EARLY exercise training improves exercise capacity and physical function in adults hospitalised for chronic obstructive pulmonary disease (COPD), according to a recent combined systemic review and meta-analysis.
Pertinent data (published between December 2021–January 2024) was sourced from PubMed, the Cochrane Library, PEDro, and EMBASE. Relevant studies were selected according to the following inclusion criteria: at least one experimental group that had been prescribed exercise training within 48 hours of hospitalisation, and comparable control group(s) receiving standard care in the absence of exercise training. Study quality was assessed using the PEDro scale, or by independent reviewers. Patient outcomes were recorded with reference to exercise capacity (2-minute step-in-place, 2-min walk distance, 3-min walk distance, 6-min walk distance), physical function (5-times sit-to-stand, 30s sit-to-stand, timed-up-and-go), adverse events, and uptake of outpatient pulmonary rehabilitation programs at discharge.
The meta-analysis comprised 10 studies, totalling 423 patients (mean age range: 62–78 years) with mean forced expiratory volume in one second spanning 0.26–0.5 (healthy range: >0.7). At discharge, the experimental groups demonstrated improved exercise capacity (standardised mean difference: 0.58; 95% confidence interval: 0.32–0.83; five studies; moderate effect; low certainty evidence) and physical function (standardised mean difference: -0.54; 95% confidence interval: -0.86– -0.22; four studies; moderate effect; low certainty evidence). There was no record of adverse effects across all 10 studies, and likewise, no record of pulmonary rehabilitation among patients post-discharge.
The authors noted potential limitations of their analysis, including the limited range of studies, some of which had potential methodological flaws, as well as a lack of information regarding uptake of patient pulmonary rehabilitation programmes post-discharge. These possible limitations underscore the need for further research into early exercise training as an adjuvant to standard treatment. Kylie Hill, corresponding author, Curtin School of Allied Health, Curtin University, Australia, and colleagues, concluded: “The results of this review provide evidence to support initiating exercise training on wards with individuals with an exacerbation of COPD.”
Reference
Lai Y et al. Exercise training initiated early during hospitalisation in individuals with chronic obstructive pulmonary disease is safe and improves exercise capacity and physical function at hospital discharge: a systematic review and meta-analysis. Respir Med. 2024;233:107554.
