Intensity of physical exercise and its effect on functional capacity in COPD: systematic review and meta-analysis

Adolfo, Juliano Rodrigues; Dhein, William; Sbruzzi, Graciele

doi:10.1590/1806-3713/e20180011

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Jornal Brasileiro de Pneumologia

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Brasil

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Sumário

META-ANALYSIS • J. bras. pneumol. 45 (06) • 2019 • https://doi.org/10.1590/1806-3713/e20180011 copy

Intensity of physical exercise and its effect on functional capacity in COPD: systematic review and meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate the effects of high-intensity interval training (HIIT), in comparison with those of continuous exercise, on functional capacity and cardiovascular variables in patients with COPD, through a systematic review and meta-analysis of randomized controlled trials.

Methods:

We searched PubMed, the Physiotherapy Evidence Database, the Cochrane Central Register of Controlled Trials, and EMBASE, as well as performing hand searches, for articles published up through January of 2017. We included studies comparing exercise regimens of different intensities, in terms of their effects on functional capacity and cardiovascular variables in patients with COPD.

Results:

Of the 78 articles identified, 6 were included in the systematic review and meta-analysis. Maximal oxygen consumption (VO_2max) did not differ significantly between HIIT and control interventions. That was true for relative VO_2max (0.03 mL/kg/min; 95% CI: −3.05 to 3.10) and absolute VO_2max (0.03 L/min, 95% CI: −0.02 to 0.08).

Conclusions:

The effects of HIIT appear to be comparable to those of continuous exercise in relation to functional and cardiovascular responses. However, our findings should be interpreted with caution because the studies evaluated present a high risk of bias, which could have a direct influence on the results.

