COPD Balance Study Research
07/11/2024

*REPORT IN HEALTH & WELLBEING NEWS NE & CUMBRIA VONNE *

(Voluntary Organizations Network Northeast)

This is the B Pure project with Teesside Uni.

 A review of exercise-based interventions to improve balance and reduce falls in people with chronic obstructive pulmonary disease (COPD)

Quick-read summary

People with chronic obstructive pulmonary disease (COPD) are more likely to fall than those who don’t have COPD because they have worse balance.

We wanted to find out whether there was any evidence that exercise-based interventions could help improve balance and reduce falls in people with COPD.

We also wanted to know what the ‘key ingredients’ were in those interventions found to be beneficial.

To do this, we conducted a systematic review and meta-analysis. A systematic review and meta-analysis tries to find and compare all of the existing research on a particular topic.

We analysed 34 good-quality studies which included a total of 1712 participants.

We found only weak evidence that exercise for people with COPD improves balance and we do not know if this improvement leads to fewer falls.

We also found that when balance training is included as part of pulmonary rehabilitation it seems to be more beneficial than other forms of exercise.

Who is this evidence useful for?

People who have a lung condition called Chronic Obstructive Pulmonary Disease (COPD), carers of those with COPD and clinicians working with patients with respiratory (breathing) problems.

What is the issue?

People with COPD are more likely to fall than those who don’t have COPD because they have worse balance. Individual research studies support the usefulness of exercise for improving balance in people with COPD but only a small number of people were included in each. We also do not know why exercise is effective at improving balance or how any changes in balance come about.

Research summary

For this review we tried to find out whether there was any evidence that exercise-based interventions could help improve balance and reduce falls in people with COPD. We also wanted to know what the ‘key ingredients’ were in those interventions found to be beneficial.

We analysed 34 good-quality studies which included a total of 1712 participants. The studies included a wide range of activities, either in addition to or separately from, pulmonary rehabilitation (an exercise and education programme for people with breathlessness). Some of the activities included balance training.

Interventions included targeted balance or falls-prevention training, neuromuscular stimulation, dance, singing, water-based exercise, whole-body vibration, tai chi, gait modification and programmes which included family members.

What the research found

There is only weak evidence that exercise for people with COPD improves balance.

When balance training was included as part of pulmonary rehabilitation it seemed to be more beneficial than other forms of exercise.

However, it is unknown whether this improvement led to fewer falls, mainly because this data had not been measured or reported.

The research also showed that including behaviour change techniques to improve self-regulation, for example monitoring situations or thoughts, or to reduce negative emotions, seemed to improve the benefit of exercise on balance.

Importantly no research looked into equity meaning no studies have investigated whether exercise was more of less effective at improving balance for specific groups of people based on factors such as age, sex, ethnicity or socioeconomic status.

Why is this important?

This research has identified that to influence clinical practice and policy, research needs to:

Improve the quality of study reporting

Include a larger number of people, with a range of characteristics, to address the variability observed in the effect of exercise on balance

Collect and report information on falls

How were patients involved in this work?

We are very closely linked to Breath Easy Darlington, a support group for people with chronic breathlessness, and members of this group are key contributors to this research project.

Our interest in investigating balance and falls in this population has stemmed from many conversations with members who describe falling and becoming unsteady.

Six members of Breathe Easy Darlington supported the interpretation of findings by ranking, in order of importance, the behaviour change techniques which were identified in the exercise interventions.

The same group of individuals have also worked alongside the research team and a multi-media artist to produce a storyboard illustrating the research.

You can view the storyboard here

What’s next?

We have presented these findings at a workshop that was held to co-create balance training for people with COPD.

A pilot randomised controlled trial of the balance training intervention will begin at the end of 2024 and run for 18-months.

If successful we hope that balance training will be included as a core component of clinical care for individuals with COPD.

Read more

Read the full study – Exercise-based interventions targeting balance and falls in people with COPD: a systematic review and meta-analysis European Respiratory Review in June 2024

How was this work funded?

Professor Samantha Harrison is supported by a National Institute for Heath and Care Research (NIHR) Advanced Fellowship.

Co-authors Dr Eileen Kaner, Dr Sophie Suri, Professor Tim Rapley and Professor Denis Martin are supported by the NIHR Applied Research Collaboration (ARC) North East and North Cumbria (NENC).

Get in touch

Professor Samantha Harrison

s.l.harrison@tees.ac.uk

Twitter/X – @SamHarry_lung