Page 40 - JCTR-11-4

Journal of Clinical and
Translational Research Physical exercise on COPD

in oxidative muscle fibers, along with decreased improvement in the 6-min walk distance was observed,
vascularization and oxygen transport capacity, is one but there was no change in the perception of dyspnea. This
of the main causes of the decline in functional capacity suggests that, despite improvements in physical endurance,
in these patients. In this context, aerobic exercise, as Nordic walking may not be sufficiently effective in
proposed by Zwerink et al., improves muscle perfusion improving the sensation of shortness of breath, a common
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and oxygenation, partially reversing this “phenotype” and, symptom in COPD. This finding is important, as dyspnea
consequently, increasing exercise capacity. is one of the main limiting factors of functional capacity in
However, in the study by Breyer et al., which these patients and one of the primary targets of pulmonary
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used outdoor Nordic walking training, a significant rehabilitation training.
According to Lange et al., the effectiveness of
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Table 1. Article classification on the Physiotherapy Evidence exercise in improving functional capacity is not only
Database scale related to the intensity or type of exercise but also to
the psychological and behavioral effects of exercise,
Study 1 a 2 3 4 5 6 7 8 9 10 11 Total
Zwerink et al. 16 - 1 1 1 0 0 1 1 0 1 1 7 which can reduce the perception of effort and,
consequently, dyspnea. Perceived effort is a complex
Breyer et al. 14 - 1 0 1 0 0 0 1 0 1 1 5 psychophysiological factor influenced by the interaction
Wootton et al. 17 - 1 1 1 0 0 1 1 1 1 1 8 between respiratory and muscular capacities. Often,
Behnke et al. 15 - 1 0 1 0 0 0 1 0 1 1 5 improvements in cardiovascular or muscular endurance
Wootton et al. 18 - 1 1 1 0 0 1 1 1 1 1 8 do not directly lead to a reduction in the sensation of
Notes: Items on the Physiotherapy Evidence Database (PEDro) Scale: dyspnea without a more specific approach to respiratory
(1) Eligibility criteria were specified ( This item is not used to calculate symptom management.
a
the PEDro score); (2) Subjects were randomly allocated to groups;
(3) Allocation of subjects was concealed; (4) Groups were initially Another relevant aspect to consider is the duration of
similar regarding the most important prognostic indicators; (5) All the training and its long-term effects. The study by Behnke
subjects were blinded in the study; (6) All therapists who administered et al., which implemented a 10-day training program,
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the therapy were blinded; (7) All assessors who measured at least showed a significant improvement in functional capacity,
one key outcome were blinded; (8) Measurements of at least one
key outcome were obtained for more than 85% of the subjects but the observed effects were limited to the duration of the
initially allocated to groups; (9) All subjects from whom outcome program. Although the increase in physical activity over
measurements were presented received the treatment or control 24 h was more pronounced in the intervention group, the
condition according to allocation or, if this was not the case, data were short duration of the study limits conclusions about the
analyzed for at least one outcome by intention-to-treat;
(10) Statistical comparisons between groups were reported for at sustainability of long-term gains.
least one key outcome; (11) The study presented both precision and Similarly, the study by Breyer et al. showed
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variability measures for at least one key outcome.
Abbreviations: 1:Item present; 0: Item not present. improvements in walking distances after 3 months of

Figure 2. Forest plot of the results of the meta-analysis
Abbreviations: CI: Confidence interval; df: Degree of freedom; IV: Inverse variance; SD: Standard deviation.

Figure 3. Forest plot of the results of the meta-analysis
Abbreviations: CI: Confidence interval; df: Degree of freedom; IV: Inverse variance; SD: Standard deviation.

Volume 11 Issue 4 (2025) 34 doi: 10.36922/jctr.25.00004