Ward Thomas J C, Latimer Lorna, Daynes Enya, Freeman Suzanne C, Ward Sarah, Xu Jiaqing, Haris Muhammed, Bakali Majda, Reap Sophie, Iqbal Mamoon, Wang Lin, Mavilakandy Akash, Olaiya Aarinola, Aung Hnin, Harvey-Dunstan Theresa C, Singh Sally J, Greening Neil J, Evans Rachael A, Steiner Michael C, Sutton Alex J
Department of Respiratory Sciences, University of Leicester, Leicester, UK.
Department of Respiratory Medicine, University Hospitals of Leicester, Leicester, UK.
EClinicalMedicine. 2025 Aug 20;87:103433. doi: 10.1016/j.eclinm.2025.103433. eCollection 2025 Sep.
Pulmonary rehabilitation (PR) is a key treatment for chronic obstructive pulmonary disease (COPD) recommended by all guidelines. However, programmes vary widely and the optimal combination of components to maximise benefits and efficiency remains unknown. We aimed to use the novel technique of component network meta-analysis (cNMA) to investigate the relative contribution of 1) exercise modality and intensity, 2) non-exercise components, 3) type of supervision, and 4) programme duration of PR for people with COPD.
MEDLINE, EMBASE, CINAHL, and Cochrane databases searched in October 2023 with no date or language restrictions. We included randomised controlled trials (RCTs) which included an intervention involving exercise for people with COPD. We present outcomes of exercise capacity, breathlessness and health related quality of life (HRQoL). Screening and eligibility were assessed by two independent reviewers. cNMA, a technique developed to investigate complex interventions such as PR, was conducted to examine the contribution of single components within diverse multicomponent interventions controlling for cohort demographics. PROSPERO: CRD42022322058.
We included 337 RCTs with 18,911 participants and 227 intervention components. In-person supervision enhanced gains in exercise capacity (Standardised mean difference (SMD) 0.41, 95% CrI 0.20; 0.63), HRQoL (0.43 95% CrI 0.19; 0.68) and breathlessness (0.31 95% CrI 0.04; 0.58) over exercise training alone with moderate to high certainty. Remote supervision increased gains in exercise capacity (0.40 95% CrI 0.08; 0.73) with trends towards improvements in HRQoL and breathlessness, with low certainty. Aerobic training appeared to be most effective for all outcomes at high or very high intensity but with low certainty. Addition of structured education did not improve any outcome. Psychological interventions led improvements in exercise capacity (0.37 95% CrI 0.01; 0.73, low certainty) and HRQoL (0.54 95% CrI 0.18; 0.91, moderate certainty). There was trend towards improvements in breathlessness with addition of breathing exercises (0.26 95% CrI -0.04; 0.56, low certainty). Programme duration did not impact outcomes. For outcomes of exercise capacity, HRQoL and breathlessness there were 60%, 63% and 59% studies at high risk of bias respectively.
This large-scale analysis of over 300 randomised PR trials found the strongest effects for in-person supervised and prescribed aerobic exercise training with less certainty for the benefit of other commonly used PR components and delivery methods.
This research was funded through a National Institute for Health and Care Research (NIHR) Applied Research Collaboration East Midlands grant (2.12) and carried out at the NIHR Leicester Biomedical Research Centre (BRC).
肺康复（PR）是所有指南推荐的慢性阻塞性肺疾病（COPD）的关键治疗方法。然而，各项目差异很大，能使效益和效率最大化的最佳组成部分组合仍不明确。我们旨在使用成分网络荟萃分析（cNMA）这项新技术，来研究1）运动方式和强度、2）非运动成分、3）监督类型以及4）COPD患者肺康复项目持续时间的相对贡献。
2023年10月检索MEDLINE、EMBASE、CINAHL和Cochrane数据库，无日期或语言限制。我们纳入了随机对照试验（RCT），其中包括针对COPD患者的涉及运动的干预措施。我们呈现运动能力、呼吸困难和健康相关生活质量（HRQoL）的结果。由两名独立 reviewers 评估筛选和合格性。进行cNMA（一种为研究如PR等复杂干预措施而开发的技术），以检验在控制队列人口统计学特征的情况下，不同多成分干预措施中单个成分的贡献。PROSPERO：CRD42022322058。
我们纳入了337项RCT，共18911名参与者和227个干预成分。与单独的运动训练相比，面对面监督能使运动能力（标准化均数差（SMD）0.41，95% CrI 0.20；0.63）、HRQoL（0.43，95% CrI 0.19；0.68）和呼吸困难（0.31，）的改善更显著，具有中到高度确定性。远程监督能增加运动能力的改善（0.40，95% CrI 0.08；0.73），对HRQoL和呼吸困难有改善趋势，但确定性较低。有氧训练在高强度或非常高强度时似乎对所有结果最有效，但确定性较低。添加结构化教育并未改善任何结果。心理干预能改善运动能力（0.37，95% CrI 0.01；0.73，低确定性）和HRQoL（0.54，95% CrI 0.18；0.91，中度确定性）。添加呼吸训练有改善呼吸困难的趋势（0.26，95% CrI -0.04；0.56，低确定性）。项目持续时间未影响结果。对于运动能力、HRQoL和呼吸困难的结果，分别有60%、63%和59%的研究存在高偏倚风险。
这项对300多项随机肺康复试验的大规模分析发现，面对面监督和规定的有氧训练效果最强，而对于其他常用的肺康复成分和实施方法的益处，确定性较低。
本研究由国家卫生与保健研究机构（NIHR）东米德兰兹应用研究合作基金（2.12）资助，并在NIHR莱斯特生物医学研究中心（BRC）开展。
