Figure 1
PRISMA flowchart.
Table 1
Baseline characteristics of included studies.
| Author/year/country or region | Subject characteristics | Intervention | Control | Time points | Measuring tools |
|---|---|---|---|---|---|
| Daniel Langer/2015/USA | C: 10 I: 10 Age: >75 Stable COPD | MTL IMT —mechanical threshold loading (MTL) | TFRL IMT — tapered flow resistive loading (TFRL) | 8 weeks | -Inspiratory muscle strength -Inspiratory muscle endurance -PF |
| Dimitra Nikoletou/2015/Britain | C: 34; I: 34. Stages: moderate to severe Age: >50 years | BE IMT with a threshold loading device | Not to train the respiratory muscles | 7 weeks | -PImax -SNIP -diaphragm contractility (Pdi,tw) -ISWT -RME -CRDQ -HADS -the SF-36 |
| Fahrahnaz Mohammadi/2015/Iran | 40 patients: I: 20 C: 20 Stages: GOLD 2–3 Age: no limit | EDU+LLE+BE Three one-hour sessions of face-to-face + the correct methods of walking + drug therapy | Drug therapy. | 7 weeks | -SF-12 -FSS -BI |
| Marieke L Duiverman/2011/The Netherlands | I: 24 C: 32 Stages: III or IV Ages: 40–76 | EDU 12 weeks NIPPV+PR | At home: EDU 12 weeks PR | 6, 12, 18, 24 M | -CRQ -MRF-28 -GARS -HADS -FEV1 -MRC -6MWD |
| María Rosa Güell/2007/Spain | 51 patients: I: 23 C: 28 Stage III Age: I: 66 (5.8) C: 63.2 (6.6) | EDU+ BE\ULE\LLE: unsupervised street walking daily at a pace of 4 km/h marked by a podometer went up and down stairs for 5 minutes before and after each walk | Hospital: EDU+ BE\ULE\ LLE: | 3 times per week | Respiratory muscle function. Arm muscle exercise tests. Leg muscle exercise test. CRQ |
| Juliana M. de Sousa Pinto/2014/Spain | I: 29 C: 21 Stages: severe and very severe Age: <80 | BE+ULE+LLE Endurance training: walking, stair climbing, cycling. standard medical therapy + inhaler devices and nebulizer therapy. | At home: standard medical therapy + the nursing counseling session. | 12 weeks | -The Spirometer Jaeger MasterScope model -SGRQ -LCADL -6MWD -The Borg scale -a pulse oximeter |
| Atsuyoshi Kawagoshi/2014/Japan | I: 20 C: 19 Stage: stable Age: Elderly aged | BE+ULE+LLE PR + pedometer use | At home: BE+ULE+LLE PP | 1 Y | -CRQ -BODE -6MWD -FVC -FVC1 |
| Tristan Bonnevie/2018/France | C: 27; I: 24 Stages: severe to very severe Age: >18 years | BE+ULE+LLE NMES | Outpatient or home: EDU+BE+ULE+LLE muscle strength training | 8 weeks | -6MWT -VO2peak -Wmax -mMRC -SGRQ |
| Xujingjuan/2016/China | C: 62; I: 63 Stages: modified or above | BE+ULE+LLE Improved lung-rehabilitation training program (including breathing training + routine care) + relaxation training +LLE +ULE | BE including breathing training + routine care | 12 weeks | -6MWT -mMRC -PF -SGRQ |
| Fernanda Dultra Dias/2013/Brazil | I: 13 C: 10. Stages: stable Age: >40 | EDU+BE+LLE a protocol at home with aerobic and muscle strength exercises | EDU only instructions to perform breathing and stretching exercises | 2 M | -ISWT and VLIT -strength and endurance test (MIP and MEP) -AQ-20 |
| W-T. Liu/2008/Taiwan, China | 48 patients: I: 24 C: 24 Stages: moderate to severe Age: 40–80 years | LLE: Walking at a speed following the tempo of the music | At home: same protocol and take daily walking exercise | 4 weeks for 3 M and again after 1 yr | -PF -ISWT -SF-12 -BMI |
| Chiung-Fang Ho/2012/Taiwan, China | 41 patients: I: 20 C: 21 Stage II–III Age: 74 ± 10.3 years | LLE: The paced walking to music.at initial speed was set at 80% VO2 peak and increased gradually. | At Home: Receive the usual care. | 12 weeks | -ISWT -PFT -HRQOL -SGRQ -Health resource utility |
| Marcel du Moulin/2009/Germany | 20 patients: I: 10 C: 10 Stage: moderate Age: I: 67 (63–72) C: 72 (69–77) | EDU+3W Receive an individualized training plan. LLE: daily activities. (walking) with a pedometer | EDU+3W carry out their activities of daily living in their accustomed way. | after 3 M and 6 M. | -CRQ -PFT -6MWT |
