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Effectiveness of pulmonary rehabilitation performed through exercise training for patients with stable COPD: A meta-analysis of randomized controlled trials

Dorjana Zerbo Šporin
Dorjana Zerbo Šporin
, 
David Domjanič
David Domjanič
 e 
Boštjan Žvanut
Boštjan Žvanut
   | 28 set 2022
Slovenian Journal of Public Health's Cover Image
INFORMAZIONI SU QUESTO ARTICOLO
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Article Category: Review
Pubblicato online: 28 set 2022
Pagine: 231 - 241
Ricevuto: 21 set 2021
Accettato: 12 set 2022
DOI: https://doi.org/10.2478/sjph-2022-0031
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© 2022 National Institute of Public Health, Slovenia, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Database search flowchart.
Database search flowchart.

Figure 2

Effects of PR-ET on 6MWD: a) home-/institution-based and b) duration of PR-ET ≤8 weeks/>8 weeks.
Effects of PR-ET on 6MWD: a) home-/institution-based and b) duration of PR-ET ≤8 weeks/>8 weeks.

Figure 3

Effects of PR-ET on SGRQ total score: a) home-/institution-based and b) duration of PR-ET ≤8 weeks/>8 weeks.
Effects of PR-ET on SGRQ total score: a) home-/institution-based and b) duration of PR-ET ≤8 weeks/>8 weeks.

Assessment of the 12 TIDieR items for the RCTs included in the meta-analyses.

RCT Item 1 Item 2 Item 3 Item 4 Item 5 Item 6 Item 7 Item 8 Item 9 Item 10 Item 11 Item 12
Breyer et al. (2010) yes yes yes yes yes yes yes yes yes no no no
Finnerty et al. (2001) yes yes yes yes yes yes unclear yes no no no no
Gallo-Silva et al. (2019) yes yes yes yes unclear yes yes yes yes no yes no
Gottlieb et al. (2011) yes yes yes yes unclear yes unclear yes no no yes no
Hospes et al. (2009) yes yes yes yes yes yes yes yes yes no no no
Lahham et al. (2020) yes yes yes yes yes yes yes yes yes no yes no
Li et al. (2018) yes yes yes yes unclear yes yes yes yes no yes yes
McNamara et al. (2013) (land-based PR-ET) yes yes yes yes yes yes yes yes yes no no no
McNamara et al. (2013) (water-based PR-ET) yes yes yes yes yes yes yes yes yes no no no
Pradella et al. (2015) yes yes yes yes unclear yes unclear yes no no yes no
Ringbaek et al. (2000) yes yes yes yes yes yes yes yes yes no no no
Román et al. (2013) yes yes yes yes yes yes yes yes no no no no
Tsai et al. (2017) yes yes yes yes yes yes yes yes yes no yes no
Wadell et al. (2013) yes yes yes yes yes yes unclear yes yes no yes unclear
Wijkstra et al. (1996) yes yes yes yes yes yes yes yes yes no yes no
Xi et al. (2015) yes yes yes yes unclear unclear yes yes no no no no
Yekefallah et al. (2019) (home-based PR-ET) yes yes yes yes yes* yes yes yes unclear no unclear no
Yekefallah et al. (2019) (institution-based PR-ET) yes yes yes yes yes* yes yes yes unclear no no no
Yudhawati and Rasjid Hs (2019) yes yes yes yes yes yes unclear yes no no no no
Zhu et al. (2018) yes yes yes yes yes yes unclear yes no no yes yes

Characteristics of RCTs: type and duration of intervention, intervention at home or in an institution, frequency and duration of sessions including relevant details.

