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

Background

Physical 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.

Objective

The aim of this systematic review and meta-analysis was to study the effects of randomized controlled trials (RCTs) targeting PA in COPD.

Methods

Databases (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).

Results

A total of 37 RCTs with 4,314 participants (mean forced expiratory volume in one second (FEV ₁) % 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.

Conclusion

Interventions that included ET and PA counseling during PR were effective strategies to improve PA in COPD.

Journal

Journal ID (nlm-ta): Int J Chron Obstruct Pulmon Dis

Journal ID (iso-abbrev): Int J Chron Obstruct Pulmon Dis

Journal ID (publisher-id): International Journal of COPD

Title: International Journal of Chronic Obstructive Pulmonary Disease

Publisher: Dove Medical Press

ISSN (Print): 1176-9106

ISSN (Electronic): 1178-2005

Publication date Collection: 2016

Publication date (Electronic): 08 December 2016

Volume: 11

Pages: 3121-3136

Affiliations

[1 ]Discipline of Physiotherapy, La Trobe University

[2 ]Institute for Breathing and Sleep

[3 ]Department of Respiratory and Sleep Medicine, Austin Health

[4 ]Department of Medicine, The University of Melbourne

[5 ]Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia

Author notes

Correspondence: Aroub Lahham, Discipline of Physiotherapy, La Trobe University Clinical School, Alfred Health, 99 Commercial Road, Melbourne, VIC 3004, Australia, Email a.lahham@ 123456latrobe.edu.au

Article

Publisher ID: copd-11-3121

DOI: 10.2147/COPD.S121263

PMC ID: 5153296

Copyright statement: © 2016 Lahham et al. This work is published and licensed by Dove Medical Press Limited

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Categories

Subject: Review