Effect of Endurance Training in COPD Patients Undergoing Pulmonary Rehabilitation: A Meta-Analysis

Abstract

Background. The efficacy of endurance training (ET) on patients with chronic obstructive pulmonary disease (COPD) has been controversial. This study was aimed at meta-analyzing the effect of ET in COPD patients undergoing pulmonary rehabilitation. Methods. The literature retrieval was performed in databases to screen relevant literature. Inclusion criteria were as follows: (1) subjects—COPD patients; (2) inclusion of interventional and control groups; (3) intervention measures—the interventional group received whole-body ET and other lung rehabilitation training, while the control group did not receive intervention or other lung rehabilitation training; (4) outcome indicators which included at least one of the following—6MWD, modified Medical Research Council questionnaire (mMRC), and COPD Assessment Test (CAT); and (5) study type—randomized controlled trials (RCTs). The Cochrane risk-of-bias tool was used to assess the risk of bias. The chi-square test was used to evaluate the magnitude of heterogeneity. Subgroup analysis was used to explore the source of heterogeneity. A funnel plot and Egger’s test were used to evaluate publication bias. Results. The 6MWD in the ET group was significantly higher than that in the control group ( MD = 47.20 , 95% CI [28.60, 65.79], P < 0.00001 ). Significant heterogeneity ( P < 0.00001 , I 2 = 76 % ) without publication bias ( P > 0.05 ) was noted. Subgroup analysis showed that the 6MWD of the ET group was significantly larger than that of the control group without heterogeneity ( P = 0.63 , I 2 = 0 % ; P = 0.59 , I 2 = 0 % ) in both the no training subgroup ( MD = 79.26 , 95% CI [72.69, 85.82], P < 0.00001 ) and other rehabilitation training group ( MD = 23.64 , 95% CI [6.70, 40.57], P = 0.006 ). The mMRC score ( MD = − 0.72 , 95% CI [-1.09, -0.34], P = 0.002 ) and CAT ( MD = − 6.07 , 95% CI [-7.28, -4.87], P < 0.00001 ) of the ET group were significantly lower than those of the control group. There was no heterogeneity ( P = 0.32 , I 2 = 15 % ; P = 0.16 , I 2 = 41 % ). Conclusion. ET can improve patients’ motor function and reduce dyspnea. ET might be incorporated as an important part of lung rehabilitation training.

Changes in Blood Markers of Oxidative Stress, Inflammation and Cardiometabolic Patients with COPD after Eccentric and Concentric Cycling Training

“…Several studies have shown that exercise training is the cornerstone of pulmonary rehabilitation as it markedly improves functional performance, muscle mass, and exercise capacity in COPD patients [ 8 , 9 , 10 ]. Endurance exercise training is the most common exercise modality prescribed in COPD [ 11 , 12 , 13 ], which has been shown to improve exercise tolerance and muscle oxidative capacity in these patients [ 12 , 14 , 15 , 16 ]. However, endurance training could also increase oxidative stress levels in severe COPD patients [ 17 ], which may not be desirable as it could impair skeletal muscle function.…”