Evidence summary (Updated 2022)
A large body of interventional data shows a reduction in dyspnoea symptoms as measured by outcome scores. This is further confirmed by a recent review of evidence with reduced breathlessness and improved respiratory muscle strength .
A meta-analysis by Pan et al, of 7 studies, and 240 patients, examining whether unsupported upper limb exercise reduces dyspnoea and arm fatigue, found that ADL dyspnoea (breathlessness during activities of daily living) reduced (WMD=-0.58; 95% CI = -1.13 to -0.02), however the overall treatment effects were lower than the MCID of 1 unit for the Borg scale.(1)
Gao et al compared HIIT vs usual care. 5 RCTs (n = 297) showed statistically decreased dyspnoea scores with Borg and MRC (SMD = − 0.32, 95% CI [− 0.56, − 0.09], P = 0.007).(2)
A 7 study MA showed land or water-based training group significantly improved dyspnoea (MD –0.61 [–1.08, –0.15]; P=0.01). There were no statistically significant benefits found on subgroup analysis for the water-based group (MD –1.09 [–2.25, 0.07]; P=.06).(3)
A 20 study (n = 992) MA showed significantly improved Borg with SMD of 0.37 (95% CI, 0.52 to 0.22), indicating that participation in a PR program significantly reduced dyspnoea in patients with COPD (Z ¼ 4.90, p < .001), as well as improving respiratory muscle strength (Max Expiratory Pressure (SMD, 0.87; 95% CI, 0.42-1.32; p < .001), MIP (SMD, 0.53; 95% CI, 0.13-0.93; p = .009)).(4)
An eight RCT meta-analysis (n =758) looking at telemedicine-based PR compared with none or centre-based rehabilitation. Tele-R compared to no rehabilitation improved the mMRC of -1.02U (CI: -1.49, -0.59; p<0.001) but no difference was seen compared to centre-based rehabilitation (p=0.911).(5)
An 11 study meta-analysis of PR with Yoga and Tai Chi. Pulmonary rehabilitation, compared to control group, showed significant changes in the MRC (WMD, −0.59; 95% CI: −0.81 to −0.37; p < .001; I2 = 76.8%) , but no significant difference was found in 8 studies using Borg scores (WMD, −0.33; 95% CI: −0.91–0.24; p < .001; I2 = 76.4%). There were also significant observed changes in FEV1% predicted values (WMD, 0.20; 95% CI: 0.03–0.36; p < .001; I2 = 92.7%).(6)
A total of 42 studies (n = 2150) were analysed in the SR/MA which looked at the positive effects of PR programmes, including lower limb endurance training. For MRC, 5 studies found improved changes with PR (MD, −0.64; 95% CI, −0.99 to −0.30; p = 0.0003; I2 = 68%). In the transitional Dyspnoea Index, 5 studies showed improvements again (MD, 1.95; 95% CI, 1.09 to 2.81; p = 0.0001; I2 = 65%). The Borg scale improved in 12 studies (MD, −0.62; 95% CI, −1.10 to −0.14; p = 0.01; I2 = 54%) and CRQ also improved over 12 studies (MD, 0.91; 95% CI, 0.39 to 1.44; p = 0.0007; I2 = 40%).(7)
A 6 study MA showed the mMRC was significantly lower in the early PR group following an AECOPD compared to usual care (MD = −0.36, 95%CI −0.52 to −0.21, Z = 4.56, p ˂ 0.00001). 4 studies however, showed no significant difference in FEV1% predicted compared with usual care (MD = 0.50, 95%CI −1.43 to 2.44, Z = 0.51, p = 0.61).(8)
This SR/MA of 15 studies (n = 514) looked at the effects of upper limb training. Upper limb endurance showed significantly greater improvement in dyspnoea than the control (SMD=-0.56; 95% CI, -0.95 to -0.16; p=0.006) with similar effects seen for upper limb strength programmes (SMD=-0.36; 95% CI, -0.61 to -0.11; p=0.004). When all modes of upper limb training were analysed, it showed a significantly greater improvement in dyspnoea than the control (SMD=-0.44; 95% CI, -0.64 to -0.23; p<0.001), with the greatest effect seen in severe COPD sufferers.(9)
A qigong SR/MA showed, on analysis of 3 studies a significantly lowered mMRC compared with the control group (MD = −0.73, 95% CI [−0.96, −0.50], P < .00001) as well as improvements in forced expiratory volume in one second (FEV1) (MD = −0.16, 95% CI [0.09, 0.23], P < .00001) and FEV1% (MD = 9.71, 95% CI [8.44, 10.98], P < .00001).(2)
The following were shown to be beneficial: continuous training, HIIT, land or water-based training, pulmonary rehabilitation(PR), telemedicine PR, Tai Chi, Yoga & qigong.(10–13) Whole body vibration had no significant benefit.(14)
Quality of evidence
Grade B – Moderate quality
Strength of recommendation
Grade 1 – Strong recommendation
Conclusion
Overall a considerable number of physical activity interventions can improve dyspnoea and feelings of breathlessness in patients with COPD.
