Efficacy of unsupervised exercise in adults with obstructive lung disease: a systematic review and meta-analysis

Introduction: The benefits of unsupervised exercise
programmes in obstructive lung disease are unclear.
The aim of this systematic review was to synthesise
evidence regarding the efficacy of unsupervised exercise
versus non-exercise-based usual care in patients with
obstructive lung disease.
Methods: Electronic databases (MEDLINE, CINAHL,
Embase, Allied and Complementary Medicine Database,
Web of Science, Cochrane Central Register of Controlled
Trials and Physiotherapy Evidence Database) and trial
registers (ClinicalTrials.gov, Current Controlled Trials, UK
Clinical Trials Gateway and WHO International Clinical
Trials Registry Platform) were searched from inception to
April 2020 for randomised trials comparing unsupervised
exercise programmes with non-exercise-based usual care
in adults with chronic obstructive pulmonary disease
(COPD), non-cystic fibrosis bronchiectasis or asthma.
Primary outcomes were exercise capacity, quality of
life, mortality, exacerbations and respiratory cause
hospitalisations.
Results: Sixteen trials (13 COPD, 2 asthma, 1 chronic
bronchitis: 1184 patients) met the inclusion criteria.
Only data on COPD populations were available for
meta-analysis. Unsupervised exercise resulted in a
statistically but not clinically significant improvement in
the 6-Minute Walk Test (n=5, MD=22.0 m, 95% CI 4.4
to 39.6 m, p=0.01). However, unsupervised exercise did
lead to statistically significant and clinically meaningful
improvements in St. George’s Respiratory Questionnaire
(n=4, MD=−11.8 points, 95% CI −21.2 to −2.3 points,
p=0.01) and Chronic Respiratory Disease Questionnaire
domains (dyspnoea: n=4, MD=0.5 points, 95% CI 0.1 to
0.8 points, p<0.01; fatigue: n=4, MD=0.7 points, 95%
CI 0.4 to 1.0 points, p<0.01; emotion: n=4, MD=0.5
points, 95% CI 0.2 to 0.7 points, p<0.01; mastery:
unable to perform meta-analysis) compared with nonexercise-based usual care.
Discussion: This review demonstrates clinical benefits
of unsupervised exercise interventions on healthrelated quality of life in patients with COPD. Highquality randomised trials are needed to examine the
effectiveness of prescription methods.