Optimal Exercise Modalities and Doses for Alleviating Dyspnea Symptoms and Enhancing Exercise Capacity in Patients With Chronic Obstructive Pulmonary Disease: A Network and Dose-Response Meta-analysis.

OBJECTIVE

To investigate the optimal exercise modalities and doses for alleviating dyspnea and enhancing exercise capacity in patients with chronic obstructive pulmonary disease (COPD).

DATA SOURCES

PubMed, Cochrane, Embase, and Web of Science were searched until June 2024.

STUDY SELECTION

Randomized controlled trials on dyspnea and exercise capacity in patients with COPD were included.

DATA EXTRACTION

Exercises were compared using a network and dose-response meta-analysis. Two authors independently extracted the data and assessed bias risk.

DATA SYNTHESIS

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).

CONCLUSIONS

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.