RT Journal Article
SR Electronic
T1 Physical training and non-invasive ventilation in stable chronic obstructive pulmonary disease patients: a meta-analysis and meta-regression.
JF Respiratory Care
FD American Association for Respiratory Care
SP respcare.02626
DO 10.4187/respcare.02626
A1 Cristian Ricci
A1 Stefano Terzoni
A1 Maddalena Gaeta
A1 Antonio Sorgente
A1 Anne Destrebecq
A1 Francesco Gigliotti
YR 2013
UL http://rc.rcjournal.com/content/early/2013/10/22/respcare.02626.abstract
AB Background: Exercise training improves both exercise tolerance and Quality of Life in patients with chronic obstructive pulmonary disease (COPD). The intensity of exercise training is crucial to achieve a true physiological effect. However, in COPD patients, exertional dyspnea and leg fatigue mean that the patient cannot maintain intensity of training for enough time to yield a physiological training effect. The use of non-invasive ventilation support (NIV) has been proposed as an alternative strategy to improve exercise tolerance, respiratory and cardiovascular performances. The first aim of our meta-analysis was to evaluate exercise training with NIV in terms of physiological effects after the completion of a pulmonary rehabilitation programme. A second aim was to investigate the dose-response relationship between physical improvement and training intensity. Methods: Literature research was performed using MEDLINE, EMBASE and CINAHL. Meta-analysis and meta-regressions were performed using random effect models. Results Eight studies provided a proper description of a training schedule in stable COPD patients. A similar effect between NIV and placebo was observed for the outcomes considered despite differences between studies. However, subjects experienced a relevant and statistically significant improvement after rehabilitation for almost all of the outcomes considered. Heart rate (6 beats min-1 [0.98; 11.01] P = 0.02), workload (9.73 Watt [3.78; 15.67] P = 0.0001), and VO2 (242.11 ml min-1 [154.93; 329.9] P < 0.0001) significantly improved after training. Improvements in heart rate and workload were significantly correlated to training intensity. Conclusion: Given the small number of available papers, the small sample sizes and the complete absence of power calculation we think that this topic deserves a more in-depth investigation. Randomised clinical trials, with larger sample sizes based on statistical power calculations, and designed to investigate the effect of training duration and intensity on rehabilitation, are needed to confirm results in this important field.