| Elizabeth J Horton/2017/UK | C: 142 I: 145 Stages: 2–5 Mean age: 68 | LLE Structure unsupervised home exercise | Center-based exercise: LLE | 7 W;6 M | -CRQ-SR-HADS -PRAISE-ISWT -ESWT |
| P.de Roos/2016/Holland | C: 26 I: 26 Stages: Stable and moderate Mean age: 69.4 and 71.0 | LLE 10 week supervised exercise training and home-based walk. | Center-based: standard medical care | 10 weeks | -The accelerometry -Physical Activity Scale for the Elderly; -6MWT; -CRQ; -Exercise Self-Regulatory Efficacy Scale |
| Wangxin/2013/China | I: 17 C: 18 Stages: very severe Age: 58–74 years | LLE+ Oxygen therapy + drug therapy + noninvasive positive Exercise under pressure ventilation | Oxygen therapy + drug therapy | 6 M | -6MWD -Brog -SGRQ |
| Cristiane O Pradella/2015/Brazil | I: 29 C: 15 Age: 40–75 yearrs | LLE+ULE (1) warm-up, (2) aerobic activity, (3) stretching, and (4) relaxation. | At home: no intervention. | 8 weeks | -SGRQ -6MWT -treadmill endurance test -spirometry |
| Júlio C/2010/Italy | 85 patients: HOME: 33 Outpatient: 29 C: 23 Stage: GOLD I–IV Age: H: 66.4 ± 9.5 O: 71.3 ± 6.7 C: 70.8 ± 8.7 | (1) EDU LLE+ULE Aerobic=walks on flat ground and strengthening exercises (2) Outpatient: EDU ULE+LLE aerobic and strengthening exercises | (3) C: At home Not perform any PR | three mornings a week for three months. | -BMI -6MWT -BODE -mMRC dyspnea scale |
| Anne E Holland/2016/Australia | C: 86 I: 80 Stages: stable Mean age: 69 | Structure Home Exercise (aerobic\LLE) with Physical Therapists Visiting and Telephone Supervision | Outpatient: twice weekly outpatient group-based supervised program, | 8 weeks 1 Y | -6MWD -modified Medical Research Council dyspnea scale -CRQ -PRAISE -HADS |
| François Maltais/2008/America | 252 patients: I: 126 C: 126 Stages: II–IV Mean age: 66 | EDU+ Aerobic and strength exercise: ? | Outpatient: EDU+ LLE: Leg cycling | 8 weeks | -CRQ -SGRQ -PFT -6MWT |
| Carol McFarland, P T/2012/America | I: 13 C: 11 Stages: Mild and moderate Mean ages: 72.2 and 76.2 | Home visits +EDU A: aerobic conditioning | Home visits +EDU B: At home: functional strength training | 8 weeks 16 weeks | -CRQ -Geriatric Depression Scale (GDS) -2MWT |
[i] Abbreviations: 6MWD, 6-minute walking distance; 6MWT, Six-minute walk test; CRQ, Respiratory Questionnaire; IMT, inspiratory muscle training; LLE, lower limb exercise; MTL, mechanical threshold loading; NIPPV, noninvasive intermittent positive pressure ventilation; NMES, neuromuscular electrical stimulation; PA, physical activity; PR, Pulmonary rehabilitation; SGRQ, Saint George’s Respiratory Questionnaire; TFRL, tapered flow resistive loading device; ULE, upper limb exercise; mMRC, modified Medical Research Council; HADS, Hospital Anxiety and Depression Scale.
Table 2
Outcomes of home-based intervention of included studies.
| Author/year/country | Intervention | Control | Outcome | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| EDU | BE | LLE | ULE | Aerobic/Resistance exercise | Add-on | Our patient or hospital | Home | HRQOL | Dyspnea | Physical activity/Exercise capacity | PF | Anxiety/Depression | Others | |
| Daniel Langer/2015/America | – | √ | – | – | – | MTL | – | TFRL | – | – | – | PF: no improvement and no difference (both groups) PIMAX (inspiratory muscle strength) and Tlim (inspiratory muscle endurance)√ (TFRL>MTL) | – | – |
| Dimitra Nikoletou/2015/Britain | . – | √ | – | – | – | Device | – | No training | SF-36√ (emotion, mental, health) | – | ISWT: No difference between groups | PImax (r=0.6, P = 0.04)√ | HADS√ (P = 0.03) Perception of wellbeing√ | – |
| Fahrahnaz Mohammadi /2015/Iran | √ | √ | √ | – . | – | – | – | Drug therapy | SF-12 (21.94 vs 54.63, P < 0.001) | – | Fatigue √FSS (21.94 vs 54.63, P < 0.001) | – | – | BI (95.55 vs 80.88, P = 0.001) ADL:√ |
