TY - JOUR
T1 - Effects of pharmacological and non-pharmacological interventions on physical activity outcomes in COPD
T2 - a systematic review and meta-analysis
AU - Megaritis, Dimitrios
AU - Hume, Emily
AU - Chynkiamis, Nikolaos
AU - Buckley, Christopher
AU - Polhemus, Ashley Marie
AU - Watz, Henrik
AU - Troosters, Thierry
AU - Vogiatzis, Ioannis
N1 - Funding information: This work was supported by the Mobilise-D project that has received funding from the Innovative Medicines Initiative (IMI) 2 Joint Undertaking (JU) under grant agreement number 820820. This JU receives support from the European Union's Horizon 2020 research and innovation programme and the European Federation of Pharmaceutical Industries and Associations (EFPIA). Content in this publication reflects the authors’ view and neither the IMI nor the European Union, EFPIA or any Associated Partners are responsible for any use that may be made of the information contained herein. Funding information for this article has been deposited with the Crossref Funder Registry.
PY - 2023/9/25
Y1 - 2023/9/25
N2 - RATIONALE: The effect of pharmacological and non-pharmacological interventions on physical activity (PA) outcomes is not fully elucidated in patients with COPD. The objectives of the present study were to provide estimation of treatment effects of all available interventions on PA outcomes in patients with COPD and to provide recommendations regarding the future role of PA outcomes in pharmacological trials.MATERIALS AND METHODS: This review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions and reported in line with PRISMA. Records were identified through searches of 12 scientific databases; the most updated search was performed in January 2023.RESULTS: 74 studies published from 2000 to 2021 were included, with a total of 8140 COPD patients. Forced expiratory volume in 1 s % predicted ranged between 31% and 74%, with a mean of 55%. Steps/day constituted the most frequently assessed PA outcome in interventional studies. Compared to usual care, PA behavioural modification interventions resulted in improvements in the mean (95% CI) steps/day when implemented alone (by 1035 (576-1493); p<0.00001) or alongside exercise training (by 679 (93-1266); p=0.02). Moreover, bronchodilator therapy yielded a favourable difference of 396 (125-668; p=0.004) steps/day, compared to placebo.CONCLUSIONS: PA behavioural modification and pharmacological interventions lead to significant improvements in steps/day, compared to control and placebo groups, respectively. Compared to bronchodilator therapy, PA behavioural modification interventions were associated with a 2-fold greater improvement in steps/day. Large-scale pharmacological studies are needed to establish an intervention-specific minimal clinically important difference for PA outcomes as well as their convergent validity to accelerate qualification as potential biomarkers and efficacy end-points for regulatory approval.
AB - RATIONALE: The effect of pharmacological and non-pharmacological interventions on physical activity (PA) outcomes is not fully elucidated in patients with COPD. The objectives of the present study were to provide estimation of treatment effects of all available interventions on PA outcomes in patients with COPD and to provide recommendations regarding the future role of PA outcomes in pharmacological trials.MATERIALS AND METHODS: This review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions and reported in line with PRISMA. Records were identified through searches of 12 scientific databases; the most updated search was performed in January 2023.RESULTS: 74 studies published from 2000 to 2021 were included, with a total of 8140 COPD patients. Forced expiratory volume in 1 s % predicted ranged between 31% and 74%, with a mean of 55%. Steps/day constituted the most frequently assessed PA outcome in interventional studies. Compared to usual care, PA behavioural modification interventions resulted in improvements in the mean (95% CI) steps/day when implemented alone (by 1035 (576-1493); p<0.00001) or alongside exercise training (by 679 (93-1266); p=0.02). Moreover, bronchodilator therapy yielded a favourable difference of 396 (125-668; p=0.004) steps/day, compared to placebo.CONCLUSIONS: PA behavioural modification and pharmacological interventions lead to significant improvements in steps/day, compared to control and placebo groups, respectively. Compared to bronchodilator therapy, PA behavioural modification interventions were associated with a 2-fold greater improvement in steps/day. Large-scale pharmacological studies are needed to establish an intervention-specific minimal clinically important difference for PA outcomes as well as their convergent validity to accelerate qualification as potential biomarkers and efficacy end-points for regulatory approval.
UR - http://www.scopus.com/inward/record.url?scp=85175153674&partnerID=8YFLogxK
U2 - 10.1183/23120541.00409-2023
DO - 10.1183/23120541.00409-2023
M3 - Review article
C2 - 37753290
SN - 2312-0541
VL - 9
JO - ERJ Open Research
JF - ERJ Open Research
IS - 5
M1 - 00409-2023
ER -