Camillo Carlos A, Osadnik Christian R, van Remoortel Hans, Burtin Chris, Janssens Wim, Troosters Thierry
KU Leuven, Dept of Rehabilitation Sciences, Leuven, Belgium; University Hospital Leuven, Respiratory Division and Rehabilitation, Leuven, Belgium; Both authors contributed equally.
KU Leuven, Dept of Rehabilitation Sciences, Leuven, Belgium; Monash University, Dept of Physiotherapy, Victoria, Australia; Institute for Breathing and Sleep, Victoria, Australia; Monash Health, Monash Lung and Sleep, Victoria, Australia; Both authors contributed equally.
ERJ Open Res. 2016 Mar 29;2(1). doi: 10.1183/23120541.00078-2015. eCollection 2016 Jan.
The aim of this review was to identify the effectiveness of therapies added on to conventional exercise training to maximise exercise capacity in patients with chronic obstructive pulmonary disease (COPD). Electronic databases were searched, identifying trials comparing exercise training with exercise training plus "add-on" therapy. Outcomes included peak oxygen uptake ('), work rate and incremental/endurance cycle and field walking tests. Individual trial effects on exercise capacity were extracted and collated into eight subgroups and pooled for meta-analysis. Sensitivity analyses were conducted to explore the stability of effect estimates across studies employing patient-centred designs and those deemed to be of "high" quality (PEDro score >5 out of 10). 74 studies (2506 subjects) met review inclusion criteria. Interventions spanned a broad scope of clinical practice and were most commonly evaluated the 6-min walking distance and '. Meta-analysis revealed few clinically relevant and statistically significant benefits of "add-on" therapies on exercise performance compared with exercise training. Benefits favouring "add-on" therapies were observed across six different interventions (additional exercise training, noninvasive ventilation, bronchodilator therapy, growth hormone, vitamin D and nutritional supplementation). The sensitivity analyses included considerably fewer studies, but revealed minimal differences to the primary analysis. The lack of systematic benefits of "add-on" interventions is a probable reflection of methodological limitations, such as "one size fits all" eligibility criteria, that are inherent in many of the included studies of "add-on" therapies. Future clarification regarding the exact value of such therapies may only arise from adequately powered, multicentre clinical trials of tailored interventions for carefully selected COPD patient subgroups defined according to distinct clinical phenotypes.
本综述的目的是确定在传统运动训练基础上添加其他疗法对慢性阻塞性肺疾病（COPD）患者运动能力最大化的有效性。检索了电子数据库，确定了比较运动训练与运动训练加“附加”疗法的试验。结果包括峰值摄氧量、工作率以及递增/耐力周期和实地步行测试。提取各个试验对运动能力的影响，并整理成八个亚组，合并进行荟萃分析。进行敏感性分析以探讨采用以患者为中心设计的研究以及那些被认为“高质量”（PEDro评分>10分中的5分）的研究中效应估计值的稳定性。74项研究（2506名受试者）符合综述纳入标准。干预措施涵盖广泛的临床实践范围，最常评估的是6分钟步行距离和峰值摄氧量。荟萃分析显示，与运动训练相比，“附加”疗法对运动表现几乎没有临床相关且具有统计学意义的益处。在六种不同的干预措施（额外的运动训练、无创通气、支气管扩张剂治疗、生长激素、维生素D和营养补充）中观察到了有利于“附加”疗法的益处。敏感性分析纳入的研究少得多，但与主要分析相比差异极小。“附加”干预措施缺乏系统性益处可能反映了方法学上的局限性，例如许多纳入的“附加”疗法研究中固有的“一刀切”入选标准。关于此类疗法的确切价值，未来可能只有通过针对根据不同临床表型精心挑选的COPD患者亚组进行的充分有力的多中心量身定制干预临床试验才能明确。
