Understanding the effectiveness of different aerobic training modalities in COPD: a component network meta-analysis

Background: Aerobic exercise training (AExT) improves cardiorespiratory fitness in COPD, but the optimal mode of training is unclear. Aim: To investigate the effect of different AExT modalities on change in peak oxygen uptake (V̇O2peak) in COPD. Methods: We performed random effects frequentist additive component network meta-analysis to investigate the effectiveness of AExT components on V̇O2peak in COPD. We included randomised controlled trials (RCTs) in which at least one intervention arm performed AExT (Ward et al, Chest. 2020; 158:131). Results: We included 28 RCTs comparing AExT with usual care (n = 16) or comparing different AExT modalities (n = 9), or 3-arm studies with both comparisons (n = 3). Trials included 20 different programme designs composed of 11 different AExT components. The effects on V̇O2peak of the AExT components are shown in figure 1. Whilst high intensity training modalities resulted in the greatest increase in V̇O2peak, the differences compared to moderate intensity modalities were not significant (all p > 0.05). Combination programmes including high intensity continuous cycling and walking (P-score = 0.96), or high intensity interval cycling and walking (P-score = 0.91) were the most effective compared to usual care. Conclusion: The optimal mode of AExT to improve V̇O2peak in COPD remains unclear but high intensity AExT may be preferable over moderate intensity AExT.