Pulmonary Rehabilitation Using Minimal Equipment for People With Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.

Only five small trials, with 164 people in total, compared minimal equipment directly with gym-based rehabilitation, and the certainty of that comparison was low. The comparison against usual care had high statistical heterogeneity (86% for walking distance), driven by differences in the type, length and progression of the programmes, so the pooled 85 m is an average that hides wide variation. Most participants had stable COPD, were men, and had moderate airflow obstruction; the review cannot say whether the results hold during or soon after an exacerbation, or for people with more severe disease. Anxiety, depression, breathing discomfort and some strength outcomes were pooled from only one or two small trials. It remains unclear whether minimal equipment training improves breathing discomfort, because studies used different dyspnea measures and results could not be pooled. Every included programme was supervised at least twice weekly, so the review says nothing about unsupervised or self-directed training. Fewer than ten studies could be pooled in any analysis, so publication bias could not be assessed reliably.

Do not read this as proof that minimal equipment programmes are equivalent to gym-based rehabilitation. Only five small trials compared the two directly, and that comparison was rated low certainty, while the 85 m benefit comes from comparisons against usual care rather than against equipment.