BACKGROUND We investigated the effect of aerobic training and exercise prescription on peak oxygen uptake (V̇O2peak) in COPD. METHODS A systematic review was performed using MEDLINE, EMBASE, CINAHL and Cochrane databases for all studies measuring V̇O2peak before and after supervised lower limb aerobic training in COPD (PROSPERO CRD42018099300). A random effects meta-analysis limited to randomised controlled trials (RCTs) comparing aerobic training to usual care was conducted. Other study designs were included in a secondary meta-analysis and meta-regression to investigate the influence of programme and patient factors on outcome. RESULTS 112 studies were included (participants, n=3484): 21 controlled trials (n=489), of which 13 were randomised (n=288), and 91 uncontrolled studies (n=2995). Meta-analysis demonstrated a moderate positive change in V̇O2peak (SMD 0.52;95%CI 0.34-0.69) with the intervention. The change in V̇O2peak was positively associated with target duration of exercise bout (p=0.01) and, when studies over one year duration were excluded, greater total volume of exercise training (p=0.01). Similarly, the change in V̇O2peak was greater for programmes over 12 weeks compared to 6-12 weeks when adjusted for age and gender. However, reported prescribed exercise intensity (p=0.77), training modality (p>0.35) and mode (p=0.29) did not affect V̇O2peak. Cohorts with more severe airflow obstruction demonstrated smaller improvements in V̇O2peak (p<0.001). CONCLUSIONS Overall, people with COPD achieved moderate improvements in V̇O2peak through supervised aerobic training. There is sufficient evidence to show that programmes with greater total exercise volume, including duration of exercise bout and programme duration, are more effective. Reduced effects in severe disease suggest alternative aerobic training methods may be needed in this population.

中文翻译：

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COPD患者有氧运动训练后V̇O2peak的变化及其与运动处方的关系：系统评价和荟萃分析

背景 我们研究了有氧训练和运动处方对 COPD 患者峰值摄氧量 (V̇O2peak) 的影响。方法 使用 MEDLINE、EMBASE、CINAHL 和 Cochrane 数据库对 COPD 患者进行监督下肢有氧训练前后测量 V̇O2peak 的所有研究进行系统评价（PROSPERO CRD42018099300）。进行了一项仅限于比较有氧训练与常规护理的随机对照试验 (RCT) 的随机效应荟萃分析。其他研究设计被纳入二级荟萃分析和荟萃回归，以调查项目和患者因素对结果的影响。结果 纳入 112 项研究（参与者，n=3484）：21 项对照试验（n=489），其中 13 项随机化（n=288）和 91 项非对照研究（n=2995）。荟萃分析表明，干预后 V̇O2peak 出现了适度的正变化（SMD 0.52；95%CI 0.34-0.69）。V̇O2peak 的变化与运动的目标持续时间 (p=0.01) 呈正相关，当排除超过一年的研究时，运动训练的总量更大 (p=0.01)。同样，在调整年龄和性别后，与 6-12 周相比，12 周以上项目的 V̇O2peak 变化更大。然而，报告的规定运动强度 (p=0.77)、训练方式 (p>0.35) 和模式 (p=0.29) 并未影响 V̇O2peak。气流阻塞更严重的队列显示 V̇O2peak 的改善较小（p<0.001）。结论 总体而言，COPD 患者通过有监督的有氧训练实现了 V̇O2peak 的适度改善。有足够的证据表明，总运动量（包括运动持续时间和计划持续时间）更大的计划更有效。对严重疾病的影响降低表明该人群可能需要替代的有氧训练方法。