Abstract
Rationale The effect of pharmacological and non-pharmacological interventions on physical activity (PA) outcomes is not fully elucidated in patients with COPD.
Objectives 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 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 Seventy-four studies published from 2000 to 2021 were included, with a total of 8140 COPD patients. FEV1% 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 (UC), 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 MCID for PA outcomes as well as their convergent validity to accelerate qualification as potential biomarkers and efficacy endpoints for regulatory approval.
Footnotes
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Conflict of interest: TT declares involvement in studies funded by Astra Zeneca and Boehringer Ingelheim.
Conflict of interest: AMP declares employment contract with MSD International.
Conflict of interest: The remaining authors explicitly state that there are no conflicts of interest in connection with this article and have no relevant financial disclosures.
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- Received June 20, 2023.
- Accepted July 31, 2023.
- Copyright ©The authors 2023
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