Atividade física de intensidade moderada e moderada-vigorosa associada a desfechos clínicos e funcionais em indivíduos com doença pulmonar obstrutiva crônica

Abstract

Chronic obstructive pulmonary disease (COPD) causes several morbidities and high mortality. Due to systemic changes and symptoms, physical inactivity is common in people with COPD. The World Health Organization (WHO) recommends moderate physical activity (AFM) and/or vigorous physical activity (PAV) for the health of the general population, and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend the regular practice of physical activity (PA) for people with COPD. However, it is still unclear how different PA intensities benefit this population. Most studies are limited to the analysis of total PA, light intensity or intensities assessed by self-reports. Thus, this systematic review sought to prospectively assess the association between MPA and moderatevigorous physical activity (MVPA), measured by accelerometer, with clinical and functional outcomes related to health in individuals with COPD. Observational prospective cohort studies with adults subjects (> 18 years), both sexes, diagnosed with COPD were included. MPA or MVPA should be evaluated by accelerometer making associations with clinical and functional outcomes. Outcomes were not considered as eligibility criteria, with all associated outcomes reported in the review. Studies were identified through MEDLINE, EMBASE, SPORTDiscus, and CINAHL database searches with no restrictions on publication date and language. Reference lists of eligible studies were reviewed and a manual search for gray literature was carried out to identify possibly eligible studies. Two reviewers carried out the selection of studies, extraction of data and assessment of risk of bias and certainty of evidence. When possible, meta-analysis was conducted using a random-effects model and heterogeneity was measured by I2 statistic. When this was not possible, data were reported descriptively. The risk of bias of the included studies was assessed using the Joanna Bridggs Institute (JBI) Critical Appraisal Checklist instrument. The certainty of a body of evidence was assessed by the Grading of Recommendations Assessment Development and Evaluation (GRADE). Of the 22356 studies identified, five were included after removal of duplicates and screening, covering 743 subjects with COPD. Moderate risk of bias was identified in most studies, with a mean score of 5.6 out of 11. Very low certainty evidence showed a positive association between MPA and lung function (r=0.20, 95%CI=0.08–0.31, p=0.0008, I2 =0%) and quality of life (r=0.18, 95%CI=0.06–0.29, p=0.003, I2 =0%) in the long term. For studies that were not possible to group, a positive association was found between MVPA and exercise capacity (r=0.4085, 95%CI=0.3097 – 0.5073, p=0.000) and a negative association with quality of life (r= -0.3228, 95%CI= -0.2165 – -0.4291, p= 0.0000) and dyspnea (r= -0.3392, 95%CI= -0.2344 – -0.444, p= 0.000) in the medium term. There were only descriptive data available for mortality. Evidence suggests that MPA appears to be positively associated with long-term lung function and quality of life. MVPA appears to be positively associated with exercise capacity and negatively with quality of life and dyspnea in the medium term. More studies are needed to gain confidence in these findings.