Physical Training and Noninvasive Ventilation in COPD Patients: A Meta-Analysis

Abstract

BACKGROUND: Exercise training improves both exercise tolerance and quality of life in patients with COPD. The intensity of exercise training is crucial to achieve a true physiologic effect. However, in COPD patients, exertional dyspnea and leg fatigue mean that the patient cannot maintain intensity of training for enough time to yield a physiologic training effect. The use of noninvasive ventilation (NIV) support has been proposed as an alternative strategy to improve exercise tolerance and respiratory and cardiovascular performances. The first aim of our meta-analysis was to evaluate exercise training with NIV in terms of physiologic effects after the completion of a pulmonary rehabilitation program. The second aim was to investigate the dose-response relationship between physical improvement and training intensity. METHODS: Literature research was performed using MEDLINE, Embase, and CINAHL. Meta-analysis and meta-regressions were performed using random effects models. RESULTS: Eight studies provided a proper description of a training schedule in stable COPD patients. A similar effect between NIV and placebo was observed for the outcomes considered despite differences between studies. However, subjects experienced a relevant and statistically significant improvement after rehabilitation for almost all of the outcomes considered. Heart rate (6 beats/min [95% CI 0.94 -11.01], P ‫؍‬ .02), work load (9.73 W [95% CI 3.78 -15.67], P < .001), and oxygen consumption (242.11 mL/min [95% CI 154.93-329.9], P < .001) significantly improved after training. Improvements in heart rate and work load were significantly correlated to training intensity. CONCLUSIONS: Given the small number of available studies, the small sample sizes, and the complete absence of power calculation, we think that this topic deserves a more in-depth investigation. Randomized clinical trials with larger sample sizes based on statistical power calculations and designed to investigate the effect of training duration and intensity on rehabilitation are needed to confirm results in this important field.

Aerobic Exercise Protects from Pseudomonas aeruginosa-Induced Pneumonia in Elderly Mice

“…Exercise is proven to slow down the lung function decline in chronic obstructive pulmonary disease (COPD) [35], and decrease inflammation in allergic asthma [36-38]. Early mobilization of critically ill ARDS patients has been shown to attenuate skeletal muscle wasting [39] and likely reduces inflammation [40] as well.…”

Hot Topics in Noninvasive Ventilation: Report of a Working Group at the International Symposium on Sleep-Disordered Breathing in Leuven, Belgium

“…In a systematic review, Ricci et al 105 concluded that although NIV beneficially affected heart rate and oxygen consumption, these effects were not statistically significant. Similarly, Corner and Garrod 104 suggested that NIV may allow increased exercise intensity and duration during pulmonary rehabilitation in subjects with moderate-to-verysevere COPD, making it reasonable to propose this treatment for patients with severe COPD.…”

“…[96][97][98][99][100][101][102][103] This topic has been further addressed in 3 systematic reviews. [104][105][106] In all studies, the included study population was small (generally 7-10 per group and study). Moreover, a considerable heterogeneity between studies makes it difficult to draw firm conclusions from the published data.…”

Year in Review 2014: COPD

“…In most cases, exertional dyspnea prevents patients from sustaining training intensity for the allocated time, making controlled breathing exercises so important. 5 Ricci et al 6 conducted a meta-analysis evaluating noninvasive ventilation as an adjunct during physical training of subjects with COPD who were undergoing pulmonary rehabilitation. Eight studies provided a proper description of a training schedule for subjects with stable COPD.…”