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Exercise-based interventions targeting balance and falls in people with COPD: a systematic review and meta-analysis

Lookup NU author(s): Dr Leah Avery, Dr Darren Flynn, Professor Eileen KanerORCiD, Professor Tim Rapley, Stephanie Harrison

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


Abstract

Copyright © The authors 2024. INTRODUCTION: This review quantifies the mean treatment effect of exercise-based interventions on balance and falls risk in people with COPD. METHODS: A structured search strategy (2000-2023) was applied to eight databases to identify studies evaluating the impact of exercise-based interventions (≥14 days in duration) on balance or falls in people with COPD. Pooled mean treatment effects (95% confidence intervals (CIs), 95% prediction intervals (PIs)) were calculated for outcomes reported in five or more studies. Inter-individual response variance and the promise of behaviour change techniques (BCTs) were explored. RESULTS: 34 studies (n=1712) were included. There were greater improvements in balance post intervention compared to controls for the Berg Balance Scale (BBS) (mean 2.51, 95% CI 0.22-4.80, 95% PI -4.60-9.63), Timed Up and Go (TUG) test (mean -1.12 s, 95% CI -1.69- -0.55 s, 95% PI -2.78-0.54 s), Single-Leg Stance (SLS) test (mean 3.25 s, 95% CI 2.72-3.77 s, 95% PI 2.64-3.86 s) and Activities-specific Balance Confidence (ABC) scale (mean 8.50%, 95% CI 2.41-14.58%, 95% PI -8.92-25.92%). Effect on falls remains unknown. Treatment effects were larger in male versus mixed-sex groups for the ABC scale and SLS test, and in balance training versus other exercise-based interventions for the BBS and TUG test. Falls history was not associated with changes in balance. Meta-analysis of individual response variance was not possible and study-level results were inconclusive. Eleven promising BCTs were identified (promise ratio ≥2). CONCLUSION: Evidence for the effect of exercise-based interventions eliciting clinically important improvements in balance for people with COPD is weak, but targeted balance training produces the greatest benefits. Future exercise interventions may benefit from inclusion of the identified promising BCTs.


Publication metadata

Author(s): Loughran KJ, Emerson J, Avery L, Suri S, Flynn D, Kaner E, Rapley T, Martin D, McPhee J, Fernandes-James C, Harrison SL

Publication type: Article

Publication status: Published

Journal: European Respiratory Review

Year: 2024

Volume: 33

Issue: 172

Online publication date: 26/06/2024

Acceptance date: 19/03/2024

Date deposited: 15/07/2024

ISSN (print): 0905-9180

ISSN (electronic): 1600-0617

Publisher: European Respiratory Society

URL: https://doi.org/10.1183/16000617.0003-2024

DOI: 10.1183/16000617.0003-2024

Data Access Statement: Extracted data used for analyses are available from the lead author on request.

PubMed id: 38925795


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Funding

Funder referenceFunder name
National Institute for Heath and Care Research (NIHR) Advanced Fellowship (NIHR300856)
NIHR Applied Research Collaboration (ARC) North East and North Cumbria (NENC) (NIHR200173)

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