Using a systematic review design, this study located, appraised, and synthesized the practice recommendations for exercises in people with COPD published across clinical practice guidelines (CPG). Specifically, this review provided recommendations for the type and dosage of exercises in people with COPD.
A pre-defined search strategy developed by a medical librarian guided a comprehensive search across five electronic databases (CINAHL, Medline, PsychINFO, Cochrane Library, and PEDro) to locate CPGs for managing COPD. The CPGs that provided practice recommendations for only pharmacological or medical management of COPD and not for exercises were excluded. Two student physical therapists (SPT) independently reviewed the citations from the literature to identify relevant CPGs for the review. They also appraised the quality of the included CPGs using the Appraisal of Guidelines for REsearch & Evaluation II (AGREE) instrument. The clinical applicability of the recommendations was assessed using the AGREE-REX tool. The quality scores were calculated for CPGs using a 0-100% scale, where 100% indicated the best quality. The guidelines were synthesized for examining cardiopulmonary status, assessment of exercise response, recommended types (e.g., aerobic, resisted, or structured pulmonary rehabilitation), and dosage of exercises.
Of the 774 records identified in the literature search, 3 CPGs met the eligibility criteria. The AGREE II tool revealed that the CPG developed by Rochester et al. had the best methodological quality (89%), followed by Cosio et al. (44%) and Langer et al. (48%). The AGREE-REX tool also indicated that only Rochester et al. provided strong recommendations supporting clinical applicability. The CPGs recommended using a 6-minute walk test (6MWT) to examine cardiopulmonary status and the Borg Dyspnea Scale (BDS) to assess exercise response. The primary recommendations across all three CPGs included integrating aerobic and resistance training in physical therapy management. The CPGs recommended that these exercises be done 2-3 per week at 60-80% at 1 repetition maximum for resisted exercises and 70-80% maximum heart rate for aerobic exercises. However, domains like applicability and clarity scored low, highlighting the need for clear recommendations that have better applicability for practice.
While the CPGs provided exercise recommendations for people with COPD, the quality of two of the three CPGs was affected by moderate methodological quality and poor clinical applicability. These findings emphasize the need for further high-quality research and comprehensive guidelines to better support exercise recommendations for people with COPD. Future guidelines should provide more detailed recommendations on exercise intensity, frequency, and type to ensure effective implementation in clinical settings.
Physical therapists should prescribe a combination of aerobic and resisted exercises to people with COPD. Additionally, the therapists should use 6MWT to assess cardiopulmonary status and a BDS score of 6/10 as the threshold for stopping exercises.
COPD
exercises