Keywords:
Pulmonary disease, chronic obstructive; Exercise; Oxygen consumption

Authors	Intervention group parameters	Intervention duration	Control group parameters	I/C patients, n	I/C patient age, years; mean ± SD
Arnardóttir et al.²⁵25 Arnardóttir RH, Boman G, Larsson K, Hedenström H, Emtner M. Interval training compared with continuous training in patients with COPD. Respir Med. 2007;101(6):1196-204. https://doi.org/10.1016/j.rmed.2006.11.004 https://doi.org/10.1016/j.rmed.2006.11.0...	Type of training: cycling; exercise intensity: 3-min intervals at ≥ 80% of baseline peak exercise capacity and 3-min intervals at 30-40% of baseline peak exercise capacity; total time: 39 min	16 weeks (2 times a week)	Type of training: cycling (endurance training at ≥ 65% of baseline peak exercise capacity) + breathing and relaxation exercises	28/32	65 ± 7/64 ± 8
Brønstad et al.²⁹29 Brønstad E, Tjonna AE, Rognmo Ø, Dalen H, Heggli AM, Wisloff U, et al. Aerobic exercise training improves right- and left ventricular systolic function in patients with COPD. COPD. 2013;10(3):300-6. https://doi.org/10.3109/15412555.2012.745843 https://doi.org/10.3109/15412555.2012.74...	Type of training: treadmill; intensity: 4 × 4-min intervals at 90-95% of HR_max (10-min warm-up at 50%-60% of VO_2max and at 60-70% of HR_max); each interval was separated by 3 min of active rest at 50-70% of HR_max; total exercise time: 38 min	10 weeks (3 times a week); at least 26 of 32 sessions	Type of training: treadmill; intensity: 70% of HR_max (moderate-intensity continuous exercise); total exercise time: 47 min	10/7	65 ± 7/65 ± 5
Hentschel et al.²⁴24 Hentschel M, Becker J, Lepthin HJ. Effects of a high intensity training program on patients with chronic obstructive airways disease (COAD) [Article in German]. Pneumologie. 2002;56(4):240-6. https://doi.org/10.1055/s-2002-25073 https://doi.org/10.1055/s-2002-25073...	Type of training: cycle ergometer; intensity: training load = power at the anaerobic threshold + 40% of the difference to peak exercise; total exercise time: 40 min	4 weeks (at least 22 sessions)	Type of training: rehabilitation, education, medications, nutrition, physical therapy, and breathing exercises	84/39	48 ± 10/49 ± 12
Normandin et al.²⁸28 Normandin EA, McCusker C, Connors M, Vale F, Gerardi D, ZuWallack RL. An evaluation of two approaches to exercise conditioning in pulmonary rehabilitation. Chest. 2002;121(4):1085-91. https://doi.org/10.1378/chest.121.4.1085 https://doi.org/10.1378/chest.121.4.1085...	Type of training: treadmill and cycle ergometer; intensity: 80% of maximum workload (2 min of warm-up and cool-down time not counted); total exercise time: 30 min; intensity increased if Borg = 4 and intensity decreased if Borg = 7 or if HR close to maximum	8 weeks (2 times a week); 16 sessions	Type of training: classroom exercises/calisthenics with 8-10 repetitions (45-60 s; low-intensity continuous exercise); total exercise time: 40 min; total class time: 45 min	20/20	69 ± 7/67 ± 9
Vogiatzis et al.²⁶26 Vogiatzis I, Nanas S, Roussos C. Interval training as an alternative modality to continuous exercise in patients with COPD. Eur Respir J. 2002;20(1):12-9. https://doi.org/10.1183/09031936.02.01152001 https://doi.org/10.1183/09031936.02.0115...	Type of training: cycling; intensity: 100% of baseline peak work rate (30 s) and 45% of baseline peak work rate (30 s) in weeks 1-4; 120% of baseline peak work rate in weeks 5-8; and 140% of baseline peak work rate in weeks 9-12; total exercise time: 40 min	12 weeks (2 times a week)	Type of training: cycle ergometer exercise at 50%, 60%, and 70% of baseline peak work rate + education, breathing exercises, psychological support, and relaxation	18/18	67 ± 2/69 ± 2
Vogiatzis et al.²⁷27 Vogiatzis I, Terzis Z, Nanas S, Stratakos G, Simoes DC, Geordiadou O, et al. Skeletal muscle adaptations to interval training in patients with advanced COPD. Chest. 2005;128(6):3838-45. https://doi.org/10.1378/chest.128.6.3838 https://doi.org/10.1378/chest.128.6.3838...	Type of training: cycling; intensity: 100% of baseline peak work rate (30 s) and 45% of baseline peak work rate (30 s); total exercise time: 45 min	10 weeks (3 times a week)	Type of training: cycle ergometer exercise at 60%, 70%, and 80% of baseline peak work rate + education, breathing exercises, psychological support, and relaxation	10/9	64 ± 3/67 ± 2

