Zahno K1,2, Taeymans J2, Hilfiker R3
1Inselspital Bern, Bern University Hospital, Department of Physiotherapy, Bern, Switzerland, 2Bern University of Applied Sciences, Department of Physiotherapy, Bern, Switzerland, 3HES-SO Valais-Wallis. University of Applied Sciences and Arts Western Switzerland Valais, Department of Physiotherapy, Leukerbad, Switzerland
Background: According to the WHO, COPD will be the third leading cause of death in 2020. There is no cure yet, but there are possibilities to relieve symptoms and improve quality of life. Physical training is one of them and well-studied. However, it is still unknown which training modality is the most effective for adult patients with COPD.
Purpose: The aim of this study was to identify the relative effects of different training modalities on quality of life and functional capacity in male and female adult patients with COPD as well as to rank the effectiveness of the different training modalities of endurance, resistance training and combined resistance plus endurance training.
Methods: The electronic databases Pubmed, Cochrane Central, CINAHL, Medline and Embase were systematically searched until July 1, 2017. Two reviewers performed the screening of titles, abstracts and full texts, and decided on the eligibility of the publications independently. To reduce bias due to small study effects, we excluded studies with less than 20 participants per treatment arm. Outcomes were health-related quality of life and functional capacity. Risk of bias was assessed using the Cochrane Risk of Bias Tool 2.0 (Whiting et al., 2016). For assessing the quality of evidence of the included reviews the internet service GRADEpro approach was used. The planned network-meta-analysis was not feasible because the assumptions of transitivity were not met. Therefore, eight pairwise-meta-analyses were calculated. The statistical analyses were performed with R-Studio.
Results: In terms of quality of life, high intensity interval training compared with aerobic training did not show any difference for adult patients with COPD (2 studies; n=101; SMD=0.17, 95%CI: - 0.23 to 0.56) neither did resistance training on the whole vibration platform compared with high intensity interval training (2 studies; n=123; SMD=0.09, 95%CI: -0.26 to 0.44).
The results for functional capacity are similar: High intensity interval training was not better than aerobic training (2 studies; n= 101; SMD =0.08; 95%CI: -0.71 to 0.86), neither was sprint interval training compared to aerobic training (2 studies; n=128, SMD =0.26; 95%CI: -0.20 to 0.72), nor inspiratory muscle training (IMT) compared to sham IMT therapy (2 studies; n=109; SMD = 0.53; 95%CI: -0.72 to 1.79). Resistance training was not better than resistance training performed on a body vibration platform (3 studies; n= 197; SMD=0.21, 95%CI: -0.39 to 0.8), or no training (2 studies; n=104; SMD=0.41, 95%CI -0.67 to 1.49). However, aerobic training is better compared to no training for patients with COPD (2 studies n=105; SMD= -0.76; 95%CI: -1.15 to -0.36).
Conclusion(s): Aerobic exercise was confirmed to be effective, however, we still can not determine the best aerobic-exercise modality nor was it possible to rank training modalities. .
Implications: Future large scale randomised controlled studies should use better definitions and reporting of exercise parameters to make them comparable and therefore allow the determination of the most effective exercise modality.
Keywords: COPD, training, meta-analysis
Funding acknowledgements: No funding has been received.
Purpose: The aim of this study was to identify the relative effects of different training modalities on quality of life and functional capacity in male and female adult patients with COPD as well as to rank the effectiveness of the different training modalities of endurance, resistance training and combined resistance plus endurance training.
Methods: The electronic databases Pubmed, Cochrane Central, CINAHL, Medline and Embase were systematically searched until July 1, 2017. Two reviewers performed the screening of titles, abstracts and full texts, and decided on the eligibility of the publications independently. To reduce bias due to small study effects, we excluded studies with less than 20 participants per treatment arm. Outcomes were health-related quality of life and functional capacity. Risk of bias was assessed using the Cochrane Risk of Bias Tool 2.0 (Whiting et al., 2016). For assessing the quality of evidence of the included reviews the internet service GRADEpro approach was used. The planned network-meta-analysis was not feasible because the assumptions of transitivity were not met. Therefore, eight pairwise-meta-analyses were calculated. The statistical analyses were performed with R-Studio.
Results: In terms of quality of life, high intensity interval training compared with aerobic training did not show any difference for adult patients with COPD (2 studies; n=101; SMD=0.17, 95%CI: - 0.23 to 0.56) neither did resistance training on the whole vibration platform compared with high intensity interval training (2 studies; n=123; SMD=0.09, 95%CI: -0.26 to 0.44).
The results for functional capacity are similar: High intensity interval training was not better than aerobic training (2 studies; n= 101; SMD =0.08; 95%CI: -0.71 to 0.86), neither was sprint interval training compared to aerobic training (2 studies; n=128, SMD =0.26; 95%CI: -0.20 to 0.72), nor inspiratory muscle training (IMT) compared to sham IMT therapy (2 studies; n=109; SMD = 0.53; 95%CI: -0.72 to 1.79). Resistance training was not better than resistance training performed on a body vibration platform (3 studies; n= 197; SMD=0.21, 95%CI: -0.39 to 0.8), or no training (2 studies; n=104; SMD=0.41, 95%CI -0.67 to 1.49). However, aerobic training is better compared to no training for patients with COPD (2 studies n=105; SMD= -0.76; 95%CI: -1.15 to -0.36).
Conclusion(s): Aerobic exercise was confirmed to be effective, however, we still can not determine the best aerobic-exercise modality nor was it possible to rank training modalities. .
Implications: Future large scale randomised controlled studies should use better definitions and reporting of exercise parameters to make them comparable and therefore allow the determination of the most effective exercise modality.
Keywords: COPD, training, meta-analysis
Funding acknowledgements: No funding has been received.
Topic: Cardiorespiratory
Ethics approval required: No
Institution: Bern University of Applied Sciences
Ethics committee: Internal board
Reason not required: Literature review with no involvement of human participants, material or data outside of the published, primary studies.
All authors, affiliations and abstracts have been published as submitted.
