Paneroni Mara, Simonelli Carla, Vitacca Michele, Ambrosino Nicolino
From the Respiratory Rehabilitation Unit, Fondazione Salvatore Maugeri, IRCCS, Institute of Lumezzane, Lumezzane (BS), Italy (MP, CS, MV); and Auxilium Vitae, Volterra, Pisa, Italy (NA).
Am J Phys Med Rehabil. 2017 Aug;96(8):541-548. doi: 10.1097/PHM.0000000000000667.
To evaluate the effectiveness of exercise training in patients with very severe chronic obstructive pulmonary disease (COPD).
We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature databases using the following as search terms: COPD, Chronic Obstructive Pulmonary Disease, Exercise, and Pulmonary Rehabilitation. We included randomized controlled trials (RCTs) of subjects with forced expiratory volume in the first second of less than 35% of the predicted normal value enrolled in in-patient, outpatient, or home- or community-based training programs lasting at least 4 weeks with respect to usual care. We included RCTs with outcome measures including the 6-minute walking test and/or health-related quality of life assessed by the St. George's Respiratory Questionnaire (SGRQ).
Of 580 articles screened, 10 were included. The programs' duration ranged from 4 to 52 weeks with 1 to 5 sessions per week lasting 15 to 40 minutes each. The intervention group improved in 6-minute walking test [weighted mean difference, 67.1 (95% confidence interval [CI], 37.897-98.927); standardized mean difference, 3.86 (95% CI, 2.04-5.67)], and St. George's Respiratory Questionnaire [weighted mean difference, -8.041 (95% CI, -15.273 to -0.809); standardized mean difference, -1.23 (95% CI, -2.14 to -0.31)].
Exercise training improves exercise tolerance and health-related quality of life in patients with very severe COPD. However, because few studies on severely affected patients are available and the training programs are Highly heterogeneous, larger RCTs are needed.
评估运动训练对极重度慢性阻塞性肺疾病（COPD）患者的有效性。
我们使用以下检索词检索了MEDLINE、EMBASE、Cochrane对照试验中心注册库以及护理与健康相关文献累积索引数据库：COPD、慢性阻塞性肺疾病、运动和肺康复。我们纳入了第一秒用力呼气量低于预测正常值35%的受试者的随机对照试验（RCT），这些受试者参加了住院、门诊、家庭或社区为基础的持续至少4周的训练项目，对照常规护理。我们纳入了以6分钟步行试验和/或圣乔治呼吸问卷（SGRQ）评估的健康相关生活质量作为结局指标的RCT。
在筛选的580篇文章中，纳入了10篇。训练项目持续时间为4至52周，每周1至5次，每次持续15至40分钟。干预组在6分钟步行试验中有所改善[加权平均差，67.1（95%置信区间[CI]，37.897 - 98.927）；标准化平均差，3.86（95%CI，2.04 - 5.67）]，在圣乔治呼吸问卷中也有所改善[加权平均差，-8.041（95%CI，-15.273至-0.809）；标准化平均差，-1.23（95%CI，-2.14至-0.31）]。
运动训练可改善极重度COPD患者的运动耐力和健康相关生活质量。然而，由于针对严重受影响患者的研究较少且训练项目高度异质性，需要进行更大规模的RCT。
