Table_1_Effects of Exercise Intervention on Peripheral Skeletal Muscle in Stable Patients With COPD: A Systematic Review and Meta-Analysis.docx

Objectives: Peripheral skeletal muscle dysfunction is an important extrapulmonary manifestation of chronic obstructive pulmonary disease (COPD) that can be counteracted by exercise training. This study aimed to review the effect of three major exercise training modalities, which are used in pulmonary rehabilitation to improve on skeletal muscle mass, function, and exercise capacity in COPD.
Methods: PubMed, Embase, EBSCO, Web of Science, and the PEDro database were searched on April 25, 2020. Only randomized controlled studies published in English evaluating the effects of exercise interventions on peripheral skeletal muscle mass, strength, and exercise capacity in stable COPD patients were included. The quality of included studies was evaluated using the PEDro scale. The mean difference (MD) or the standardized mean difference (SMD) with 95% CI was calculated to summarize the results. Subgroup meta-analysis was used to investigate the effects of different exercise training modalities and different outcome measures. The Grading of Recommendations Assessment, Development, and Evaluation guidelines were used to rate evidence quality.
Results: A total of 30 randomized controlled trials involving 1,317 participants were included. Data from trials investigating endurance exercise (EE), resistance exercise (RE), and combined aerobic and resistance exercise (CE) were pooled into a meta-analysis, and the differences compared with the non-exercising COPD control were improvement in the muscle strength and exercise capacity in stable COPD patients. Subgroup meta-analysis for different exercise training modalities showed that RE significantly improved muscle strength (SMD = 0.6, 95% CI 0.35–0.84, I2 = 61%), EE and CE significantly increased VO2peak (EE: MD = 3.5, 95% CI 1.1–5.91, I2 = 92%; CE: MD = 1.66, 95% CI 0.22–3.1, I2 = 1%). Subgroup meta-analysis for different outcome measures showed that only isotonic strength was improved after exercise interventions (SMD = 0.89, 95% CI 0.51–1.26, I2 = 71%).
Conclusion: Moderate evidence supports that exercise training in stable COPD patients has meaningful and beneficial effects on peripheral skeletal muscle strength and exercise capacity. Peripheral skeletal muscle shows a higher response to RE, and the isotonic test is relatively sensitive in reflecting muscle strength changes. The proportion of aerobic and resistance exercise components in a combined exercise program still needs exploration.
Systematic Review Registration: The review was registered with the PROSPERO: (The website is https://www.crd.york.ac.uk/PROSPERO/, and the ID is CRD42020164868).

研究目的：外周骨骼肌功能障碍（peripheral skeletal muscle dysfunction）是慢性阻塞性肺疾病（COPD）重要的肺外表现，可通过运动训练加以改善。本研究旨在综述肺康复（pulmonary rehabilitation）中常用的三大运动训练方式对稳定期COPD患者外周骨骼肌质量、功能及运动能力的改善效果。
研究方法：本研究于2020年4月25日检索PubMed、Embase、EBSCO、Web of Science及PEDro数据库。仅纳入以英文发表的、评估运动干预对稳定期COPD患者外周骨骼肌质量、力量及运动能力影响的随机对照研究。采用PEDro量表（PEDro scale）评价纳入研究的方法学质量。通过计算均数差（mean difference, MD）或标准化均数差（standardized mean difference, SMD）及95%置信区间（95% CI）对研究结果进行汇总。采用亚组Meta分析（meta-analysis）探讨不同运动训练方式及不同结局指标的干预效果。采用推荐等级的评估、制定与评价（Grading of Recommendations Assessment, Development and Evaluation, GRADE）指南对证据质量进行分级。
研究结果：本研究共纳入30项随机对照试验，涉及1317名受试者。将耐力运动（endurance exercise, EE）、抗阻运动（resistance exercise, RE）及有氧联合抗阻运动（combined aerobic and resistance exercise, CE）相关试验数据汇总进行Meta分析，结果显示，与未接受运动干预的COPD对照组相比，稳定期COPD患者的肌肉力量及运动能力均得到显著改善。针对不同运动训练方式的亚组Meta分析结果显示：抗阻运动可显著提升肌肉力量（SMD=0.6，95%CI 0.35~0.84，I²=61%）；耐力运动与有氧联合抗阻运动均可显著提升峰值摄氧量（VO2peak）（耐力运动：MD=3.5，95%CI 1.1~5.91，I²=92%；有氧联合抗阻运动：MD=1.66，95%CI 0.22~3.1，I²=1%）。针对不同结局指标的亚组Meta分析结果显示：运动干预仅可显著改善等张力量（isotonic strength，SMD=0.89，95%CI 0.51~1.26，I²=71%）。
研究结论：中等质量证据表明，对稳定期COPD患者实施运动训练，可对其外周骨骼肌力量及运动能力产生具有临床意义的有益效果。外周骨骼肌对抗阻运动的响应更为显著，等张力量测试在反映肌肉力量变化方面具有较高灵敏度。有氧训练与抗阻训练在联合运动方案中的占比仍有待进一步探索。
系统综述注册：本研究已在PROSPERO平台注册（注册网址：https://www.crd.york.ac.uk/PROSPERO/，注册编号：CRD42020164868）。