1. M.Vooijs, P.Siemonsma, I.Heus, J.Sont, A.Rövekamp, N. van Meeteren
Therapeutic validity and effectiveness of supervised physical exercise training on exercise capacity in patients with COPD - a systematic review and meta-analysis
M.Vooijs, P.Siemonsma, I.Heus, J.Sont, A.Rövekamp, N. van Meeteren

2. Modest effects of exercise on capacity
BACKGROUND
Modest effects of exercise on capacity
Heterogeneity in programs?
Type, dose and duration of training?
Therapeutic validity?

3. Titel van de presentatie
AIM
To determine the effectiveness of supervised physical exercise training in patients with COPD taken into consideration indices such as therapeutic validity of the interventions, methodological quality of studies and exercise duration and volume.

4. METHODS: systematic review
Electronic search of MEDLINE, The Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, and PEDro
All records until 11th July 2015, by two independent reviewers
English or Dutch language, RCT, supervised physical exercise compared with usual care, in patients with COPD

5. RESULTS: systematic review
Titel van de presentatie
RESULTS: systematic review
1845 unique articles
141 full tekst review
No usual care (n=41)
Exercise combined with other treatment (n=47)
13 studies included
(Vooijs et al., Clinical Rehab, okt 2015)

6. METHODOLOGICAL QUALITY
Cochrane Collaboration risk of bias tool
Score ranging from 0-7
Two reviewers independently
Median score: 3
Range: 2-6 (no blinding possible)
Max. score: n=2

7. Consensus on Therapeutic Exercise Training scale (CONTENT)
THERAPEUTIC VALIDITY
Consensus on Therapeutic Exercise Training scale (CONTENT)
Range: 0-9
Two reviewers independently
(Hogenboom, PLOS, 2012)

8. Results therapeutic validity
Titel van de presentatie
Results therapeutic validity

9. METHOD: Pooled meta-analyses
Titel van de presentatie
METHOD: Pooled meta-analyses
Pooled analyses were performed using Comprehensive Meta-Analysis software
Endurance exercise capacity
Maximal exercise capacity

10. RESULTS: Effect physical exercise on endurance exercise capacity (ESWT-6MWT-Endurance cycle test)
Significant effect: 0.52, 95% CI 0.31 to 0.74, I2 < 0.001, p for heterogeneity = 0.65

11. METHOD: Meta-regression
Titel van de presentatie
METHOD: Meta-regression
META-cart analysis was used to explore associations between
methodological quality
therapeutic validity
mean weekly volume and total volume of exercise
and exercise capacity

12. RESULTS: meta-regression of therapeutic validity and endurance exercise capacity
No association between the overall effect size and therapeutic validity β =−0.10; 95% CI −0.23 to 0.01, p=0.07

13. RESTULTS: META-REGRESSION
No significant association between
methodological quality
therapeutic validity
mean weekly volume and total volume
and endurance and maximal exercise capacity

14. Type of intervention: endurance or strength
Titel van de presentatie
Subgroup analyses
Type of intervention: endurance or strength
Combination of endurance and strength training yielded significantly larger effects on 6MWD than either one

15. CONCLUSIONS
No significant association between therapeutic validity and the effect of supervised physical exercise in patients with COPD was found
The optimal type, dose and duration of physical exercise training remains unclear
Rationale for intervention not described
Use of a combination of endurance and strength training is recommended

16. Thank you for your attention!
Titel van de presentatie
Thank you for your attention!

17. CONTENT scale Items A. Patient eligibility 1.
Was the patient selection described? 2.
Was the patient selection adequate?
B. Competences and setting 3.
Were eligibility criteria for therapist and setting determined and adequate?
C. Rationale 4.
Was the therapeutic exercise based on a-priori aims and intentions? 5.
Was the rationale for the content and intensity of the therapeutic exercise described and plausible?
D. Content 6.
Was the intensity of the therapeutic exercise described? 7.
Was the therapeutic exercise monitored and adjusted when considered necessary? 8.
Was the therapeutic exercise personalised and contextualised to the individual participants?
E. Adherence 9.
Was adherence to the therapeutic exercise determined and acceptable?