The effectiveness of supplemental oxygen during exercise training in patients with chronic obstructive pulmonary disease who show severe exercise-induced desaturation: a protocol for a meta-regression analysis and systematic review

Abstract Background Supplemental oxygen during exercise training is used to increase the training effect of an exercise program in patients with chronic obstructive pulmonary disease (COPD) who show exercise-induced desaturation. Exercise-induced desaturation is not clearly defined in the guidelines; however, it is generally defined in clinical studies as a decrease in SpO2 of more than 4% from rest or a decrease to less than 88% during exercise. Although some meta-analyses examined the effectiveness of supplemental oxygen during exercise training, these studies concluded that it does not further improve exercise tolerance compared to exercise training alone. However, supplemental oxygen during exercise training may be effective in improving exercise tolerance in COPD patients with severe exercise-induced desaturation. Therefore, this study will be performed to elucidate the effectiveness of supplemental oxygen during exercise training and the relationship between its effectiveness and severity of exercise-induced desaturation at baseline. Methods We will first assess the effectiveness of supplemental oxygen during exercise training in COPD. The main outcome is the change in exercise tolerance before and after the intervention, indicated by the 6-min walking distance, the walking distance, or the walking time in incremental shuttle walking test, and analyzed as the standardized mean difference (SMD). The quality and risk of bias in individual studies will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and risk-of-bias tool (RoB ver.2). If statistical heterogeneity in terms of the effectiveness of exercise tolerance is shown, we will conduct meta-regression analyses to examine the association between the effectiveness of exercise training with supplemental oxygen and severity of exercise-induced desaturation at baseline. Discussion One strength of this study is that it is a systematic review with meta-regression analysis to elucidate the effectiveness of supplemental oxygen during exercise training in patients with COPD who show severe exercise-induced desaturation. Furthermore, we will assess the severity of exercise-induced desaturation for which exercise training with supplemental oxygen is effective, the influence of acute effects at baseline, and the effect of supplemental oxygen on adverse events. Systematic review registration Registration number, UMIN000039960.

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The effectiveness of supplemental oxygen during exercise training in patients with chronic obstructive pulmonary disease who show sever exercise-induced desaturation: a protocol for a meta-regression analysis and systematic review

10.21203/rs.3.rs-26926/v1 ◽

2020 ◽

Author(s):

Shohei Kawachi ◽

Shuhei Yamamoto ◽

Kenichi Nishie ◽

Takayoshi Yamaga ◽

Manaka Shibuya ◽

...

Keyword(s):

Systematic Review ◽

Exercise Training ◽

Exercise Tolerance ◽

Supplemental Oxygen ◽

Walking Distance ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Meta Regression ◽

Meta Regression Analysis ◽

Exercise Induced

Abstract Background: Supplemental oxygen during exercise training has been used to prevent hypoxemia or allow toleration of higher intensity training in patients with chronic obstructive pulmonary disease (COPD) who show exercise-induced desaturation. Although some meta-analyses examined the efficacy of supplemental oxygen during exercise training, these studies concluded that it does not further improve exercise tolerance compared to exercise training alone. However, supplemental oxygen during exercise training may be effective to improve exercise tolerance in COPD patients with severe desaturation during exercise under breathing room air or compressed air. Therefore, this study will be performed to elucidate the efficacy of supplemental oxygen during exercise training and the relationship between its efficacy and severity of desaturation during exercise at baseline.Methods: We will first assess the effectiveness of supplemental oxygen during exercise training in COPD. The main outcome is the change in exercise tolerance before and after the intervention, indicated by 6-minute walking distance or shuttle walking distance, and analyzed as the standardized mean difference (SMD). The quality and risk of bias in individual studies will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and risk-of-bias tool (RoB ver.2). If statistical heterogeneity in effectiveness of exercise tolerance is shown, we will conduct meta-regression analyses to examine the association between efficacy of exercise training with supplemental oxygen and severity of desaturation at baseline.Discussion: One strength of this study is that it is a systematic review with meta-regression analysis to elucidate the effectiveness of supplemental oxygen during exercise training in patients with COPD who show sever exercise-induced desaturation. However, the quality and number of studies included meta-analysis may be low.Systematic review registration: Registration number, UMIN000039960.

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Validation of Clinical Characteristics and Effectiveness of Pulmonary Rehabilitation in a COPD Population with Discrepancy between Exercise Tolerance and FEV1

Healthcare ◽

10.3390/healthcare9010053 ◽

2021 ◽

Vol 9 (1) ◽

pp. 53

Author(s):

Jun Horie ◽

Koichiro Takahashi ◽

Shuuichi Shiranita ◽

Kunihiko Anami ◽

Shinichiro Hayashi

Keyword(s):

