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

作者：Jun Xie, Yang Zhu, Ya Wang, Yingying Mo, Xiaohui Shi, Wen-Ming Liang, Fei-Fei Ren, Zhenmin Bai, Feng Nie · 发表于：Frontiers in Medicine · 年份：2025 · DOI：10.3389/fmed.2025.1621375 · 被引用次数：12 · 研究领域：Chronic Obstructive Pulmonary Disease (COPD) Research、Delphi Technique in Research、Cardiovascular and exercise physiology

Background Pulmonary rehabilitation 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-min walk distance (6MWD)], respiratory muscle strength [maximal inspiratory pressure (PImax)], and pulmonary function metrics (FEV 1 , FEV 1 %). Methods A systematic search of PubMed, EMBASE, Web of Science, and the Cochrane Library (January 2005–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, FEV 1 , FEV 1 %, 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. Results 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, I 2 = 48.7%, low-quality evidence). FEV 1 and FEV 1 % tr...