Data_Sheet_1_Effects of Exercise Intervention on Peripheral Skeletal Muscle in Stable Patients With COPD: A Systematic Review and Meta-Analysis.pdf

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是慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）重要的肺外表现，可通过运动训练予以对抗。本研究旨在综述肺康复领域常用的三种主要运动训练方式对稳定期COPD患者外周骨骼肌质量、功能及运动能力的干预效应。

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、肌力及运动能力影响的随机对照研究。采用PEDro量表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）及其95%置信区间（confidence interval, CI）汇总研究结果。采用亚组meta分析探讨不同运动训练方式及不同结局指标的效应差异。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：最终纳入30项随机对照试验，共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）的相关试验数据整合进行meta分析，结果显示，与非运动的COPD对照组相比，稳定期患者的肌力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分析显示：抗阻运动可显著提升患者肌力（SMD=0.6，95%CI 0.35~0.84，I²=61%）；耐力运动与联合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%；联合运动：MD=1.66，95%CI 0.22~3.1，I²=1%）。针对不同结局指标的亚组meta分析显示，运动干预后仅等张肌力得到显著改善（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，可对其外周骨骼肌肌力及运动能力产生具有临床意义的有益影响。外周骨骼肌对抗阻运动的响应更为显著，且等张肌力测试在反映肌力变化方面具有较高的敏感性。联合运动方案中有氧运动与抗阻运动的占比仍有待进一步探索。

系统综述注册信息：本系统综述已在PROSPERO平台注册（注册网址：https://www.crd.york.ac.uk/PROSPERO/，注册编号：CRD42020164868）。