Gait Speed ◽

Pulmonary Rehabilitation ◽

Exercise Tolerance ◽

Respiratory Illness ◽

Forced Expiratory Volume ◽

Walking Distance ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

St George's Respiratory Questionnaire ◽

History Of

This study’s objective was to examine the characteristics of patients with chronic obstructive pulmonary disease (COPD) presenting with various exercise tolerance levels. A total of 235 patients with stable COPD were classified into 4 groups: (1) LoFlo + HiEx—patients with a six-minute walking distance (6MWD) ≥350 m and percentage of predicted forced expiratory volume in 1 s (%FEV1.0) <50%; (2) HiFlo + HiEx—patients with a 6MWD ≥350 m and a %FEV1.0 ≥50%; (3) LoFlo + LoEx—patients with a 6MWD < 350 m and %FEV1.0 < 50%; and (4) HiFlo + LoEx—patients with a 6MWD <350 m and %FEV1.0 ≥ 50%. Aspects of physical ability in the HiFlo + LoEx group were significantly lower than those in the HiFlo + HiEx group. The HiFlo + LoEx group was characterized by a history of hospitalization for respiratory illness within the past year, treatment with at-home oxygen therapy, and lacking daily exercise habits. Following three months of pulmonary rehabilitation, the LoFlo + HiEx group significantly improved in the modified Medical Research Council dyspnea score, maximum gait speed, and 6MWD, while the HiFlo + LoEx group significantly improved in the percentage of maximal expiratory pressure, maximum gait speed, 6MWD, incremental shuttle walking distance, and St. George’s Respiratory Questionnaire score. The HiFlo + LoEx group had the greatest effect of three-month pulmonary rehabilitation compared to other groups.

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Therapeutic validity and effectiveness of supervised physical exercise training on exercise capacity in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis

Clinical Rehabilitation ◽

10.1177/0269215515609413 ◽

2016 ◽

Vol 30 (11) ◽

pp. 1037-1048 ◽

Cited By ~ 4

Author(s):

Martijn Vooijs ◽

Petra C Siemonsma ◽

Inge Heus ◽

Jacob K Sont ◽

Ton AJM Rövekamp ◽

...

Keyword(s):

Systematic Review ◽

Chronic Obstructive Pulmonary Disease ◽

Exercise Training ◽

Physical Exercise ◽

Pulmonary Disease ◽

Exercise Capacity ◽

Meta Analysis ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Physical Exercise Training

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Prevalence of depressive symptoms in patients with chronic obstructive pulmonary disease: a systematic review, meta-analysis and meta-regression

General Hospital Psychiatry ◽

10.1016/j.genhosppsych.2011.03.009 ◽

2011 ◽

Vol 33 (3) ◽

pp. 217-223 ◽

Cited By ~ 102

Author(s):

Melvyn W.B. Zhang ◽

Roger C.M. Ho ◽

Mike W.L. Cheung ◽

Erin Fu ◽

Anselm Mak

Keyword(s):

Systematic Review ◽

Chronic Obstructive Pulmonary Disease ◽

Depressive Symptoms ◽

Pulmonary Disease ◽

Meta Analysis ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Meta Regression

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High-Flow Oxygen Therapy During Exercise Training in Patients With Chronic Obstructive Pulmonary Disease and Chronic Hypoxemia: A Multicenter Randomized Controlled Trial

Physical Therapy ◽

10.1093/ptj/pzaa076 ◽

2020 ◽

Author(s):

Michele Vitacca ◽

Mara Paneroni ◽

Elisabetta Zampogna ◽

Dina Visca ◽

Annalisa Carlucci ◽

...

Keyword(s):

Exercise Training ◽

Exercise Capacity ◽

Controlled Trial ◽

Walking Distance ◽

Chronic Obstructive ◽

Endurance Time ◽

Obstructive Pulmonary Disease ◽

Randomized Controlled ◽

High Flow Oxygen ◽

Chronic Hypoxemia

Abstract Objective The study aimed to evaluate whether high-flow oxygen therapy (HFOT) during training was more effective than oxygen in improving exercise capacity in hypoxemic chronic obstructive pulmonary disease (COPD). Methods A total of 171 patients with COPD and chronic hypoxemia were consecutively recruited in 8 rehabilitation hospitals in a randomized controlled trial. Cycle-ergometer exercise training was used in 20 supervised sessions at iso inspiratory oxygen fraction in both groups. Pre- and post-training endurance time (Tlim), 6-minute walking distance (6MWD), respiratory and limb muscle strength, arterial blood gases, Barthel Index, Barthel Dyspnea Index, COPD Assessment Test, Maugeri Respiratory Failure questionnaire, and patient satisfaction were evaluated. Results Due to 15.4% and 24.1% dropout rates, 71 and 66 patients were analyzed in HFOT and Venturi mask (V-mask) groups, respectively. Exercise capacity significantly improved after training in both groups with similar patient satisfaction. Between-group difference in post-training improvement in 6MWD (mean: 17.14 m; 95% CI = 0.87 to 33.43 m) but not in Tlim (mean: 141.85 seconds; 95% CI = −18.72 to 302.42 seconds) was significantly higher in HFOT. The minimal clinically important difference of Tlim was reached by 47% of patients in the V-mask group and 56% of patients in the HFOT group, whereas the minimal clinically important difference of 6MWD was reached by 51% of patients in the V-mask group and 69% of patients in the HFOT group, respectively. Conclusion In patients with hypoxemic COPD, exercise training is effective in improving exercise capacity. Impact Statement The addition of HFOT during exercise training is not more effective than oxygen through V-mask in improving endurance time, the primary outcome, whereas it is more effective in improving walking distance.

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