Early exercise training benefits hospitalized adults with COPD

Key takeaways:

• Exercise capacity and physical function improved in patients hospitalized for a COPD exacerbation with use of exercise training.
• Exercise training started early on in hospitalization was safe.

Starting exercise training early in a hospitalization for a COPD exacerbation led to improved exercise capacity and physical function at discharge, according to study results published in Respiratory Medicine.

Kylie Hill

“Physiotherapists who work with patients who are admitted to hospital with an exacerbation of their COPD should aim to start these patients on a simple exercise program as soon as possible,” Kylie Hill, PhD, professor at Curtin University’s School of Allied Health, told Healio.

“Physiotherapists will need to complete an appropriate assessment to ensure the patient is safe to exercise, and these patients will need to be carefully monitored during their exercise program (which includes monitoring their pulse rate, rhythm and oxygen saturation), but this study suggests that, for the average patient admitted with an exacerbation of COPD, initiating an exercise program is a safe and useful strategy,” Hill continued.

Using PubMed, Cochrane Library, PEDro and EMBASE, Hill and colleagues reviewed and assessed 10 studies including 423 adults (mean age range, 62-78 years) hospitalized with an exacerbation of COPD to find out if exercise capacity, physical function, adverse events and uptake of outpatient pulmonary rehabilitation programs differ based on prescription of exercise training early during admission (within 48 hours) vs. no prescription of exercise training during admission (usual care).

Researchers reported use of several types of exercise in these studies: aerobic exercises, resistance exercises for the upper and lower limb muscles, bed exercises, functional exercises and/or neuromuscular electrostimulation therapy.

Of the total cohort, mean FEV₁ ranged from 26% to 50% predicted. All but one study reported sex, with most patients (84%) being men.

Notably, risk of bias and imprecision observed across the included studies suggested low certainty evidence, according to researchers.

Despite low certainty evidence, researchers found that adults prescribed exercise training had better exercise capacity at discharge than adults not ordered to do this training (standardized mean difference [SMD], 0.58; 95% CI, 0.32-0.83) in five studies (n = 268). Notably, the effect was moderate.

Physical function was assessed through sit-to-stand tests (eg, 5 times sit to stand), and researchers found that this outcome was better among patients prescribed vs. not prescribed exercise training (SMD, –0.54; 95% CI, –0.86 to –0.22) at discharge in four studies (n = 159).

Similar to exercise capacity, evidence on physical function was deemed low certainty and the effect was moderate.

“We were surprised to see a moderate effect size after such a brief intervention period,” Hill told Healio. “People admitted with an exacerbation of COPD are not usually in hospital for long (a few days). But this study suggests that if physiotherapists who work in a hospital setting can facilitate these patients to start doing some exercise very early during their admission, this will improve their exercise tolerance and physical function by the time they are ready for discharge.”

Researchers could not determine if uptake of pulmonary rehabilitation after discharge differed between the two groups because no included studies evaluated this outcome.

Seven studies reported adverse event data, and researchers noted one serious adverse event in an exercise training group. During training, one patient with a history of atrial fibrillation reported chest pain, which was later determined to be atrial fibrillation. This issue went away in an hour, according to researchers.

“It would be interesting to see if patients who start an exercise program during a period of hospitalization for an exacerbation are more likely to attend a structured exercise program (known as pulmonary rehabilitation) once they leave the hospital,” Hill told Healio.