Review
Author: Cacau, Lucas Assis Pereira ; Reboredo, Maycon Moura ; Ohara, Daniela Gonçalves ; Oliveira, Cristino Carneiro ; Di Lorenzo, Valéria A Pires ; de Carvalho, Celso Ricardo Fernandes ; Malaguti, Carla ; Mesquita, Fabrício Olinda Souza ; Abreu, Raphael Martins ; Carneiro, Saul Rassy ; Mendes, Renata Goncalves ; Velloso, Marcelo ; Ramos, Ercy Mara Cipulo ; Lanza, Fernanda C ; Fontanela, Lais Coan ; Isoppo, Karoliny Dos Santos ; Pinto, Ana Carolina Pereira Nunes ; Melo, Vivian Sussuarana Queiroz ; Janahú, Lila Teixeira Araújo ; Gulart, Aline Almeida ; Cipriano, Gerson ; Camillo, Carlos Augusto ; Vieira, Daniele Rocha Soares ; Pereira, Hugo Leonardo Alves ; Hernandes, Nidia Aparecida ; Neves, Laura Maria Tomazi ; Rehder-Santos, Patrícia ; Cahalin, Lawrence P ; Fernandes, Ana Tereza do Nascimento Sales ; Pitta, Fábio de Oliveira ; Karloh, Manuela ; Silveira, Bruna Mara Franco ; Arcuri, Juliano Ferreira ; Rocha, Rodrigo Santiago Barbosa ; Mendes, Liliane Patrícia de Souza ; Santino, Thayla Amorim ; Mesquita, Rafael ; Monteiro, Karolinne Souza ; Formiga, Magno F
BACKGROUND:Exercise training is essential in pulmonary rehabilitation (PR) for individuals with chronic obstructive pulmonary disease (COPD). In Brazil, physical therapists typically deliver exercise in PR. This document presents ASSOBRAFIR recommendations for prescribing exercise training for patients with COPD.
OBJECTIVE:To provide evidence-based recommendations for structuring exercise training programs for people with COPD.
METHODS:The guideline panel followed the Guidelines International Network (GIN) principles and the Appraisal of Guidelines for Research & Evaluation (AGREE-II) to ensure methodological rigor. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was employed to assess the certainty of evidence (CoE). This method assessed evidence quality and developed recommendations for five key questions addressing aspects of exercise training for people with stable COPD. Treatment effects were evaluated using systematic reviews and meta-analyses.
RESULTS:The following conditional recommendations were drawn: 1. Combined exercise training (aerobic + resistance) is suggested over aerobic training alone (very-low CoE); 2. No suggestion for or against adding inspiratory muscle training, non-invasive ventilation, or supplemental oxygen to combined exercise training (moderate to very-low CoE); 3. Either interval or continuous training is suggested, with no preference for partitioned or nonlinear training (moderate to very-low CoE); 4. Maintenance exercise programs are suggested as an alternative to usual care after PR (very-low CoE); 5. Minimal resource exercise training, especially with elastic resistance, or conventional exercise training is suggested (very-low CoE).
CONCLUSION:The results of the present guideline can aid clinicians in structuring exercise training for people with COPD.