In People With COPD, There Is Limited Evidence That Exercise Training Reduces Sedentary Time, and Behavior Change Techniques Are Poorly Reported: Systematic Review and Meta-Analysis

Abstract

Abstract Objective In people with chronic obstructive pulmonary disease (COPD), the authors sought to explore (1) the effect of any intervention on the time spent in sedentary behavior and, (2) which behavior change techniques (BCTs) have shown promise in achieving this lifestyle target. Methods Five electronic databases were searched on January 7, 2021. Studies were included if they (1) recruited people with stable COPD, (2) applied an intervention ≥4 weeks, and (3) measure sedentary time (ST) before and after the intervention period using wearable technology or via self-reports of television viewing. The primary analyses were restricted to data reported in randomized controlled trials (RCTs). All BCTs described during the intervention periods were mapped using an established taxonomy. Results Of the 1142 records identified, 8 were RCTs, of which 6 had exercise training as the intervention. Random effects meta-analysis of data from 4 of these 6 trials that implemented exercise training showed no clear effect on ST (mean difference, −3.4 minutes; 95% CI, −27.9–21.0 minutes). Commonly mapped BCTs in the majority of studies included action planning and instruction on how to perform the behavior. Of all the BCTs mapped, 25% were reported with sufficient information to be graded “beyond reasonable doubt.” Conclusion Despite robust evidence that exercise training improves functional outcomes and reduces dyspnea, this intervention does not seem to translate into behavior change. The primary analysis demonstrated that, in adults with COPD, the effect of exercise training on ST was, at best, uncertain. The BCTs embedded within the interventions were often poorly reported. Future RCTs are required that appropriately report BCT and ST to improve the precision of our estimate of the effect exercise training may have on ST, and BCTs used during intervention periods need to be reported with greater specificity. Impact In people with COPD, there is currently limited evidence to suggest that exercise training will reduce sedentary behavior. To move this area of research forward, BCTs embedded within these interventions need to be described with greater precision. Lay Summary In people with COPD, interventions such as exercise training do not seem to produce a reduction in sedentary behavior (ie, time spent sitting or lying down) during daily life. The techniques used to help people change their sedentary behavior were poorly reported, so we do not know what exactly was done and therefore cannot know what may have worked well.