Page 38 - JCTR-11-4

Journal of Clinical and
Translational Research Physical exercise on COPD

studies was then conducted, followed by a selective and 3. Results
analytical reading. Data extracted from the articles were
summarized with information, such as authors, journal, According to the data presented in the article selection
year, title, and conclusions, to obtain relevant information flowchart (Figure 1), the database search yielded a total
for the research. of 6,550 articles, with 2,010 initially excluded due to
duplication. Of the remaining articles, 2,198 were excluded
Two independent reviewers assessed the methodological based on title screening. Subsequently, 1,345 articles
quality of the studies. In cases of disagreement, the were assessed by abstract reading, from which 897 were
article was re-evaluated through full-text reading. If the excluded for not being directly related to the theme of this
disagreement persisted, a third reviewer was consulted to study. Thus, 100 articles were selected for full-text reading.
assess the article and make the final decision. Of these, 10 did not present the necessary data, 67 did not
2.7. Data items classify the severity of airflow limitation, and 18 were pilot
studies; all were excluded. Therefore, five articles met the
Two authors (VKMFJ and LML) independently extracted eligibility criteria and were included in this systematic
data from the published reports using a standardized review.
data extraction process, considering the following items:
(i) Patients of both sexes, aged between 18 and 80 years, 3.1. Methodological quality results
(ii) sample size, (iii) follow-up duration, (iv) loss to According to the PEDro scale, two studies 14,15 were classified
follow-up, (v) outcome measures, and (vi) presentation of as having moderate methodological quality, and three
results. as having high methodological quality. 16-18 The criteria

2.8. Study quality evaluated by the PEDro scale and the scores obtained by
each study are presented in detail in Table 1.
The methodological quality of the studies was assessed
using the Physiotherapy Evidence Database (PEDro) 3.2. Participants
scale, which evaluates 11 criteria: (i) Eligibility criteria, A total of 576 patients received the intervention across the
13
(ii) random allocation, (iii) concealed allocation, studies included in this review, with ages ranging from 41
(iv) baseline comparison, (v) blinding of participants, to 76 years. Additional data are presented in Tables 2 and 3.
(vi) blinding of therapists, (vii) blinding of assessors,
(viii) adequate follow-up, (ix) intention-to-treat analysis, 3.3. Functional capacity
(x) comparisons between groups, and (xi) reporting of 14,16-18
point estimates and variability. Each item is scored as Five studies analyzed the impact of exercise
present (1) or absent (0), with a maximum total score of on functional capacity. For the meta-analysis of this
2
10 points (excluding the first item, which is not included comparison, a random-effects model was used (I = 80%,
in the final score). degree of freedom [df] = 4, p=0.0006). A statistically
significant difference was observed between the exercise
2.9. Synthesis of results and control groups (MD: 43.12 m; 95% CI: −0.70 – 86.94;
Figure 2).
Heterogeneity among the studies was evaluated using the
Chi-square test and the I statistic. The I statistic indicates 3.4. Dyspnea
2
2
the percentage of variability in effect estimates that is due 15,17
to heterogeneity rather than sampling error. Two studies analyzed the impact of exercise on dyspnea.
For the meta-analysis of this comparison, a random-effects
2.10. Statistical assessment model was used (I = 0%, df = 1, p=0.84). No statistically
2
The mean difference (MD) between groups and the significant difference was found between the exercise and
corresponding 95% confidence intervals (CIs) were the control groups (MD: −0.24; 95% CI: −0.72 – 0.25;
calculated to quantify the effect of continuous outcomes. Figure 3).
For the meta-analyses in which studies used the same 4. Discussion
scales, the results were presented as MD with 95% CIs.
When different scales were used, the effects were calculated The effects of physical exercise on the functional capacity
using standardized MD (SMD) and 95% CIs. The effect of patients with COPD have been extensively investigated,
size of the interventions was defined as small (MD <10% with studies suggesting significant benefits. However,
of the scale or SMD <0.4), moderate (MD = 10 – 20% of the variability in observed results, particularly regarding
the scale or SMD = 0.41 – 0.7), or large (MD >20% of the exercise intensity, type, and duration of rehabilitation
scale or SMD >0.7). programs, highlights the complexity of COPD treatment.

Volume 11 Issue 4 (2025) 32 doi: 10.36922/jctr.25.00004