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COPD – Able to walk further

Evidence Summary

A large body of good quality randomised controlled trial study data shows an improvement in physical and functional capacity as measured by mean walking distance.

Quality of Evidence

Grade B – moderate quality. Evidence comes from randomised controlled trials

Strength of recommendation

Grade 1 – strong recommendation. Clinical and patient consensus is that physical activity can improve physical and exercise capacity. On the basis of the existing evidence, clinical opinion is that all or most patients will be best served by following this piece of evidence. The vast majority of patients would choose to follow this evidence when given the choice

Conclusion

Strong recommendations can be applied to most patients in most circumstances and should be followed unless there are compelling reasons to do otherwise

1) Pan, et al. (Respiratory Medicine, 2012)34

Meta-analysis, 7 studies,240 patients, examining whether unsupported upper limb exercise reduces dyspnoea and arm fatigue.

ADL arm fatigue reduced (WMD= -0.55; 95% CI = -1.08 to -0.01)

2) Arnardottir (Respiratory Medicine, 2007)35

Continuous vs Interval Training (16 weeks, twice weekly) – 60 participants

Functional Capacity: 12 min WD – improved 75/94m

3) Kotianou (ERS Congress Abstract, 2010)36

Continuous vs Interval Training (40 mins 3x weekly, 30 sessions)- 46 participants

Functional Capacity: change in 6MWD 40/31;

4) Mador (J Cardiopulm Rehabil Prev, 2009)37

HIT vs LIT (3x weekly 8 weeks), 252 participants

Functional Capacity: change in 6MWD 158/106m

5) Nasis (Respiratory Medicine, 2009)38

Continuous vs Interval Training (3x weekly 10 weeks), 42 participants

Functional Capacity: change in 6MWD: 52/44m

6) Puhan (Annals of Internal Medicine, 2006)39

Continuous vs Interval Training (12-15 sessions over 3 weeks)

6MWD improved

7) Santos (Respiratory Care, 2015)40

HIT vs LIT (3x weekly 8 weeks), 34 participants

Function: London Chest ADL scale: 2.3/1.5, 6MWD: 98.9/95.4

8) Iepsen (COPD, 2016)41

RCT- aerobic vs resistance training (35mins 3x weekly)

6MWD improved in both training groups (39/24m, p<0.05)

3) Zwerink (Respiratory Medicine, 2014)42

Outcomes other than physical activity: Maximal exercise capacity, CRQ (chronic respiratory questionnaire) score has dyspnoea, fatigue, emotional function and mastery domains, CCQ (clinical COPD questionnaire) score, HADS (hospital anxiety and depression score)

11-month community based physiotherapy-led exercise programme + 4 self-management sessions  vs 4 self-management sessions only, 12 and 24 month follow-up. Specific outcomes (i.e. p value and absolute change and size of study). 80 patient intervention group, 79 control group. No significant difference in maximal exercise capacity at 24 months.