RCT Intervention Home-/ Institution- based Duration Frequency of sessions Session duration Details
Breyer et al. (2010) Nordic walking Institution 3 mo. 3 / w. 1h 75% of the initial maximum heart rate. Total duration of intervention: 9 months, data assessment after 3 months was used in meta-analysis.
Finnerty et al. (2001) Walking Home 3 mo. 1 / w. 1h Walking program with nine levels, the maximum level being 10 min of rest and then 10 min of walking. Total duration 6 months, assessment after 3 months was used in meta-analysis.
Gallo-Silva et al. (2019) Water based physical training Institution 8 w. 3 / w. 30 – 50 min Intervention consisted of warm-up (10 min) and aerobic exercises – upper limbs, and lower limbs that involved the hips, feet, ankles, hands/wrists, and shoulders (initial duration was eight 20-min sessions, progressing to eight sessions of 30 min and finishing with eight 40-min sessions). The prescribed intensity was based on a Borg CR-10 scale rating of 4 to 6.
Gottlieb et al. (2011) Physical training Institution 7 w. 2 / w. 90 min Endurance training, static circuit training, free brisk walking and breathing techniques. The aim was an intensity of 16–17 on a 20-point Borg scale.
Hospes et al. (2009) Pedometer- based exercise Home 12 w. Individualized - see details Individualized - see details Individual pedometer-based exercise counselling program promoting daily physical activities and usual care. Predominantly based on the principles of individualized goal setting and implementation of goals to enhance patients’ daily physical activities and to develop a more physically active lifestyle.
Lahham et al. (2020) Resistance training Home 8 w. Goal: 5 / w. Goal: 30 min. Work towards achieving the goal of 30 min of whole-body resistance training (upper and lower limb exercises using home stairs for step-ups and sealed water bottles as weights) and record their exercise participation using the home-exercise diary. Training programme calculated at 80% of initial walking speed from the baseline 6MWT. The intensity was gauged using the Borg scale.
Li et al. (2018) Aerobic training (A), upper limb resistance training (UR), and respiratory training (R) Home 8 w. A: 3 / w. UR: 3 / w. R: 1 / d. A: 5 – 20 min UR: (see details) R: 30 min. A: 70%–80% of maximum HR (duration: 5 min from the onset, and then accumulate to 20 min.). UR: 0.5 kg-weight load, hold on for 5 s at the end of inspiration and then expire slowly. R: Half-closed-lip abdominal respiratory training and sputum drainage. Health education was included.
McNamara et al. (2013) -land-based PR-ET Land-based exercise training Institution 8 w. 3 / w. 60 min. Warm-up (8 min), lower limb endurance (20 min), rest period (3 min), lower limb endurance (15 min), rest period (2 min), upper limb endurance (10 min), cool down (2 min). Intensity of 80% of the average 6MWT speed either over ground or on a treadmill.
McNamara et al. (2013) -water-based PR-ET Water-based exercise training Institution 8 w. 3 / w. 60 min. Similar to above. Exercise in water and on land was matched as closely as possible for intensity duration and muscle groups trained, considering the different exercise media.
Pradella et al. (2015) Walking, climbing stairs and upper limb exercises Home 8 w. 3 / w. 70 min. Walking (40 min), climbing stairs (15 min), and exercising the arms with an oil can (1 kg) using diagonal movements (15 min).
Ringbaek et al. (2000) Exercise programme (see details) Institution 8 w. 2 / w. 60 min. Warming-up, mobility training, coordination tests, dynamic strength exercise of upper and lower extremities and abdominal musculature, stair climbing and jogging as endurance training, stretching and relaxation. The intensity and load of the exercise were individualized so the patients achieved a dyspnoea-score of 4-5 out of 10 on a Borg scale.
Román et al. (2013) Respiratory physiotherapy + low intensity peripheral muscle training Institution 3 m. 1 / w. 60 min. Respiratory physiotherapy (self-conscious breathing control, diaphragmatic breathing control) and exercises for the chest wall and abdominal muscle walls (15 min) and low intensity peripheral muscle training (abdominal and upper and lower limb exercises, shoulder and full arm circling, weight-lifting and other exercises – each exercise was repeated 8–10 times over 45 min).
Tsai et al. (2017) Supervised group exercise Telerehabilitation training Home 8 w. 3 / w. 41-55 min + lower limb exercises Participants received a laptop computer with an in-built camera, a stationary lower limb cycle ergometer, and a fingertip pulse oximeter. Warm-up (5 min) and cardiovascular exercises were performed on lower limb cycle ergometer (15-20 min), followed by the rest period (3-5 min), walking training (15-20 min), rest period (3-5 min) and lower limb strengthening exercises (3 x 10 sit to stand, 3 x 10 squats).
Wadell et al. (2013) Graduated exercise training for upper and lower limbs and exercises to increase mobility Institution 8 w. 3 / w. 2.5 h Graduated exercise training for upper and lower limbs, i.e., walking on treadmill and in corridor, cycle ergometer, arm ergometer, strength/resistance exercises for upper and lower limbs, and mobility exercises. Subjects worked at their highest attainable work rate for the longest tolerable duration by targeting at least a “moderate” intensity of breathing discomfort on the modified 10-point Borg scale.
Wijkstra et al. (1996) Exercise programme (see details) Home 12 w. 2 / d. 30 min Relaxation exercises, breathing retraining, upper limb training, target-flow inspiratory muscle training (IMT – 15 min), and exercise training on a home-trainer (4-12 min). During IMT, the patients had to generate 70% of their maximal inspiratory pressure during 3 s, whilst the unloaded expiration was 4 s.
Xi et al. (2015) Exercise programme (see details) Home 12 m. See details. See details. Pursed-lip breathing (three times 5 min per day), abdominal breathing (two times 10 min per day) and upper and lower limb exercises (daily: 5 min each time, gradually increasing to 20 min).
Yekefallah et al. (2019) -home-based PR-ET Breathing exercises Home 1 m. 4 / d. Not specified (see details) Pursed-lip and diaphragmatic breathing exercises performed at home (morning, noon, evening, and night).
Yekefallah et al. (2019) -institution-based PR-ET Exercise programme (see details) Institution 1 m. 3 / w 30 min. Warm-up (5 min), upper limb strengthening exercises using one- or two-kilogram dumbbells (20 min), cool-down exercises (5 min).
Yudhawati and Rasjid Hs (2019Zhu et al. (2018) ) Yoga Tai Chi Institution Institution 12 w. 3 m. 2 / w. 1 / w. 60 min. 40-50 min Yoga classes with emphasis on breathing techniques. Supervised modified Tai Chi training, adapted to patients with COPD.
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