Faculty of Sport Science, Research Academy of Grand Health, Ningbo University, Ningbo 315211, China.
School of Physical Education & Sport Training, Shanghai University of Sport, Shanghai 200438, China.
Int J Environ Res Public Health. 2021 Jul 18;18(14):7643. doi: 10.3390/ijerph18147643.
(1) Objective: Our objective was to conduct a meta-analysis of randomized controlled trials that have evaluated the benefits of exercise training for elderly pulmonary fibrosis (PF) patients. (2) Methods: Studies in either English or Chinese were retrieved from the China National Knowledge Infrastructure (CNKI) and the Wanfang, PubMed, Web of Science and SPORTDiscus databases from inception until the first week of April 2021. Age, body mass index (BMI), and exercise frequency, intensity, type, and duration were considered for each participant. The specific data recorded were the six-minute walk distance (6MWD), maximal rate of oxygen consumption (peak VO), predicted forced vital capacity (FVC% pred), predicted diffusing capacity of the lung for carbon monoxide (DLCO% pred), predicted total lung capacity (TLC% pred), St. George's respiratory questionnaire (SGRQ) total score and a modified medical research council score (mMRC). (3) Results: Thirteen studies comprised this meta-analysis (eleven randomized controlled trials and two prospective studies design), wherein 335 patients were exercised and 334 were controls. The results showed that exercise training increased the 6MWD (Cohen's = 0.77, MD = 34.04 (95% CI, 26.50-41.58), < 0.01), peak VO (Cohen's = 0.45, MD = 1.13 (95% CI, 0.45-1.82), = 0.0001) and FVC% pred (Cohen's = 0.42, MD = 3.94 (95% CI, 0.91-6.96), = 0.01). However, exercise training reduced scores for the SGRQ (Cohen's = 0.89, MD = -8.79 (95% CI, -10.37 to -7.21), < 0.01) and the mMRC (Cohen's = 0.64, MD = -0.58 (95% CI, -0.79 to -0.36), < 0.01). In contrast, exercise training could not increase DLCO% pred (Cohen's = 0.16, MD = 1.86 (95% CI, -0.37-4.09), = 0.10) and TLC% pred (Cohen's = 0.02, MD = 0.07 (95% CI, -6.53-6.67), = 0.98). Subgroup analysis showed significant differences in frequency, intensity, type, and age in the 6MWD results ( < 0.05), which were higher with low frequency, moderate intensity, aerobic-resistance-flexibility-breathing exercises and age ≤ 70. Meanwhile, the subgroup analysis showed significant differences in exercise intensity and types in the mMRC results ( < 0.05), which were lower with moderate intensity and aerobic-resistance exercises. (4) Conclusions: Exercise training during pulmonary rehabilitation can improved cardiopulmonary endurance and quality of life in elderly patients with PF. The 6MWDs were more noticeable with moderate exercise intensity, combined aerobic-resistance-flexibility-breathing exercises and in younger patients, which all were not affected by BMI levels or exercise durations. As to pulmonary function, exercise training can improve FVC% pred, but has no effect on DLCO% pred and TLC% pred.
（1）目的：本研究旨在对评估运动训练对老年肺纤维化（PF）患者益处的随机对照试验进行荟萃分析。（2）方法：从中国国家知识基础设施（CNKI）和万方、PubMed、Web of Science 和 SPORTDiscus 数据库中检索到 2021 年 4 月第一周之前发表的英文或中文研究。对每个参与者考虑了年龄、体重指数（BMI）和运动频率、强度、类型和持续时间。记录的具体数据包括 6 分钟步行距离（6MWD）、最大耗氧量（peak VO）、预计用力肺活量（FVC%pred）、预计一氧化碳弥散量（DLCO%pred）、预计总肺容量（TLC%pred）、圣乔治呼吸问卷（SGRQ）总分和改良医学研究委员会评分（mMRC）。（3）结果：该荟萃分析纳入了 13 项研究（11 项随机对照试验和 2 项前瞻性研究设计），其中 335 例患者接受了运动训练，334 例为对照组。结果显示，运动训练增加了 6MWD（Cohen's = 0.77，MD = 34.04（95%CI，26.50-41.58），< 0.01）、peak VO（Cohen's = 0.45，MD = 1.13（95%CI，0.45-1.82），= 0.0001）和 FVC%pred（Cohen's = 0.42，MD = 3.94（95%CI，0.91-6.96），= 0.01）。然而，运动训练降低了 SGRQ（Cohen's = 0.89，MD = -8.79（95%CI，-10.37 至-7.21），< 0.01）和 mMRC（Cohen's = 0.64，MD = -0.58（95%CI，-0.79 至-0.36），< 0.01）评分。相比之下，运动训练不能增加 DLCO%pred（Cohen's = 0.16，MD = 1.86（95%CI，-0.37-4.09），= 0.10）和 TLC%pred（Cohen's = 0.02，MD = 0.07（95%CI，-6.53-6.67），= 0.98）。亚组分析显示，在 6MWD 结果中，频率、强度、类型和年龄的差异具有统计学意义（< 0.05），低频率、中等强度、有氧-抗阻-柔韧性-呼吸锻炼和年龄≤70 时更高。同时，在 mMRC 结果中，运动强度和类型的亚组分析显示差异具有统计学意义（< 0.05），中等强度和有氧-抗阻运动时更低。（4）结论：肺康复期间的运动训练可以改善老年 PF 患者的心肺耐力和生活质量。6MWD 随着中等运动强度、有氧-抗阻-柔韧性-呼吸锻炼的结合以及在年轻患者中更为明显，这一切均不受 BMI 水平或运动持续时间的影响。至于肺功能，运动训练可以改善 FVC%pred，但对 DLCO%pred 和 TLC%pred 没有影响。
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