The Role of Physical Activity Interventions in Chronic Obstructive Pulmonary Disease: A Systematic Review

Improving physical activity is a central goal of pulmonary rehabilitation (PR), and emerging programs now incorporate physical activity targeted interventions to enhance patient outcomes. Existing reviews on this topic lack rigor and are limited. Therefore, this review synthesized literature on the effectiveness of physical activity interventions added to traditional PR programs to change physical activity levels in individuals with chronic obstructive pulmonary disease (COPD). Using PubMed, Web of Science, Cochrane Library, and Embase, 4 researchers screened 463 articles with the search terms: (pulmonary or respiratory rehab*) AND (daily physical activity or activity level or physical activit* and sedentary*). Seven articles were finalized with predetermined eligibility criteria. Reviewers extracted information and appraised the articles using the Physiotherapy Evidence Database (PEDro) scale. A pooled analysis (n = 587) showed that the addition of physical activity interventions to PR produced a statistically significant increase in daily steps per day compared with group with only PR. Analyses of moderate-to-vigorous physical activity, walking time, sedentary time, endurance, and quality of life showed no significant between group differences. The PEDro scores of the studies ranged from 4 to 7. Our findings suggest that adjuvant physical activity interventions added to PR provided small improvements in steps per day compared with usual care in individuals with COPD. Risks of bias, heterogeneity of interventions, and differences in participant characteristics should be considered while interpreting our data. These findings may guide clinical decision making regarding incorporating physical activity interventions with traditional PR for patients with COPD.