Systematic review
Balance Impairment and Effectiveness of Exercise Intervention in Chronic Obstructive Pulmonary Disease—A Systematic Review

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Highlights

  • People with chronic obstructive pulmonary disease (COPD) have balance impairment compared to those without COPD.

  • Available evidence shows exercise can improve balance performance in people with COPD.

  • More research on exercise interventions on balance in COPD is needed.

Abstract

Objective

To systematically review the evidence for balance impairment and effectiveness of interventions on balance in people with chronic obstructive pulmonary disease (COPD).

Data Sources

Four electronic databases (Scopus, CINAHL, PubMed, Cochrane Library databases) were searched from inception until June 30, 2019.

Study Selection

Two reviewers independently searched with keywords focusing on COPD, postural control, and exercise. Cross-sectional studies related to balance and randomized controlled trials (RCTs) related to the effectiveness of exercise intervention on balance outcomes were included.

Data Extraction

Two reviewers independently extracted data of balance impairment on participants, exercise training on balance outcome measures. Methodological quality of cross-sectional studies was assessed using the National Institutes of Health (NIH) Quality Assessment Tool. Methodological quality of RCTs was assessed using the Physiotherapy Evidence Database (PEDro) scale and bias was analyzed using the Cochrane risk of bias.

Data Synthesis

A narrative review with descriptive synthesis was used. Fifteen cross-sectional studies and 4 RCTs met the final inclusion criteria. The quality of 10 cross-sectional studies were rated as moderate to high (NIH score≥7). Most studies demonstrated impaired balance in people with COPD than in people without COPD. The quality of all included RCTs was good to excellent (PEDro score=6-9). One RCT had a low risk of bias. Generally, pulmonary rehabilitation program combined with balance training, Tai Chi, and cycling exercise showed significant improvement in balance in people with COPD.

Conclusions

Impaired balance is evident in people with COPD. Available RCTs suggest that exercise interventions may improve balance performance in COPD patients. However, more research on the effect of exercise interventions on balance in COPD patients is still required.

Section snippets

Data sources and searches

Literature search was conducted by 2 independent reviewers. Four electronic databases (Scopus, CINAHL, PubMed, Cochrane Library) were searched from their inception to June 30, 2019. Both reviewers limited search terms that included “COPD,” “COAD,” “CAL,” “Chronic obstructive pulmonary disease,” “Chronic obstructive airway disease,” “Chronic airflow limitation,” “postural control,” “balance,” “base of support,” “center of mass,” “center of pressure,” “stability limits,” “postural response,”

Results

A total of 3661 studies were found on initial electronic search. After removing the duplicates (n=1343), 2318 studies were included for title and abstract screening. Of these, 2299 studies were excluded due to irrelevant balance outcome studies (n=2292) (ie, cross-sectional studies=2105, interventional studies=175, systematic reviews and meta-analyses=12), using language other than English (n=2), and nonrandomized interventional study design (n=5). Finally, 19 studies were included in this

Discussion

This systematic review investigated impaired postural control in people with COPD. In addition, this review further evaluated the effects of exercise intervention on balance performance in this population. Overall, the findings of this review suggest that people with COPD have significant balance impairment than those without COPD as measured by a variety of balance tests (ie, functional, systematic, quantitative laboratory tests). There has been limited evidence for benefits of exercise

Conclusions

People with COPD have balance impairment assessed by various balance measures including functional, systematic, and quantitative laboratory tests. The available evidence suggests that balance training as part of PR program, Tai Chi, and cycling exercise may be effective in improving balance performance. Future research focusing on the effectiveness of exercise interventions on balance performance in people with COPD is still required. Nevertheless, this review highlights impaired balance in

Acknowledgment

We thank Sothida Nantakool, MSc, for her assistance in data collection.

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    Disclosures: none

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