School of Nursing and Midwifery, National University of Ireland, Galway, Ireland.
Cochrane Airways Group, Population Health Research Institute, St George's University of London, London, UK.
Respirology. 2018 Mar;23(3):272-283. doi: 10.1111/resp.13224. Epub 2017 Nov 30.
Chronic obstructive pulmonary disease is a common, preventable and treatable disease. Exercise training programmes (ETPs) improve symptoms, health-related quality of life (HRQoL) and exercise capacity, but the optimal setting is unknown. In this review, we compared the effects of ETPs in different settings on HRQoL and exercise capacity. We searched (5 July 2016) the Cochrane Airways Group Specialised Register, ClinicalTrials.gov and World Health Organization trials portal. We selected studies, extracted data and assessed risk of bias with two independent reviewers. We calculated mean differences (MD) with 95% CI. We assessed the quality of evidence using Grades of Recommendation, Assessment, Development and Evaluation. Ten trials (934 participants) were included. Hospital (outpatient) and home-based ETPs (seven trials) were equally effective at improving HRQoL on the Chronic Respiratory Questionnaire (CRQ) (dyspnoea: MD -0.09, 95% CI: -0.28 to 0.10; fatigue: MD -0.00, 95% CI: -0.18 to 0.17; emotional: MD 0.10, 95% CI: -0.24 to 0.45; and mastery: MD -0.02, 95% CI: -0.28 to 0.25; moderate quality) and on the St George's Respiratory Questionnaire (SGRQ) (MD -0.82, 95% CI: -7.47 to 5.83, low quality). Hospital (outpatient) and community-based ETPs (three trials) were equally effective at improving HRQoL (CRQ dyspnoea: MD 0.29, 95% CI: -0.05 to 0.62, moderate quality; fatigue: MD -0.02, 95% CI: -1.09 to 1.05, low quality; emotional: MD 0.10, 95% CI: -0.40 to 0.59, moderate quality; and mastery: MD -0.08, 95% CI: -0.45 to 0.28, moderate quality). There was no difference in exercise capacity. There was low to moderate evidence that outpatient and home-based ETPs are equally effective. See related Editorial.
慢性阻塞性肺疾病是一种常见的、可预防和可治疗的疾病。运动训练计划（ETP）可改善症状、健康相关生活质量（HRQoL）和运动能力，但最佳方案尚不清楚。在本综述中，我们比较了不同环境下 ETP 对 HRQoL 和运动能力的影响。我们检索了（2016 年 7 月 5 日） Cochrane 气道组专业登记处、ClinicalTrials.gov 和世界卫生组织试验门户。我们选择了研究，由两名独立评审员提取数据并评估偏倚风险。我们计算了均值差异（MD）和 95%置信区间（CI）。我们使用推荐、评估、制定和评估分级法评估证据质量。纳入了 10 项试验（934 名参与者）。医院（门诊）和家庭为基础的 ETP （7 项试验）在改善慢性呼吸问卷（CRQ）呼吸困难（MD-0.09，95%CI：-0.28 至 0.10；疲劳：MD-0.00，95%CI：-0.18 至 0.17；情绪：MD0.10，95%CI：-0.24 至 0.45；和掌握：MD-0.02，95%CI：-0.28 至 0.25；中等质量）和圣乔治呼吸问卷（SGRQ）（MD-0.82，95%CI：-7.47 至 5.83，低质量）方面同样有效。医院（门诊）和社区为基础的 ETP （3 项试验）在改善 HRQoL 方面同样有效（CRQ 呼吸困难：MD0.29，95%CI：-0.05 至 0.62，中等质量；疲劳：MD-0.02，95%CI：-1.09 至 1.05，低质量；情绪：MD0.10，95%CI：-0.40 至 0.59，中等质量；和掌握：MD-0.08，95%CI：-0.45 至 0.28，中等质量）。运动能力没有差异。有低到中等质量的证据表明，门诊和家庭为基础的 ETP 同样有效。见相关社论。
