Ferté Jean-Baptiste, Boyer François Constant, Taiar Redha, Pineau Charlotte, Barbe Coralie, Rapin Amandine
Université de Reims Champagne-Ardenne (URCA), Equipe Associée de Recherche 3797, Département de Médecine Physique et de Réadaptation, 48 rue de Sébastopol, 51092 Reims, France.
Université de Reims Champagne-Ardenne (URCA), Equipe Associée de Recherche 3797, Département de Médecine Physique et de Réadaptation, 48 rue de Sébastopol, 51092 Reims, France.
Ann Phys Rehabil Med. 2022 May;65(3):101582. doi: 10.1016/j.rehab.2021.101582. Epub 2021 Nov 18.
The aim of this systematic review was to assess functional improvement, measured by the 6-minute walk test (6MWT) after the application of a resistance training (RT) protocol in people with chronic obstructive pulmonary disease (COPD).
The search involved the databases ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, EMBASE, PubMed and Scopus from the beginning of inception to September 1, 2019. Randomized controlled trials evaluating the functional impact of RT were included. The quality of the trials was assessed with the Physiotherapy Evidence Database (PEDro) scale. Calculations were performed according to mean difference (MD) for differences between pre- and post-intervention in 6MWT distance and according to the standardized mean difference (SMD) for post-treatment results of the 6MWT and quadriceps muscle strength (QMS) improvement.
In total, 23 studies (690 patients) met the inclusion criteria. Meta-analysis was used to compute the best improvement on the 6MWT with an analysis of improvement pre- versus post-treatment (MD 37.3, 95% confidence interval [CI] 9.8; 64.8, I = 86%, p = 0.008) versus post-treatment alone, intervention versus control group (MD 15.5, 95% CI -7.7; 38.6, I 71%, p = 0.19). QMS was significantly improved (SMD 2.9, 95% CI 1.1; 4.7, I 91%, p = 0.002).
The results of the meta-analysis show a significant improvement in walking ability and performance measured by the 6MWT and an improvement in QMS for people with COPD responding to the therapy. The main limitation of this review is the significant heterogeneity across the study results. Furthermore, the statistical significance does not totally coincide with the clinical significance. RT is recommended to reduce muscle dysfunction and seems useful when combined with endurance training.
本系统评价的目的是评估在慢性阻塞性肺疾病（COPD）患者中应用阻力训练（RT）方案后，通过6分钟步行试验（6MWT）测量的功能改善情况。
检索了ClinicalTrials.gov、Cochrane对照试验中央注册库、EMBASE、PubMed和Scopus数据库，检索时间从建库开始至2019年9月1日。纳入评估RT功能影响的随机对照试验。采用物理治疗证据数据库（PEDro）量表评估试验质量。根据6MWT距离干预前后的差异计算平均差（MD），并根据6MWT治疗后结果和股四头肌力量（QMS）改善情况计算标准化平均差（SMD）。
共有23项研究（690例患者）符合纳入标准。采用荟萃分析计算6MWT治疗前后改善情况（MD 37.3，95%置信区间[CI] 9.8；64.8，I = 86%，p = 0.008）与仅治疗后、干预组与对照组相比（MD 15.5，95% CI -7.7；38.6，I 71%，p = 0.19）的最佳改善情况。QMS有显著改善（SMD 2.9，95% CI 1.1；4.7，I 91%，p = 0.002）。
荟萃分析结果显示，对于对该治疗有反应的COPD患者，6MWT测量的步行能力和表现有显著改善，QMS也有所改善。本综述的主要局限性是研究结果存在显著异质性。此外统计显著性与临床显著性并不完全一致。建议进行RT以减少肌肉功能障碍，并且与耐力训练相结合似乎有用。
