Ricci Cristian, Terzoni Stefano, Gaeta Maddalena, Sorgente Antonio, Destrebecq Anne, Gigliotti Francesco
Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.
Respir Care. 2014 May;59(5):709-17. doi: 10.4187/respcare.02626. Epub 2013 Oct 22.
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.
Literature research was performed using MEDLINE, Embase, and CINAHL. Meta-analysis and meta-regressions were performed using random effects models.
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.
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.
运动训练可改善慢性阻塞性肺疾病（COPD）患者的运动耐量和生活质量。运动训练的强度对于实现真正的生理效应至关重要。然而，COPD患者的运动性呼吸困难和腿部疲劳意味着患者无法维持足够长的训练强度以产生生理训练效果。无创通气（NIV）支持的使用已被提议作为提高运动耐量以及呼吸和心血管功能的替代策略。我们的荟萃分析的首要目的是评估在完成肺康复计划后，使用NIV进行运动训练的生理效应。第二个目的是研究身体改善与训练强度之间的剂量反应关系。
使用MEDLINE、Embase和CINAHL进行文献检索。采用随机效应模型进行荟萃分析和荟萃回归。
八项研究对稳定期COPD患者的训练方案进行了恰当描述。尽管各研究之间存在差异，但在所考虑的结局方面，观察到NIV与安慰剂之间有相似的效果。然而，几乎所有所考虑的结局在康复后受试者都有显著且具有统计学意义的改善。训练后心率（6次/分钟[95%CI 0.94 - 11.01]，P = 0.02）、工作量（9.73瓦[95%CI 3.78 - 15.67]，P < 0.001）和耗氧量（242.11毫升/分钟[95%CI 154.93 - 329.9]，P < 0.001）显著改善。心率和工作量的改善与训练强度显著相关。
鉴于现有研究数量少、样本量小且完全没有功效计算，我们认为这个主题值得更深入的研究。需要基于统计学功效计算的更大样本量的随机临床试验，旨在研究训练持续时间和强度对康复的影响，以证实这一重要领域的结果。
