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Aerobic Exercise Training in Very Severe Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

Paneroni, Mara PT, MSc; Simonelli, Carla PT; Vitacca, Michele MD, FERS; Ambrosino, Nicolino MD, FERS

American Journal of Physical Medicine & Rehabilitation: August 2017 - Volume 96 - Issue 8 - p 541–548
doi: 10.1097/PHM.0000000000000667
Original Research Articles

Objective: To evaluate the effectiveness of exercise training in patients with very severe chronic obstructive pulmonary disease (COPD).

Design: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature databases using the following as search terms: COPD, Chronic Obstructive Pulmonary Disease, Exercise, and Pulmonary Rehabilitation. We included randomized controlled trials (RCTs) of subjects with forced expiratory volume in the first second of less than 35% of the predicted normal value enrolled in in-patient, outpatient, or home- or community-based training programs lasting at least 4 weeks with respect to usual care. We included RCTs with outcome measures including the 6-minute walking test and/or health-related quality of life assessed by the St. George's Respiratory Questionnaire (SGRQ).

Results: Of 580 articles screened, 10 were included. The programs' duration ranged from 4 to 52 weeks with 1 to 5 sessions per week lasting 15 to 40 minutes each. The intervention group improved in 6-minute walking test [weighted mean difference, 67.1 (95% confidence interval [CI], 37.897–98.927); standardized mean difference, 3.86 (95% CI, 2.04–5.67)], and St. George's Respiratory Questionnaire [weighted mean difference, −8.041 (95% CI, −15.273 to −0.809); standardized mean difference, −1.23 (95% CI, −2.14 to −0.31)].

Conclusions: Exercise training improves exercise tolerance and health-related quality of life in patients with very severe COPD. However, because few studies on severely affected patients are available and the training programs are Highly heterogeneous, larger RCTs are needed.

From the Respiratory Rehabilitation Unit, Fondazione Salvatore Maugeri, IRCCS, Institute of Lumezzane, Lumezzane (BS), Italy (MP, CS, MV); and Auxilium Vitae, Volterra, Pisa, Italy (NA).

All correspondence and requests for reprints should be addressed to: Mara Paneroni, PT, MSc, Fondazione Salvatore Maugeri, IRCCS, Divisione di Pneumologia Riabilitativa, Via Giuseppe Mazzini 129, 25065 Lumezzane (BS), Italy.

AUTHORSHIP: All authors made substantial contributions to conception and design, and in analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; gave final approval of the version to be published; and agreed to be accountable for all aspects of the work.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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