Study, year	Random sequence generation	Allocation concealment	Blinding of outcome assessors	Reporting of losses and exclusions	Intention-to-treat analysis
Arnardóttir et al.²⁵25 Arnardóttir RH, Boman G, Larsson K, Hedenström H, Emtner M. Interval training compared with continuous training in patients with COPD. Respir Med. 2007;101(6):1196-204. https://doi.org/10.1016/j.rmed.2006.11.004 https://doi.org/10.1016/j.rmed.2006.11.0...	Yes	No data	No data	Yes	No
Brønstad et al.²⁹29 Brønstad E, Tjonna AE, Rognmo Ø, Dalen H, Heggli AM, Wisloff U, et al. Aerobic exercise training improves right- and left ventricular systolic function in patients with COPD. COPD. 2013;10(3):300-6. https://doi.org/10.3109/15412555.2012.745843 https://doi.org/10.3109/15412555.2012.74...	Yes	Yes	No data	Yes	No data
Hentschel et al.²⁴24 Hentschel M, Becker J, Lepthin HJ. Effects of a high intensity training program on patients with chronic obstructive airways disease (COAD) [Article in German]. Pneumologie. 2002;56(4):240-6. https://doi.org/10.1055/s-2002-25073 https://doi.org/10.1055/s-2002-25073...	No data	No data	No data	Yes	No data
Normandin et al.²⁸28 Normandin EA, McCusker C, Connors M, Vale F, Gerardi D, ZuWallack RL. An evaluation of two approaches to exercise conditioning in pulmonary rehabilitation. Chest. 2002;121(4):1085-91. https://doi.org/10.1378/chest.121.4.1085 https://doi.org/10.1378/chest.121.4.1085...	No data	No data	No data	Yes	No
Vogiatzis et al.²⁶26 Vogiatzis I, Nanas S, Roussos C. Interval training as an alternative modality to continuous exercise in patients with COPD. Eur Respir J. 2002;20(1):12-9. https://doi.org/10.1183/09031936.02.01152001 https://doi.org/10.1183/09031936.02.0115...	Yes	No data	No data	No	No data
Vogiatzis et al.²⁷27 Vogiatzis I, Terzis Z, Nanas S, Stratakos G, Simoes DC, Geordiadou O, et al. Skeletal muscle adaptations to interval training in patients with advanced COPD. Chest. 2005;128(6):3838-45. https://doi.org/10.1378/chest.128.6.3838 https://doi.org/10.1378/chest.128.6.3838...	Yes	No data	Yes^a	Yes	No

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E-mail: jbp@sbpt.org.br

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[1] Correspondence to:
Juliano Rodrigues Adolfo. Rua Dom João Becker, 1852, apto. 253, Bloco N, Fátima, CEP 92200-722, Canoas, RS, Brasil. Tel.: 55 51 99804-1164. E-mail: juliano.adolfo@ufrgs.br

#1	“Pulmonary Disease, Chronic Obstructive”[Mesh] OR “Pulmonary Disease, Chronic Obstructive” OR “COPD, Severe Early-Onset” OR “COPD” OR “Chronic Obstructive Pulmonary Disease” OR “COAD” OR “Chronic Obstructive Airway Disease” OR “Chronic Obstructive Lung Disease” OR “Airflow Obstruction, Chronic” OR “Airflow Obstructions, Chronic” OR “Chronic Airflow Obstructions” OR “Chronic Airflow Obstruction”
#2	“High-Intensity Interval training”[Mesh] OR “High-Intensity Interval Training” OR “High Intensity Interval Training” OR “High-Intensity Interval Trainings” OR “Interval Training, High-Intensity” OR “Interval Trainings, High-Intensity” OR “Training, High-Intensity Interval” OR “Trainings, High-Intensity Interval” OR “High-Intensity Intermittent Exercise” OR “Exercise, High-Intensity Intermittent” OR “Exercises, High-Intensity Intermittent” OR “High-Intensity Intermittent Exercises” OR “Sprint Interval Training” OR “Sprint Interval Trainings” OR “Interval Training” OR “Interval Exercise” OR “Intermittent Exercise” OR “High Intensity Interval Exercise” OR “High Intensity Exercise” OR “High Intensity Training” OR “High Intensity Intermittent Exercises” OR “High-Intensity Exercise”
#3	(randomized controlled trial[pt] OR controlled clinical trial[pt] OR randomized controlled trials[mh] OR random allocation[mh] OR double-blind method[mh] OR single-blind method[mh] OR clinical trial[pt] OR clinical trials[mh] OR (“clinical trial”[tw]) OR ((singl[tw] OR doubl[tw] OR trebl[tw] OR tripl[tw]) AND (mask[tw] OR blind[tw])) OR (“latin square”[tw]) OR placebos[mh] OR placebo[tw] OR random[tw] OR research design[mh:noexp] OR follow-up studies[mh] OR prospective studies[mh] OR cross-over studies[mh] OR control[tw] OR prospectiv[tw] OR volunteer*[tw]) NOT (animal[mh] NOT human[mh])
#4	#1 AND #2 AND #3