SYSTEMATIC REVIEW article
Front. Med.
Sec. Pulmonary Medicine
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1621375
Effects of Pulmonary Rehabilitation Combined with Inspiratory Muscle Training on Lung Function and Exercise Capacity in Older Patients with COPD: A Systematic Review and Meta-Analysis
Provisionally accepted
- 1Department of Rehabilitation Medicine, Chengdu Seventh People's Hospital (Affiliated Cancer Hospital of Chengdu Medical College), Chengdu, China
- 2School of Sports Medicine & Rehabilitation, Beijing Sport University, Beijing, China
- 3BaoLin Central Health Center Lezhi CountyBaoLin Central Health Center Lezhi County, Ziyang, China
- 4Physical Education Institute, Jimei University, Xiamen, China
- 5Department of Physical Education, Beijing Language and Culture University, Beijing, China
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Background: Pulmonary rehabilitation (PR) is central to COPD management, with inspiratory muscle training (IMT) as a key component. However, evidence is inconsistent on whether combining PR with IMT offers added benefits for older COPD patients. Objective: To evaluate the comparative effects of PR combined with IMT versus PR alone on key outcomes in older COPD patients, including quality of life (St. George's Respiratory Questionnaire (SGRQ)), exercise tolerance (6-minute walk distance (6MWD)), respiratory muscle strength (maximal inspiratory pressure (PImax)), and pulmonary function metrics (FEV₁, FEV₁%). Methods: A systematic search of PubMed, EMBASE, Web of Science, and the Cochrane Library (January 2005 to January 2025) identified randomized controlled trials (RCTs) meeting criteria: (1) participants were ≥55 years old with GOLD stage II-IV COPD; (2) interventions compared PR combined with IMT versus PR alone; (3) outcomes included PImax, FEV₁, FEV₁%, SGRQ, and 6MWD. Non-English and animal studies were excluded. Risk of bias was assessed using Cochrane RoB 2.0, and the certainty of evidence was evaluated via the GRADEpro 3.6.1. Result: Nine RCTs (582 patients) were included. Compared with PR alone, PR combined with IMT did not improve 6MWD (SMD = 0.15, 95% CI: -0.11-0.42; low-quality evidence) or SGRQ scores (SMD = -0.19, 95% CI: -0.38-0.01, low-quality evidence). PImax improved moderately (SMD = 0.78, 95% CI: 0.44-1.13, I² = 48.7%, low-quality evidence). FEV₁ and FEV₁% trended upward (SMD = 0.50 and 0.58, respectively) but showed high heterogeneity (FEV₁: I² = 72.9%, p = 0.025, very low-quality evidence; FEV₁%: I² = 75.6%, p = 0.006, low-quality evidence), precluding significance. Subgroup analyses showed significant PImax improvements in interventions lasting ≥12 weeks (SMD = 0.866, 95% CI: 0.579-1.153; I² = 0%) or 4 删除: 524 删除: Pulmonary rehabilitation (PR) is essential for chronic obstructive pulmonary disease (COPD) management, with inspiratory muscle training (IMT) as its important component that enhances both lung function and exercise capacity.
Keywords: Inspiratory muscle training, COPD, Pulmonary Function, exercise capacity, Pulmonary Rehabilitation
Received: 09 May 2025; Accepted: 23 Jun 2025.
Copyright: © 2025 Xie, Zhu, Wang, Mo, Shi, Liang, Ren, Bai and Nie. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Zhenmin Bai, School of Sports Medicine & Rehabilitation, Beijing Sport University, Beijing, China
Feng Nie, Department of Rehabilitation Medicine, Chengdu Seventh People's Hospital (Affiliated Cancer Hospital of Chengdu Medical College), Chengdu, China
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