Introduction The effect of pharmacological and non-pharmacological interventions on physical activity (PA) outcomes across chronic respiratory diseases (CRDs) is not fully elucidated.

Objectives i) To evaluate the effects of all available interventions on PA outcomes in CRDs; ii) to explore which PA outcomes have been used as endpoints in clinical studies.

Methods Two different databases were compiled with searches performed in July 2021 and June 2022, yielding a total of 89 studies.

Results Compared to usual care (UC), PA behavioural modification interventions, applied alone or alongside exercise training, resulted in significant improvements in the mean (95% CI) steps/day: 1060 (667, 1454) (p<0.00001) (figure 1) and 679 (93, 1266) (p=0.02), respectively. Moreover, pharmacological interventions compared to placebo yielded a significant difference in steps/day: 602 (104, 1100) (p=0.01) (figure 1). In patients with CRDs exercise training alone compared to UC led to non-significant (p=0.11) improvements in steps/day (441 (-69, 951)). In patients with COPD, PA behavioural modification interventions compared to UC led to significant (p<0.0001) improvements in steps/day 913 (504, 1322), whilst bronchodilator therapy significantly improved steps/day by 396 (125, 668) (p=0.02).

Conclusions In CRDs, only PA behavioural modification and pharmacological interventions lead to significant improvements in steps/day compared to the control. In COPD, bronchodilators led to significantly increased steps/day in patients with COPD (by 396 steps/day), compared to placebo, likely by reducing exertional breathlessness, improving lung function, and decreasing dynamic hyperinflation. PA behavioural modification interventions, however, lead to a 2-fold improvement in steps/day compared to bronchodilators, thereby promoting the assumption that there are significant (but limited improvements) in PA when lung function is ameliorated. For further improvements in PA, the behaviour of the patient towards PA should be modified. Clinical and methodological gaps were profound in the literature while large-scale clinical trials are needed to assess the minimal important difference of PA outcomes in response to different pharmacological or non-pharmacological interventions.

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