Interventions to increase physical activity in people with COPD: systematic review.

People with chronic obstructive pulmonary disease (COPD) are very sedentary and this contributes to their health problems. The aim of this systematic review was to examine the effects of interventions designed to increase physical activity (PA) in people with COPD. Studies were included when PA was the primary outcome and measured objectively. Six databases were searched and 15 studies with a total of 761 subjects were identified that met inclusion criteria. Nine of the studies were quasi-experimental (QE) and six were randomized controlled trials (RCT). Interventions included pulmonary rehabilitation (n = 7), exercise only (n = 2), behavioral only (n = 2) and a combination of both behavioral and pulmonary rehabilitation/exercise interventions (n = 4). Methodological quality was evaluated using the Downs and Black checklist. The quality of the pulmonary rehabilitation studies was the lowest with a fair rating and the quality of exercise only studies was the highest with a good rating. Eight of the 15 studies demonstrated statistically significant increases in PA: two pulmonary rehabilitation (QE = 2), two exercise only (RCT = 2), two behavioral only (RCT = 1, QE = 1), and two combined behavioral and pulmonary rehabilitation/exercise (RCT = 2). The magnitude of increase was modest in all but one study; and in many studies the increase in PA was not clinically meaningful. Longer interventions demonstrated a higher success rate and only three studies examined longer term effects of the interventions. Existing interventions are promising, but the small number of randomized controlled trials makes it difficult to draw conclusion. Further research is needed to identify a range of interventions that are effective and could be used to promote PA in people with COPD.