Evidence Summary (Updated 2022)
A large body of good quality interventional data shows an improvement in quality of life as measured by outcome scores.(1–3)
Gao et al, conducted a meta-analysis of 4 RCTs (n = 287) which showed that HIIT training improved Quality of life (QoL) compared to controls (SMD = 0.3, 95% CI [0.06, 0.54], P = 0.01).(4)
A Cochrane review of 1799 patients showed QoL improvement (measured by the Chronic Respiratory questionnaire) at 6-12 months after a supervised maintenance exercise programme (MD) 0.54 points, 95% CI [0.04, 1.03].(5)
Respiratory tele-rehabilitation was shown, compared to no PR to improve QoL (scored using CAT) -5.74U (CI: -7.42, -0.407; p<0.001) but no difference with centre-based rehabilitation (p=0.85). (8 RCTs, n = 758).(6) Similar results to Ora et al, a meta-analysis of 15 RCTs (n = 1522) found that advanced telehealth exercise therapy improved QoL vs no exercise therapy (four studies, SMD 0.22, 95% CI 0.00 to 0.43) and had similar or better effects than home-based exercise therapy (three studies, SMD 0.79, 95% CI –0.04 to 1.62) and in-patient or out-patient settings (two studies, SMD 0.23, 95% CI –0.04 to 0.50).(7)
Meta-analysis of 16 studies (n = 851) showed that pulmonary rehabilitation (PR) including lower limb endurance training significantly improved SGRQ and CRQ scores (MD, −6.06; 95% CI, −8.70 to −3.43; p < 0.00001; I2 = 87%).(8)
A 13 study meta-analyses showed that Chinese traditional exercises such as Tai Chi and Qigong significantly improved QoL, measured by CAT score (MD = −5.91; 95% CI: −8.25 to −3.75; P < 0.00001).(9)
Recent evidence across a range of studies of the following activities were all shown to improve quality of life: continuous/ Low intensity training(10), HIIT(11,12), supervised maintenance(5), tele-rehabilitation(6,7), pulmonary rehabilitation including lower limb strengthening exercises(8), Tai Chi and Qigong(9) and in addition starting early pulmonary rehabilitation within 3 days of hospitalisation(13).
Quality of Evidence
Grade B – moderate quality
Strength of recommendation
Grade 1 – strong recommendation
Evidence and clinical and patient consensus are that physical activity can improve quality of life scores. Strong recommendations can be applied to most patients in most circumstances and should be followed unless there are compelling reasons to do otherwise
- Mador MJ, Krawza M, Alhajhusian A, Khan AI, Shaffer M, Kufel TJ. Interval training versus continuous training in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil Prev [Internet]. 2009 Mar 1 [cited 2022 Oct 4];29(2):126–32. Available from: https://europepmc.org/article/med/19305238
- Puhan MA, Büsching G, Schünemann HJ, VanOort E, Zaugg C, Frey M. Interval versus continuous high-intensity exercise in chronic obstructive pulmonary disease: A randomized trial. Ann Intern Med [Internet]. 2006 Dec 5 [cited 2022 Oct 4];145(11):816–25. Available from: https://annals.org
- Amin S, Abrazado M, Quinn M, Storer TW, Tseng CH, Cooper CB. A controlled study of community-based exercise training in patients with moderate COPD. BMC Pulm Med [Internet]. 2014 Aug 4 [cited 2022 Oct 4];14(1):1–8. Available from: https://link.springer.com/articles/10.1186/1471-2466-14-125
- Gao M, Huang Y, Wang Q, Liu K, Sun G. Effects of High-Intensity Interval Training on Pulmonary Function and Exercise Capacity in Individuals with Chronic Obstructive Pulmonary Disease: A Meta-Analysis and Systematic Review. Adv Ther [Internet]. 2022 Jan 1 [cited 2022 Oct 4];39(1):94–116. Available from: https://link.springer.com/article/10.1007/s12325-021-01920-6
- Malaguti C, Dal Corso S, Janjua S, Holland AE. Supervised maintenance programmes following pulmonary rehabilitation compared to usual care for chronic obstructive pulmonary disease. Cochrane Database Syst Rev [Internet]. 2021 Aug 17 [cited 2022 Oct 4];2021(8). Available from: /pmc/articles/PMC8407510/
- Ora J, Prendi E, Attinà ML, Cazzola M, Calzetta L, Rogliani P. Efficacy of respiratory tele-rehabilitation in COPD patients: Systematic review and meta-analysis. Monaldi Arch chest Dis = Arch Monaldi per le Mal del torace [Internet]. 2022 Jan 27 [cited 2022 Oct 4];92(4). Available from: https://pubmed.ncbi.nlm.nih.gov/35086329/
- Bonnevie T, Smondack P, Elkins M, Gouel B, Medrinal C, Combret Y, et al. Advanced telehealth technology improves home-based exercise therapy for people with stable chronic obstructive pulmonary disease: a systematic review. J Physiother. 2021 Jan 1;67(1):27–40.
- Higashimoto Y, Ando M, Sano A, Saeki S, Nishikawa Y, Fukuda K, et al. Effect of pulmonary rehabilitation programs including lower limb endurance training on dyspnea in stable COPD: A systematic review and meta-analysis. Respir Investig. 2020 Sep 1;58(5):355–66.
- Yang TT, Liu X, Wang YQ, Song CY, Ma RC, Yin YY, et al. The effect of Tai Ji and Qigong in patients with chronic obstructive pulmonary disease: A systematic review and meta-analyses. Eur J Integr Med. 2020 Dec 1;40:101223.
- Santos C, Rodrigues F, Santos J, Morais L, Bárbara C. Pulmonary Rehabilitation in COPD: Effect of 2 Aerobic Exercise Intensities on Subject-Centered Outcomes–A Randomized Controlled Trial. Respir Care [Internet]. 2015 Nov 1 [cited 2022 Oct 4];60(11):1603–9. Available from: https://pubmed.ncbi.nlm.nih.gov/26221044/
- Yangxi MG, Qianyi H, Kouying W, Guozhen Sun L. Effects of High-Intensity Interval Training on Pulmonary Function and Exercise Capacity in Individuals with Chronic Obstructive Pulmonary Disease: A Meta-Analysis and Systematic Review. 1920; Available from: https://doi.org/10.1007/s12325-021-01920-6
- Vogiatzis I, Nanas S, Roussos C. Interval training as an alternative modality to continuous exercise in patients with COPD. Eur Respir J [Internet]. 2002 Jul 1 [cited 2022 Oct 4];20(1):12–9. Available from: https://erj.ersjournals.com/content/20/1/12
- Zhang D, Zhang H, Li X, Lei S, Wang L, Guo W, et al. Pulmonary Rehabilitation Programmes Within Three Days of Hospitalization for Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Int J Chron Obstruct Pulmon Dis [Internet]. 2021 [cited 2022 Oct 4];16:3525. Available from: /pmc/articles/PMC8713718/