28 Apr Effect of Exercise on Respiratory Drive in Chronic Obstructive Pulmonary Disease Patients: A Systematic Review and Meta-Analysis
Petros C. Dinas, Athanasios Daveronas, Costas Chryssanthopoulos, Serafim Nanas and Anastassios Philippou. Effect of Exercise on Respiratory Drive in Chronic Obstructive Pulmonary Disease Patients: A Systematic Review and Meta-Analysis. Exploratory Research and Hypothesis in Medicine 2022. doi:10.14218/ERHM.2021.00077
Background and objectives: Chronic obstructive pulmonary disease (COPD) dyspnea intensity is strongly correlated with respiratory drive, when assessed in relation to EMGdi activity expressed as a percentage of maximum (EMGdi%max). There is growing evidence that respiratory drive can be improved by exercise. The present systematic review investigates the effects and clinical significance of exercise interventions on respiratory drive in COPD patients.
Methods: With the application of PRISMA guidelines, Pubmed, PEDro, Science direct, and the Cochrane Central Register of Controlled Trials were searched from inception until 25 January 2022.
Results: A total of 14 studies (n = 238) were identified, and 12 studies were included in the meta-analysis. The meta-analysis revealed that EMGdi%max was higher during intense exercise, when compared to at rest, with significant heterogeneity (I2 = 89%). However, EMGdi%max significantly decreased after eight weeks of inspiratory muscle training (IMT). Three studies that examined the acute exercise effects revealed that breathlessness is highly correlated to EMGdi%max during aerobic exercise. During constant work rate exercise, EMGdi%max initially increased, and subsequently reached a plateau, while during incremental exercises, this gradually increased without reaching a plateau. This was associated with low ventilatory and neuromuscular efficiency.
Conclusions: Intense (≥75% of peak work rate) exercise induces a higher EMGdi%max, when compared to at rest, in COPD patients, and is highly correlated to dyspnea intensity during exercise. Eight weeks of IMT can reduce the dyspnea intensity and improve exercise tolerance. Measuring EMGdi%max during exercise is a useful clinical approach. This is associated with dyspnea severity, and reduced ventilatory and neuromuscular efficiency, and is sensitive to exercise interventions.
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