with COPD to enhance exercise capacity and function, reduce COPDrelated symptoms and impairments, while also improving their health-related quality of life. [10][11][12][13][14][15] The engagement in physical activity and exercise-based interventions has proven to be a cost-effective strategy with relevant gains in quality-adjusted life years (QALYs). 16,17 Therefore, it is clear that medication and traditional breathing exercises should always be complemented with exercise-based interventions in patients with COPD.…”