Xie Jingyi, Guo Jindong, Wang Bin
School of Physical Education, Central China Normal University, Wuhan.
School of Sports Economics and Management, Hubei University of Economics, Wuhan, Hubei, China.
Arch Phys Med Rehabil. 2025 May 7. doi: 10.1016/j.apmr.2025.05.001.
To investigate the optimal exercise modalities and doses for alleviating dyspnea and enhancing exercise capacity in patients with chronic obstructive pulmonary disease (COPD).
PubMed, Cochrane, Embase, and Web of Science were searched until June 2024.
Randomized controlled trials on dyspnea and exercise capacity in patients with COPD were included.
Exercises were compared using a network and dose-response meta-analysis. Two authors independently extracted the data and assessed bias risk.
The study included 46 randomized controlled trials (2363 participants). Continuous aerobic training (mean difference [MD]=55.2; 95% credible interval [CrI], 28.1-84.5; Grading of Recommendations Assessment, Development and Evaluation [GRADE]: Low), interval training (MD=84.5; 95% CrI, 24.6-145; GRADE: Low), Qigong (MD=33.3; 95% CrI, 10.4-58.1; GRADE: Low), and resistance training (MD=41.5; 95% CrI, 7.27-77.7; GRADE: Low) improved 6-minute walk distance (6MWD). Qigong (MD=-8.20; 95% CrI, -15.6 to -1.50; GRADE: Low) and yoga (MD=-28.3; 95% CrI, -48.1 to -8.61; GRADE: Low) showed significant improvements in St. George's Respiratory Questionnaire (SGRQ). Resistance training (MD=12.1; 95% CrI, 4.62-18.7; GRADE: Low) correlated positively with forced expiratory volume in 1 second (FEV1), while Qigong correlated positively with forced vital capacity (FVC) (MD=0.378; 95% confidence interval, 0.087-0.620; GRADE: Low). Interval training, yoga, resistance training, and Qigong ranked the highest in 6MWD, SGRQ, FEV1, and FVC. The dose-response curve revealed an increasing trend in the effect of exercise intensity on enhancing 6MWD with intensified exercise levels. Regarding SGRQ scores, the optimal effect was observed at an exercise intensity of 620 metabolic equivalent of task (MET)-min/wk (MD=-7.07, 95% CrI, -12.23 to -1.87). The optimal exercise intensity was 350 MET-min/wk for FEV1 (MD=0.44, 95% CrI, 0.09-0.80) and FVC (MD=0.44, 95% CrI, 0.09-0.80).
Low quality evidence shows that interval training, yoga, resistance training, and Qigong effectively improved dyspnea and exercise capacity in patients with COPD. Optimal exercise doses vary across outcomes, necessitating personalized adjustments based on health status.
探讨缓解慢性阻塞性肺疾病（COPD）患者呼吸困难及提高运动能力的最佳运动方式和剂量。
检索了PubMed、Cochrane、Embase和Web of Science数据库至2024年6月。
纳入关于COPD患者呼吸困难和运动能力的随机对照试验。
采用网状和剂量反应荟萃分析比较运动方式。两位作者独立提取数据并评估偏倚风险。
该研究纳入46项随机对照试验（2363名参与者）。持续有氧运动（平均差[MD]=55.2；95%可信区间[CrI]，28.1 - 84.5；推荐分级评估、制定和评价[GRADE]：低）、间歇训练（MD=84.5；95% CrI，24.6 - 145；GRADE：低）、气功（MD=33.3；95% CrI，10.4 - 58.1；GRADE：低）和抗阻训练（MD=41.5；95% CrI，7.27 - 77.7；GRADE：低）可改善6分钟步行距离（6MWD）。气功（MD=-8.20；95% CrI，-15.6至-1.50；GRADE：低）和瑜伽（MD=-28.3；95% CrI，-48.1至-8.61；GRADE：低）在圣乔治呼吸问卷（SGRQ）方面有显著改善。抗阻训练（MD=12.1；95% CrI，4.62 - 18.7；GRADE：低）与第1秒用力呼气量（FEV1）呈正相关，而气功与用力肺活量（FVC）呈正相关（MD=0.378；95%置信区间，0.087 - 0.620；GRADE：低）。间歇训练、瑜伽、抗阻训练和气功在6MWD、SGRQ、FEV1和FVC方面排名最高。剂量反应曲线显示，随着运动强度增加，运动强度对提高6MWD的效果呈上升趋势。关于SGRQ评分，在运动强度为620代谢当量任务（MET）-分钟/周时观察到最佳效果（MD=-7.07，95% CrI，-12.23至-1.87）。FEV1和FVC的最佳运动强度为350 MET-分钟/周（MD=0.44，95% CrI，0.09 - 0.80）。
低质量证据表明，间歇训练、瑜伽、抗阻训练和气功可有效改善COPD患者的呼吸困难和运动能力。最佳运动剂量因结局而异，需要根据健康状况进行个性化调整。
