Department of Physiotherapy, Alfred Health, Melbourne, Australia.
School of Translational Medicine, Monash University, Melbourne, Australia.
Eur Respir Rev. 2024 Oct 9;33(174). doi: 10.1183/16000617.0027-2024. Print 2024 Oct.
In adults with serious respiratory illness, fatigue is prevalent and under-recognised, with few treatment options. The aim of this review was to assess the impact of graded exercise therapy (GET) on fatigue in adults with serious respiratory illness.
Electronic databases were searched to identify randomised controlled trials (RCTs) testing GET (involving incremental increases in exercise from an established baseline) in adults with serious respiratory illness. The primary outcome was fatigue and secondary outcomes were health-related quality of life (HRQoL) and adverse events. Two authors independently screened for inclusion, evaluated risk of bias and extracted data.
76 RCTs were included with 3309 participants, most with a diagnosis of COPD or asthma. Reductions in fatigue measured by the Chronic Respiratory Disease Questionnaire fatigue domain score were demonstrated following GET consisting of aerobic with/without resistance training (mean difference (MD) 0.53 points, 95% CI 0.41-0.65, 11 RCTs, 624 participants) and GET using resistance training alone (MD 0.58 points, 95% CI 0.21-0.96, two RCTs, 82 participants) compared with usual care. Although the mean effect exceeded the minimal important difference, the lower end of the confidence intervals did not always exceed this threshold so the clinical significance could not be confirmed. GET consistently improved HRQoL in people with a range of chronic respiratory diseases on multiple HRQoL measures. No serious adverse events related to GET were reported.
GET may improve fatigue alongside consistent improvements in HRQoL in people with serious respiratory illness. These findings support the use of GET in the care of people with serious respiratory illness.
在患有严重呼吸系统疾病的成年人中，疲劳普遍存在且未得到充分认识，治疗选择有限。本综述的目的是评估分级运动疗法（GET）对严重呼吸系统疾病成年人疲劳的影响。
电子数据库搜索了测试 GET（涉及从既定基线逐渐增加运动）的随机对照试验（RCT），纳入患有严重呼吸系统疾病的成年人。主要结局是疲劳，次要结局是健康相关生活质量（HRQoL）和不良事件。两名作者独立筛选纳入、评估偏倚风险和提取数据。
纳入了 76 项 RCT，涉及 3309 名参与者，大多数参与者诊断为 COPD 或哮喘。有氧运动加/不加阻力训练的 GET（平均差异（MD）0.53 分，95%CI 0.41-0.65，11 项 RCT，624 名参与者）和单独使用阻力训练的 GET（MD 0.58 分，95%CI 0.21-0.96，两项 RCT，82 名参与者）可降低慢性呼吸疾病问卷疲劳域评分测量的疲劳。与常规护理相比，尽管平均效应超过了最小重要差异，但置信区间的下限并不总是超过这一阈值，因此无法确定其临床意义。GET 始终改善了多种 HRQoL 测量的各种慢性呼吸系统疾病患者的 HRQoL。没有报告与 GET 相关的严重不良事件。
GET 可能会改善患有严重呼吸系统疾病患者的疲劳，并一致改善 HRQoL。这些发现支持在严重呼吸系统疾病患者的护理中使用 GET。
