National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom; Centre for Exercise & Rehabilitation Science, Leicester Biomedical Research Centre-Respiratory, Glenfield Hospital, Leicester, United Kingdom; Department of Respiratory Medicine, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
School of Medicine, University of Oxford, Oxford, United Kingdom.
Chest. 2020 Jul;158(1):131-144. doi: 10.1016/j.chest.2020.01.053. Epub 2020 Mar 12.
Despite the wide-ranging benefits of pulmonary rehabilitation, conflicting results remain regarding whether people with COPD can improve their peak oxygen uptake (V˙O with aerobic training.
The goal of this study was to investigate the effect of aerobic training and exercise prescription on V˙O in COPD.
A systematic review was performed by using MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases for all studies measuring V˙O prior to and following supervised lower-limb aerobic training in COPD. A random effects meta-analysis limited to randomized controlled trials comparing aerobic training vs usual care was conducted. Other study designs were included in a secondary meta-analysis and meta-regression to investigate the influence of program and patient factors on outcome.
A total of 112 studies were included (participants, N = 3,484): 21 controlled trials (n = 489), of which 13 were randomized (n = 288) and 91 were uncontrolled (n = 2,995) studies. Meta-analysis found a moderate positive change in V˙O (standardized mean difference, 0.52; 95% CI, 0.34-0.69) with the intervention. The change in V˙O was positively associated with target duration of exercise session (P = .01) and, when studies > 1 year duration were excluded, greater total volume of exercise training (P = .01). Similarly, the change in V˙O was greater for programs > 12 weeks compared with those 6 to 12 weeks when adjusted for age and sex. However, reported prescribed exercise intensity (P = .77), training modality (P > .35), and mode (P = .29) did not affect V˙O. Cohorts with more severe airflow obstruction exhibited smaller improvements in V˙O (P < .001).
Overall, people with COPD achieved moderate improvements in V˙O through supervised aerobic training. There is sufficient evidence to show that programs with greater total exercise volume, including duration of exercise session and program duration, are more effective. Reduced effects in severe disease suggest alternative aerobic training methods may be needed in this population.
PROSPERO; No.: CRD42018099300; URL: https://www.crd.york.ac.uk/prospero/.
尽管肺康复有广泛的益处，但对于 COPD 患者是否可以通过有氧运动训练提高峰值摄氧量（V˙O），结果仍存在争议。
本研究的目的是调查有氧运动训练和运动处方对 COPD 患者 V˙O 的影响。
通过 MEDLINE、Embase、护理与联合健康文献累积索引和 Cochrane 数据库，对所有在 COPD 患者接受监督下肢有氧运动训练前后测量 V˙O 的研究进行了系统评价。对比较有氧运动训练与常规护理的随机对照试验进行了随机效应荟萃分析。其他研究设计则纳入了二次荟萃分析和荟萃回归，以研究方案和患者因素对结果的影响。
共纳入 112 项研究（参与者，N=3484）：21 项对照试验（n=489），其中 13 项为随机试验（n=288），91 项为非对照试验（n=2995）。荟萃分析发现，干预后 V˙O 有适度的正变化（标准化均数差，0.52；95%CI，0.34-0.69）。V˙O 的变化与目标运动持续时间（P=0.01）呈正相关，当排除持续时间超过 1 年的研究时，与总运动训练量（P=0.01）呈正相关。同样，当调整年龄和性别时，与 6 至 12 周的方案相比，超过 12 周的方案与 V˙O 的变化更大。然而，报告的规定运动强度（P=0.77）、训练模式（P>0.35）和模式（P=0.29）对 V˙O 没有影响。气流阻塞更严重的队列中，V˙O 的改善较小（P<0.001）。
总体而言，COPD 患者通过监督的有氧运动训练获得了 V˙O 的适度改善。有足够的证据表明，总运动量更大的方案，包括运动持续时间和方案持续时间，更有效。在严重疾病中效果降低表明，该人群可能需要替代的有氧运动训练方法。
PROSPERO；编号：CRD42018099300；网址：https://www.crd.york.ac.uk/prospero/。
