Osterling Kristin, MacFadyen Kimbly, Gilbert Robert, Dechman Gail
School of Physiotherapy, Dalhousie University, Halifax, NS, Canada.
School of Health Sciences, Dalhousie University, Halifax, NS, Canada.
Int J Chron Obstruct Pulmon Dis. 2014 Oct 1;9:1069-78. doi: 10.2147/COPD.S68011. eCollection 2014.
The objective of this systematic review was to determine whether people with moderate to severe COPD who are participating in pulmonary rehabilitation and exercising at high intensity demonstrate the changes in ventilatory parameters that are associated with decreased dyspnea.
The authors searched EMBASE, The Cochrane Library, and CINAHL databases up to December 2013 for relevant randomized control trials, systematic reviews, and observational studies. References of identified studies were also screened.
Studies conducted in a pulmonary rehabilitation setting that included education and exercise were included. Symptom-limited, graded exercise testing that measured tidal volume, respiratory rate, minute ventilation, and inspiratory capacity was required. The studies that contained these keywords in the title or the abstract were selected for further evaluation of the text. Disagreements between reviewers were resolved by consensus. Four studies met these inclusion criteria.
Quality assessment and data extraction were performed independently by two reviewers. Risk of bias and quality was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions.
Participants in three studies trained at high intensity (70%-80% maximum workload), demonstrating statistically significant changes in tidal volume and respiratory rate. One study did not demonstrate positive ventilatory benefits; however, participants may not have met the desired training intensity. Two studies reported improvement in dyspnea at submaximal exercise intensities. One study noted an increased maximum workload with no significant change in dyspnea at peak exercise.
People with moderate to severe, stable COPD were able to perform high intensity exercise, which was associated with positive changes in ventilatory parameters and dyspnea. A number of factors limit the generalizability of these results to people participating in pulmonary rehabilitation.
本系统评价的目的是确定参与肺康复并进行高强度锻炼的中重度慢性阻塞性肺疾病（COPD）患者是否表现出与呼吸困难减轻相关的通气参数变化。
作者检索了截至2013年12月的EMBASE、Cochrane图书馆和CINAHL数据库，以查找相关的随机对照试验、系统评价和观察性研究。还对已识别研究的参考文献进行了筛选。
纳入在肺康复环境中进行的包括教育和锻炼的研究。需要进行症状限制的分级运动试验，以测量潮气量、呼吸频率、分钟通气量和吸气容量。选择在标题或摘要中包含这些关键词的研究进行文本的进一步评估。评审员之间的分歧通过协商一致解决。四项研究符合这些纳入标准。
由两名评审员独立进行质量评估和数据提取。根据《Cochrane干预措施系统评价手册》评估偏倚风险和质量。
三项研究中的参与者进行了高强度训练（最大工作量的70%-80%），潮气量和呼吸频率有统计学上的显著变化。一项研究未显示出积极的通气益处；然而，参与者可能未达到所需的训练强度。两项研究报告在次最大运动强度时呼吸困难有所改善。一项研究指出最大工作量增加，而在峰值运动时呼吸困难无显著变化。
中重度稳定期COPD患者能够进行高强度运动，这与通气参数和呼吸困难的积极变化相关。一些因素限制了这些结果对参与肺康复的人群的普遍适用性。
