Kawachi Shohei, Yamamoto Shuhei, Nishie Kenichi, Yamaga Takayoshi, Shibuya Manaka, Sakai Yasunari, Fujimoto Keisaku
Department of Biomedical Laboratory Science, Graduate School of Medicine, Shinshu University, Matsumoto, Japan.
Institute for Biomedical Sciences, Shinshu University, Matsumoto, Japan.
Syst Rev. 2021 Apr 14;10(1):110. doi: 10.1186/s13643-021-01667-9.
Supplemental oxygen during exercise training is used to increase the training effect of an exercise program in patients with chronic obstructive pulmonary disease (COPD) who show exercise-induced desaturation. Exercise-induced desaturation is not clearly defined in the guidelines; however, it is generally defined in clinical studies as a decrease in SpO of more than 4% from rest or a decrease to less than 88% during exercise. Although some meta-analyses examined the effectiveness of supplemental oxygen during exercise training, these studies concluded that it does not further improve exercise tolerance compared to exercise training alone. However, supplemental oxygen during exercise training may be effective in improving exercise tolerance in COPD patients with severe exercise-induced desaturation. Therefore, this study will be performed to elucidate the effectiveness of supplemental oxygen during exercise training and the relationship between its effectiveness and severity of exercise-induced desaturation at baseline.
We will first assess the effectiveness of supplemental oxygen during exercise training in COPD. The main outcome is the change in exercise tolerance before and after the intervention, indicated by the 6-min walking distance, the walking distance, or the walking time in incremental shuttle walking test, and analyzed as the standardized mean difference (SMD). The quality and risk of bias in individual studies will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and risk-of-bias tool (RoB ver.2). If statistical heterogeneity in terms of the effectiveness of exercise tolerance is shown, we will conduct meta-regression analyses to examine the association between the effectiveness of exercise training with supplemental oxygen and severity of exercise-induced desaturation at baseline.
One strength of this study is that it is a systematic review with meta-regression analysis to elucidate the effectiveness of supplemental oxygen during exercise training in patients with COPD who show severe exercise-induced desaturation. Furthermore, we will assess the severity of exercise-induced desaturation for which exercise training with supplemental oxygen is effective, the influence of acute effects at baseline, and the effect of supplemental oxygen on adverse events.
Registration number, UMIN000039960.
运动训练期间补充氧气用于提高慢性阻塞性肺疾病（COPD）且存在运动诱发血氧饱和度下降患者运动计划的训练效果。运动诱发血氧饱和度下降在指南中未明确界定；然而，在临床研究中通常定义为运动时血氧饱和度（SpO）较静息时下降超过4%或降至低于88%。尽管一些荟萃分析研究了运动训练期间补充氧气的有效性，但这些研究得出结论，与单纯运动训练相比，补充氧气并不能进一步提高运动耐力。然而，运动训练期间补充氧气可能对运动诱发严重血氧饱和度下降的COPD患者提高运动耐力有效。因此，本研究将开展以阐明运动训练期间补充氧气的有效性及其有效性与基线时运动诱发血氧饱和度下降严重程度之间的关系。
我们将首先评估COPD患者运动训练期间补充氧气的有效性。主要结局是干预前后运动耐力的变化，以6分钟步行距离、递增往返步行试验中的步行距离或步行时间表示，并作为标准化均数差（SMD）进行分析。将使用推荐分级评估、制定和评价（GRADE）系统和偏倚风险工具（RoB ver.2）评估个体研究的质量和偏倚风险。如果显示出运动耐力有效性方面的统计异质性，我们将进行荟萃回归分析，以检验补充氧气的运动训练有效性与基线时运动诱发血氧饱和度下降严重程度之间的关联。
本研究的一个优势在于它是一项采用荟萃回归分析的系统评价，以阐明运动训练期间补充氧气对存在严重运动诱发血氧饱和度下降的COPD患者的有效性。此外，我们将评估补充氧气的运动训练有效的运动诱发血氧饱和度下降的严重程度、基线时急性效应的影响以及补充氧气对不良事件的影响。
注册号，UMIN000039960。
