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Rehabilitation
Original research
Efficacy of unsupervised exercise in adults with obstructive lung disease: a systematic review and meta-analysis
  1. Daniel Taylor1,
  2. Alex R Jenkins2,
  3. Kate Parrott3,
  4. Alex Benham4,
  5. Samantha Targett5,
  6. Arwel W Jones6
  1. 1 School of Sport and Exercise Science, University of Lincoln, Lincoln, Lincolnshire, UK
  2. 2 Division of Respiratory Medicine, University of Nottingham, Nottingham, UK
  3. 3 Physiotherapy Department, Lincoln County Hospital, Lincoln, Lincolnshire, UK
  4. 4 School of Human and Health Sciences, University of Huddersfield, Huddersfield, Kirklees, UK
  5. 5 School of Allied Health and Community, University of Worcester, Worcester, UK
  6. 6 Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia
  1. Correspondence to Dr Alex R Jenkins, Division of Respiratory Medicine, University of Nottingham, Nottingham NG5 1PB, UK; alex.jenkins{at}nottingham.ac.uk

Abstract

Introduction The benefits of unsupervised exercise programmes in obstructive lung disease are unclear. The aim of this systematic review was to synthesise evidence regarding the efficacy of unsupervised exercise versus non-exercise-based usual care in patients with obstructive lung disease.

Methods Electronic databases (MEDLINE, CINAHL, Embase, Allied and Complementary Medicine Database, Web of Science, Cochrane Central Register of Controlled Trials and Physiotherapy Evidence Database) and trial registers (ClinicalTrials.gov, Current Controlled Trials, UK Clinical Trials Gateway and WHO International Clinical Trials Registry Platform) were searched from inception to April 2020 for randomised trials comparing unsupervised exercise programmes with non-exercise-based usual care in adults with chronic obstructive pulmonary disease (COPD), non-cystic fibrosis bronchiectasis or asthma. Primary outcomes were exercise capacity, quality of life, mortality, exacerbations and respiratory cause hospitalisations.

Results Sixteen trials (13 COPD, 2 asthma, 1 chronic bronchitis: 1184 patients) met the inclusion criteria. Only data on COPD populations were available for meta-analysis. Unsupervised exercise resulted in a statistically but not clinically significant improvement in the 6-Minute Walk Test (n=5, MD=22.0 m, 95% CI 4.4 to 39.6 m, p=0.01). However, unsupervised exercise did lead to statistically significant and clinically meaningful improvements in St. George’s Respiratory Questionnaire (n=4, MD=−11.8 points, 95% CI −21.2 to −2.3 points, p=0.01) and Chronic Respiratory Disease Questionnaire domains (dyspnoea: n=4, MD=0.5 points, 95% CI 0.1 to 0.8 points, p<0.01; fatigue: n=4, MD=0.7 points, 95% CI 0.4 to 1.0 points, p<0.01; emotion: n=4, MD=0.5 points, 95% CI 0.2 to 0.7 points, p<0.01; mastery: unable to perform meta-analysis) compared with non-exercise-based usual care.

Discussion This review demonstrates clinical benefits of unsupervised exercise interventions on health-related quality of life in patients with COPD. High-quality randomised trials are needed to examine the effectiveness of prescription methods.

  • exercise
  • pulmonary rehabilitation

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/thoraxjnl-2020-216007

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • DT, ARJ and AWJ are joint co-first authors.

    • Twitter @AJ_COPD

    • DT, ARJ and AWJ contributed equally.

    • Contributors DT: contribution to conception and design of the project, participation in acquisition: preparing and validation of search strategy, searching bibliographic databases, title and abstract screening, full-text screening and drafting of the manuscript. ARJ: participation in acquisition: preparing and validation of search strategy, searching bibliographic databases, title and abstract screening, full-text screening, data extraction, data analysis, drafting of the manuscript, verification and supervision over the project. KP: contribution to conception and design of the project, participation in acquisition: searching bibliographic databases, title and abstract screening, full-text screening, data extraction and drafting of the manuscript. AB: contribution to conception and design of the project, participation in acquisition: searching bibliographic databases, title and abstract screening, full-text screening, data extraction and drafting of manuscript. ST: contribution to conception and design of the project, participation in acquisition: searching bibliographic databases, title and abstract screening and drafting of manuscript. AWJ: contribution to conception and design of the project, participation in acquisition: preparing and validation of search strategy, searching bibliographic databases, title and abstract screening, full-text screening, data analysis, drafting of the manuscript, verification and supervision over the project.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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