| Marieke L Duiverman/2011/The Netherlands | √ | √ | √ | – | – | NIPPV | – | BE+LLE | CRQ [96.8 (15.3) vs. 87.1 (18.9)]; P = 0.044√ MRF-28√ | MRC√ | GARS (−3.8 points (−7.4 to −0.4; P = 0.03))√ 6MWD√ (77.3 m (46.4 to 108.0; P < 0.001) | FEV1√ (115 ml (19 to 211; P = 0.019)). | HADS√ (−7.8 to 0.0; P = 0.05) | – |
| María Rosa Güell/2007/Spain | √ | √ | √ | √ | – | – | √ | – | CRQ I:Dys:√ C: All HRQOL scores were higher in hospital training | – | 6MWT: increased but no difference. Arm strength: had improved and not difference. | PImax Both groups had improvement | – | – |
| Juliana M. de Sousa Pinto/2014/Spain | – | √ | √ | √ | – | – | – | Standard medical therapy | I: SGRQ (P < 0.001) √ Activity domain (P = 0.008) Impact domain (P < 0.001) | I: LC-ADL (P < 0.01)√ Improve breathlessness C: No difference | I 6MWD: (P = 0.008) | – | – | – |
| Atsuyoshi Kawagoshi/2014/Japan | – | √ | √ | √ | – | Pedometer | – | BE+ULE+LLE | (Both groups) CRQ (r = 0.540, P = 0.004)√ | BODE (r = 0.656, P = 0.001) MRC:√(PR+P) | (both groups) 6MWD (r = 0.401, P = 0.038) | Both group: Imax√ | – | Qf\walking time√(PR+P) |
| Tristan Bonnevie/2018/France | – | √ | √ | √ | – | NMES | – | EDU+BE+ ULE+ LLE+ Muscle strength training | SGRQ (P = 0.01)√ (both groups) | mMRC (P < 0.01) (both groups) | 6MWT: (P < 0.01) (both groups) | – | – | – |
| Xujingjuan/2016/China | – | √ | √ | √ | – | – | – | BE | SGRQ (P < 0.05) | mMRC√, P < 0.05 | 6MWT, P < 0.05 | – | – | – |
| Fernanda Dultra Dias/2013/Brazil | √ | √ | √ | √ | – | – | – | EDU+BE+ stretching exercises | – not improved | – | ISWT: no difference (both groups) | Respiratory endurance improved in I group. | – | Biweekly supervision plays important role |
| W-T. Liu,/2008 /Taiwan | – | – | √ | – | – | Music | – | LLE | Sf-12√ | Dyspnea rating Borg scale | ISWT√ | – | – | Clinical outcomes: Endurance walking exercise compliance |
| Chiung-Fang Ho/2012/Taiwan | – | – | √ | – | – | Music | – | Usual care | SGRQ: √ | Borg scale RPE-D Resting dyspnea√ Fatigue√ | ISWT:√ | No differential change | – | – |
| Marcel du Moulin/2009/Germany | √ | – | √ | – | – | – | – | Usual care | CRQ:√(P = 0.027) CRQ (dyspnea)√ (P = 0.014) CRQ (fatigue)√ (P = 0.016) | – | 6MWT √ 6MWT in meters (primary end-point, p = 0.033 | FEV1: P = 0.007 | – | – |
| Elizabeth J Horton/2017/UK | – | – | √ | – | Resistance exercise | – | Center: LLE | – | CRQ-dyspnea√ (both groups)-7w Non-inferior | – | ESWT (both groups)√ Non-inferior | – | CRQ-emotion (within group√ Non-inferior) | – . |
| P. de Roos/2016/Holland | √ | . – | √ | – | – | – | Center: Medical care | – | – | I PA: (26.1min/d, 95%CI 7.3–44.9); 6MWD: (P < 0.01) | – | – | – | |
| Wangxin/2013/China | – | – | √ | – | – | NIPPV | – | Drug | I SGRQ (t = 11.724, P < 0.05) | I Brog (t = 13.665, P < 0.05) | I 6MWD (t = 6.787, P < 0.05) | – | – | – |
| Cristiane O Pradella/2015/Brazil | – | – . | √ | √ | – | – | – | No intervention | Decreased by >4 units in all SGRQ domains√ no difference in C group. | – | 6MWT (65.7 ± 83.1m vs 5.5 ± 92.9 m, P < 0.05) The endurance test (316.6 ± 81.8 m vs 31.2 ± 419.7 m, P < 0.05) | – | – | – |
| Júlio C/2010/Italy | √ | – | √ | √ | – | – | – | No PR | – | BODE:√(H\O) no difference between the outpatient and at-home groups (P = 0.90) | 6MWT √(H\O) no difference between the outpatient and at-home groups (P = 0.44) The control group no change | – | – | |
| Anne E Holland/2016/Australia | √ | – | √ | √ | √(aerobic) | – | Edu+LLE +ULE | – | No difference between groups | – | 6MWD (No difference between groups) | – | – | – |
| François Maltais/2008 /America | √ | – | – | – | √(aerobic) | – | √ | – | CRQ: SGRQ: All similar efficacy | – | 6MWT: 95%CI Similar efficacy | Lung function remains stable. | – | – |
| Carol McFarland/2012/America | √ | – | – | – | √(aerobic) | – | – | EDU+function strength training | CRQ (P < 0.05)√ A=B Especially in dyspnea | – | Only group A had a clinically significant improvement in walking distance | – | GDS (P < 0.05) √(both A and B) | – |