References
- Pan L, Guo YZ, Yan JH, Zhang WX, Sun J, Li BW. Does upper extremity exercise improve dyspnea in patients with COPD? A meta-analysis. Respir Med [Internet]. 2012 Nov [cited 2022 Oct 6];106(11):1517–25. Available from: https://pubmed.ncbi.nlm.nih.gov/22902265/
- Gao M, Huang Y, Wang Q, Liu K, Sun G. Effects of High-Intensity Interval Training on Pulmonary Function and Exercise Capacity in Individuals with Chronic Obstructive Pulmonary Disease: A Meta-Analysis and Systematic Review. Adv Ther [Internet]. 2022 Jan 1 [cited 2022 Oct 4];39(1):94–116. Available from: https://link.springer.com/article/10.1007/s12325-021-01920-6
- Chen H, Li P, Li N, Wang Z, Wu W, Wang J. Rehabilitation effects of land and water-based aerobic exercise on lung function, dyspnea, and exercise capacity in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Medicine (Baltimore) [Internet]. 2021 Aug 20 [cited 2022 Oct 5];100(33). Available from: https://pubmed.ncbi.nlm.nih.gov/34414971/
- Lee EN, Kim MJ. Meta-analysis of the Effect of a Pulmonary Rehabilitation Program on Respiratory Muscle Strength in Patients with Chronic Obstructive Pulmonary Disease. Asian Nurs Res (Korean Soc Nurs Sci) [Internet]. 2019 Feb 1 [cited 2022 Oct 6];13(1):1–10. Available from: https://pubmed.ncbi.nlm.nih.gov/30481604/
- Ora J, Prendi E, Attinà ML, Cazzola M, Calzetta L, Rogliani P. Efficacy of respiratory tele-rehabilitation in COPD patients: Systematic review and meta-analysis. Monaldi Arch chest Dis = Arch Monaldi per le Mal del torace [Internet]. 2022 Jan 27 [cited 2022 Oct 4];92(4). Available from: https://pubmed.ncbi.nlm.nih.gov/35086329/
- Zhang H, Hu D, Xu Y, Wu L, Lou L. Effect of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis of randomized controlled trials. Ann Med [Internet]. 2022 [cited 2022 Oct 5];54(1):262–73. Available from: https://pubmed.ncbi.nlm.nih.gov/35037535/
- Higashimoto Y, Ando M, Sano A, Saeki S, Nishikawa Y, Fukuda K, et al. Effect of pulmonary rehabilitation programs including lower limb endurance training on dyspnea in stable COPD: A systematic review and meta-analysis. Respir Investig. 2020 Sep 1;58(5):355–66.
- Du Y, Lin J, Wang X, Zhang Y, Ge H, Wang Y, et al. Early Pulmonary Rehabilitation in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Meta-Analysis of Randomized Controlled Trials. https://doi.org/101080/1541255520222029834 [Internet]. 2022 [cited 2022 Oct 5];19(1):69–80. Available from: https://www.tandfonline.com/doi/abs/10.1080/15412555.2022.2029834
- Kruapanich C, Tantisuwat A, Thaveeratitham P, Lertmaharit S, Ubolnuar N, Mathiyakom W. Effects of Different Modes of Upper Limb Training in Individuals With Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Ann Rehabil Med [Internet]. 2019 [cited 2022 Oct 5];43(5):592–614. Available from: https://pubmed.ncbi.nlm.nih.gov/31693849/
- Arnardóttir RH, Boman G, Larsson K, Hedenström H, Emtner M. Interval training compared with continuous training in patients with COPD. Respir Med [Internet]. 2007 Jun [cited 2022 Oct 5];101(6):1196–204. Available from: https://pubmed.ncbi.nlm.nih.gov/17188853/
- Nasis IG, Vogiatzis I, Stratakos G, Athanasopoulos D, Koutsoukou A, Daskalakis A, et al. Effects of interval-load versus constant-load training on the BODE index in COPD patients. Respir Med [Internet]. 2009 Sep [cited 2022 Oct 5];103(9):1392–8. Available from: https://pubmed.ncbi.nlm.nih.gov/19349153/
- Santos C, Rodrigues F, Santos J, Morais L, Bárbara C. Pulmonary Rehabilitation in COPD: Effect of 2 Aerobic Exercise Intensities on Subject-Centered Outcomes–A Randomized Controlled Trial. Respir Care [Internet]. 2015 Nov 1 [cited 2022 Oct 4];60(11):1603–9. Available from: https://pubmed.ncbi.nlm.nih.gov/26221044/
- Zwerink M, Brusse-Keizer M, van der Valk PDLPM, Zielhuis GA, Monninkhof EM, van der Palen J, et al. Self management for patients with chronic obstructive pulmonary disease. Cochrane database Syst Rev [Internet]. 2014 Mar 24 [cited 2022 Oct 5];2014(3). Available from: https://pubmed.ncbi.nlm.nih.gov/24665053/
- Zhou J, Pang L, Chen N, Wang Z, Wang C, Hai Y, et al. Whole-body vibration training – better care for COPD patients: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis [Internet]. 2018 [cited 2022 Oct 6];13:3243–54. Available from: https://pubmed.ncbi.nlm.nih.gov/30349230/