Effectiveness of Interventions to Reduce Sedentary Behaviour in People with Chronic Obstructive Pulmonary Disease: A Systematic Review of Randomised Controlled Trials

Chronic obstructive pulmonary disease (COPD) affects over 300 million people and is the third leading cause of death. People with COPD spend a large amount of their day sedentary, which is associated with reduced life expectancy.
A systematic search was conducted across electronic databases, including Medline, CINAHL, PsycINFO, and Cochrane Library. Due to the heterogeneity of study design and siting of the activity monitor, a narrative synthesis was conducted.
1086 studies were identified; six met inclusion criteria, and two reported a decreased sedentary time. Nordic walking reduced sedentary time by 128 minutes/day compared to baseline, significantly more than the control group (p < 0.01). Another study using a behaviour change intervention reduced sedentary behaviour by 64 minutes/day compared to baseline, significantly more than the control group (p = 0.018). Both studies were conducted for over 12 weeks, with a multi-modal approach incorporating behaviour change techniques, goal setting, education, self-monitoring and feedback. No studies focusing on reducing sedentary behaviour alone reported significant changes.
Few interventional studies have focused on reducing sedentary behaviour in people with COPD. Interventions that have effectively reduced sedentary time primarily focused on physical activity and adopted a multi-modal strategy. This suggests that future interventions could consider a multi-modal approach, which includes behaviour change and the incorporation of enjoyable light physical activities into daily living. We cannot conclude from the available evidence that solely targeting sedentary time will reduce sedentary behaviour. Longer interventions may reduce sedentary behaviour, but there is a lack of studies on both short- and long-term approaches.
PROSPERO registration number CRD 42024510434.

慢性阻塞性肺疾病（Chronic obstructive pulmonary disease, COPD）影响全球超3亿人群，为全球第三大死亡诱因。COPD患者每日久坐时长占比极高，而久坐行为与预期寿命缩短密切相关。
研究团队通过Medline、CINAHL、PsycINFO及考克兰图书馆（Cochrane Library）等电子数据库开展系统性文献检索。鉴于研究设计与活动监测设备部署位置存在异质性，最终采用叙述性合成（narrative synthesis）方法进行证据整合。
本次检索共识别出1086项研究，其中6项符合纳入标准；2项研究报告了久坐时长的显著降低。与基线水平相比，北欧式行走可使每日久坐时长减少128分钟，干预效果显著优于对照组（p<0.01）。另一项采用行为改变干预的研究，相较基线可使久坐行为每日减少64分钟，同样显著优于对照组（p=0.018）。上述两项研究的干预周期均超过12周，采用多模态干预策略，整合了行为改变技术、目标设定、健康教育、自我监测及反馈环节。仅针对减少久坐行为的单一干预研究，均未报告显著的干预效果。
目前针对COPD患者减少久坐行为的干预研究仍较为匮乏。已被证实可有效降低久坐时长的干预措施，均以身体活动为核心，并采用多模态策略。这提示未来的相关干预可考虑采用整合行为改变方案、将愉悦性轻体力活动融入日常生活的多模态策略。现有证据无法证实仅针对久坐时长的干预可有效减少久坐行为。更长周期的干预或可改善久坐行为，但目前仍缺乏针对短期及长期干预方案的相关研究。
本研究的PROSPERO注册编号为CRD 42024510434。