Effects of exercise-based pulmonary rehabilitation on severe/very severe COPD: a systematic review and meta-analysis

Objective:Pulmonary rehabilitation (PR) has been considered to be an effective treatment method for various respiratory diseases. However, the effects of exercise-based PR on patients with severe/very severe chronic obstructive pulmonary disease (COPD) are unclear. This review aimed to investigate the effects of exercise-based PR on patients with severe/very severe COPD. Methods:PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov databases were searched from inception to December 23, 2022, without language restrictions. Randomized controlled trials (RCTs) investigating the effects of exercise-based PR on patients with severe/very severe COPD were included. Study selection, data extraction, and risk of bias assessment were conducted independently. RevMan software (version 5.3) was used for meta-analysis. The quality of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation system. Results:Six studies (263 patients) were identified. Compared with the control group, the 6-min walking distance [MD = 52.91, 95% CI (3.80, 102.03)], the St. George's Respiratory Questionnaire total scores [MD = -7.70, 95% CI (-14.32, -1.08)] and the Borg scale scores [MD = -0.68, 95% CI (-1.28, -0.08)] in the experimental group improved, respectively. The St. George's Respiratory Questionnaire and Borg scale scores were rated as 'moderate quality' and 'low quality', respectively, and the 6-min walking distance was rated as 'very low quality'. Conclusions:Exercise-based PR may improve the exercise capacity, quality of life and dyspnea of patients with severe/very severe COPD, which can be regarded as an adjuvant treatment. High quality and large sample RCTs are needed. Registration:This systematic review and meta-analysis protocol was prospectively registered with PROSPERO (No. CRD42022294085).