Efficacy of different types of exercise therapies in patients with stable COPD: A systematic review and network meta-analysis

Abstract

Abstract Background: Chronic obstructive pulmonary disease (COPD) is a prevalent and intractablechronic airway disease. At present, COPD is one of the diseases with the highest morbidity and mortality in the world and places a heavy economic burden on patients and society. As the most common form of pulmonary rehabilitation, exercise therapy is a very effective treatment for patients with COPD, but remains underutilized worldwide. This systematic review was designed to evaluate the comparative effectiveness of different exercise therapies (including traditional Chinese exercises) in patients with stable COPD. Methods: Published articles were searched in sevenEnglish and Chinese databases from inception to May 2023. Two investigators independently conducted study selection and data extraction. Stata 14.0 was employed for data synthesis and analysis. The effect size was evaluated using the mean difference (MD) and 95% confidence interval (CI). Quality assessment for each study was based on the Cochrane Risk of Bias (RoB) Tool in RevMan 5.4. Results: The results of the network meta-analysis, which included 83 randomized controlled trials, showed that the best treatments for each outcome, based on the surface under the cumulative ranking curve, were breathing combined with resistance training (FVC, FEV1, CAT and mMRC), Wuqinxi (FEV1% and FEV1/FVC), Tai Chi (SGRQ, total and SGRQ, impact), Liuzijue (SGRQ, symptoms and SGRQ, activity), and Baduanjin (6MWD). Conclusions: Breathing combined with resistance training and some traditional Chinese rehabilitation therapies (Wuqinxi, Baduanjin, Tai Chi, and Liuzijue) have shown comparative benefits for lung function, exercise capacity, and quality of life. Nevertheless, the blinded methods of the included studies could not be implemented and their methodological quality was not generally high. Additionally, there is a lack of clinical studies on the direct comparison of different exercise therapies. Therefore, further high-quality head-to-head RCTs are essential.