OBJECTIVE: To update evidence on the effects of breathing exercises (BEs) on ventilation, exercise capacity, dyspnea, and quality of life (QoL) in chronic obstructive pulmonary disease (COPD) patients. METHODS: Randomized controlled trials investigating the effects of BEs in COPD patients published through May 2018, were retrieved from five electronic databases (MEDLINE, CINAHL, Cochrane, Scopus, and ScienceDirect). Risk of bias and quality of evidence were assessed, using Cochrane Collaboration’s tool, and the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach, respectively. RESULTS: Nineteen studies (n=745), were included. Quality of evidence, was low to moderate. When compared to the control groups, respiratory rate significantly (p≤0.001) improved in the pursed-lip breathing (PLB), ventilatory feedback (VF) plus exercise, diaphragmatic breathing exercise (DBE), and combined BEs. Additionally, PLB significantly improved tidal volume (p<0.001), inspiratory time (p=0.007), and total respiratory time (p<0.001). VF plus exercise significantly improved inspiratory capacity (p<0.001), and singing significantly improved the physical component of QoL, than did the control groups (p<0.001). All BEs did not significantly improve dyspnea, compared to the controls (p>0.05). CONCLUSION: PLB, VF plus exercise, DBE, combined BEs, and singing could be used to improve ventilation and QoL. Based on low to moderate quality of evidence, use of these BEs to improve ventilation and QoL in COPD patients is conditional (Registration No. CRD42018102995).
Bias (Epidemiology) ; Breathing Exercises ; Dyspnea ; Humans ; Inspiratory Capacity ; Pulmonary Disease, Chronic Obstructive ; Quality of Life ; Respiration ; Respiratory Rate ; Singing ; Tidal Volume ; Ventilation

OBJECTIVE: To determine effects of different modes of upper limb training on dyspnea and quality of life of individuals with chronic obstructive pulmonary disease (COPD) having different disease severity. METHODS: Randomized clinical trials were retrieved from five electronic databases. Risk of bias and quality of evidence were assessed using the Cochrane Collaboration’s tool and the GRADE approach, respectively. Effects of upper limb training compared to control were identified using standardized mean difference and 95% confidence interval. RESULTS: Fifteen studies with 514 subjects were included. When compared to control, upper limb endurance and strength training with moderate quality of evidence resulted in significant improvement in dyspnea. However, quality of life was not significantly different between upper limb training of all modes of and the control. The upper limb training was more effective in reducing dyspnea in patients with severe COPD than in those with mild to moderate levels of COPD. Although quality of life was slightly improved by upper limb training for those with moderate or severe level of COPD, such improvement did not reach a significant level when compared to the control. CONCLUSION: Upper limb endurance and strength training could significantly improve dyspnea in individuals with chronic obstructive pulmonary disease. Thus, incorporating the upper limb training into pulmonary rehabilitation is recommended to reduce dyspnea, especially for those with severe patients. Further studies with larger sample size and standardized training protocol are needed to confirm these finding (Registration No. CRD42018102805).
Bias (Epidemiology) ; Dyspnea ; Humans ; Pulmonary Disease, Chronic Obstructive ; Quality of Life ; Rehabilitation ; Resistance Training ; Sample Size ; Upper Extremity

Objective Different body positions can exert both positive and negative physiological effects on hemodynamics and respiration.This study aims to conduct a literature review and examine hemodynamic and respiratory alterations to different body positions. Methods The study protocol was registered with the International Prospective Registry of Systematic Reviews(register no.CRD42021291464).Two independent reviewers evaluated the methodological quality of all included studies using the Down and Black checklist,while the quality of evidence was evaluated using the Grading of Recommendations,Assessment,Development,and Evaluations approach.The overall effects of different body positions were reported from random effects meta-analysis. Results Three studies with low risk of bias and ten with high risk of bias met the eligibility criteria.The supine resulted in the highest cardiac output compared to the 70 deg head-up tilt,sitting,and standing positions(very low-to moderate-quality evidences)and the lowest systemic vascular resistance compared to the 70 deg head-up tilt and standing positions(moderate-quality evidence).Additionally,the supine was associated with the highest total respiratory resistance compared to the 70 deg head-up tilt,left lateral,and standing positions(very low-to moderate-quality evidence)and higher alveolar ventilation than the prone(low-quality evidence). Conclusions The supine position has the most positive association with hemodynamic variables,resulting in the highest cardiac output and the lowest systemic vascular resistance.The upright positions(70 deg head-up tilt and standing positions)has the most positive association with the respiratory variables,resulting in the lowest total respiratory resistance.