Effects of exercise-based pulmonary rehabilitation on children with
asthma:a systematic review and network meta-analysis
Abstract
Objective: This systematic review aimed to systematize
different designs of exercise-based pulmonary rehabilitation (PR) for
children with asthma and explore which designs are optimal.
Methods: PubMed, EMBASE, Cochrane Library, Web of Science Core
Collection and MEDLINE were searched up until April 01, 2021, which was
conducted for any relevant randomized controlled trials (RCTs) of
exercise-based PR in childhood asthma. Language is limited to English.
Network meta-analyses and standard meta-analyses were performed using
STATA (version 16.0), quality analyses were performed using RevMan
(version 5.3). Results: A total of 24 RCTs involving 1031
patients were included. 14 studies were endurance training, which was
the most commonly used form of exercise, and 7 studies rehabilitation
sites were conducted in hospitals. A network meta-analysis showed that
compared with other forms of exercise, interval training significantly
improved the PAQLQ (Pediatric Asthma Quality of Life Questionnaire),
including activity scores [MD=3.02, 95% CI (1.74,4.30)], symptom
scores [MD=2.68, 95% CI (2.04,3.32)], emotional scores [MD=2.47,
95% CI (0.91,4.03)], and total scores [MD=2.68, 95% CI
(1.79,3.57)]. Interval training [MD=188.97, 95% CI (-59.27,
437.21)] also had a more significant effect on the 6MWT (6-minute walk
test). No adverse events were found in this study. Exercise training had
no significant effect on FEV 1(the forced expiratory
volume at 1s to predicted value ratio) [WMD=0.59, 95% CI (-2.00,
3.19)], however, the combined of endurance training and respiratory
training was found to significantly improve both FVC (the forced vital
capacity to predicted value ratio) [MD=5.37, 95% CI (0.07,10.67)]
and FEF25-75% (the forced expiratory flow between 25% and 75% of
vital capacity ratio) [WMD=11.31, 95% CI (2.13, 20.48)].
Conclusions: Exercise-based PR is a safe and effective for
childhood asthma. Interval training may be a core component of improving
quality of life and exercise capacity in childhood asthma, the
combination of respiratory training and endurance training has
significant effects on lung function.This result should be viewed with
caution, and high-quality RCTs are still needed to confirm its clinical
efficacy,