resulted in a 18.48 improvement in peak work rate compared to usual care.
Fifteen studies with 979 subjects evaluated various intensities and types of lower limb aerobic exercise in patients.
HIIT showed the greatest improvements in exercise capacity and quality of life measures compared to usual care.
also improved peak work rate and walking distance similarly to HIIT, with notable enhancements in quality of life.
LICT led to a significant improvement in peak work rate but demonstrated limited clinical efficacy overall.
HICT was found to be as effective as MICT but was associated with increased dyspnea.
Simplified
BACKGROUND: Lower limb aerobic exercise is the core component of pulmonary rehabilitation for (COPD) patients. The optimal intensity and type (e.g., interval or continuous) of exercise training remains to be determined.
OBJECTIVES: We aimed to evaluate the optimal intensities and types of lower limb aerobic exercise in patients with COPD.
DESIGN: Systematic review and network meta-analysis of randomized controlled trials.
DATA SOURCES AND METHODS: The PubMed, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials were searched for relevant data. The interventions were classified according to their intensity and type as (HIIT), high-intensity continuous training (HICT), (MICT), and low-intensity continuous training (LICT). We assessed exercise capacity using peak work rate (Wpeak) and the 6-min walking test (6-MWT). Lung function was evaluated by measuring peak minute ventilation (VE) and the percentage of predicted FEV(FEVpred%). Dyspnea was assessed using the Modified Medical Research Council (mMRC) scale. Quality of life was measured with the Chronic Respiratory Questionnaire (CRQ). 1 1
RESULTS: Fifteen studies were identified (979 subjects). HIIT showed the greatest improvement in Wpeak, 6-MWT, VE, and mMRC compared to usual care (MD 18.48 (95% CI 12.35, 24.60), 67.73 (34.89, 100.57), 6.26 (2.81, 9.72), and -0.53 (-0.89, -0.17), respectively) and showed the improvement in CRQ (MD 10.80 (95% CI 1.65, 19.95)). MICT showed improvement in Wpeak and 6-MWT (MD 18.28 (95% CI 11.20, 25.22), 61.92 (28.34, 95.51)) similar to HICT (MD 16.08 (95% CI 8.19, 23.84), 64.64 (28.70, 100.57)) and showed the highest improvement in CRQ compared to usual care (MD 10.83 (95% CI 1.68, 19.98)). LICT significantly improved Wpeak compared to usual care (MD 13.47 (95% CI 4.77, 22.13)). The quality of evidence for outcomes varied from very low to moderate.
CONCLUSION: HIIT and MICT might be optimal training approaches for patients with COPD. LICT exhibited limited clinical efficacy. While HICT was as effective as MICT, it caused more dyspnea.
TRIAL REGISTRATION: This systematic review and network meta-analysis was prospectively registered with PROSPERO (No. CRD 42024520134).
Key numbers
18.48
Increase in Wpeak with
Mean difference compared to usual care.
67.73
Increase in 6-MWT with
Mean difference compared to usual care.
10.83
Increase in CRQ with
Mean difference compared to usual care.
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