Abstract
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.
Shareable abstract
There is only weak evidence for exercise-based interventions improving balance in people with COPD to levels that are clinically meaningful, and the effect on falls is unknown. Designing future interventions to include theory-linked BCTs might be useful. https://bit.ly/4cuqDXm
Footnotes
Provenance: Submitted article, peer reviewed.
Conflict of interest: All authors have nothing to disclose.
Support statement: S.L. Harrison is supported by a National Institute for Heath and Care Research (NIHR) Advanced Fellowship (NIHR300856). S. Suri, E. Kaner, T. Rapley and D. Martin are supported by the NIHR Applied Research Collaboration (ARC) North East and North Cumbria (NENC) (NIHR200173). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Funding information for this article has been deposited with the Crossref Funder Registry.
Data availability
Extracted data used for analyses are available from the lead author on request.
- Received January 6, 2024.
- Accepted March 19, 2024.
- Copyright ©The authors 2024
This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions{at}ersnet.org