{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T07:40:33Z","timestamp":1788853233441,"version":"build-2803163510"},"reference-count":80,"publisher":"European Respiratory Society (ERS)","issue":"174","license":[{"start":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T00:00:00Z","timestamp":1727740800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir Rev"],"accepted":{"date-parts":[[2024,5,15]]},"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>In adults with serious respiratory illness, fatigue is prevalent and under-recognised, with few treatment options. The aim of this review was to assess the impact of graded exercise therapy (GET) on fatigue in adults with serious respiratory illness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Electronic databases were searched to identify randomised controlled trials (RCTs) testing GET (involving incremental increases in exercise from an established baseline) in adults with serious respiratory illness. The primary outcome was fatigue and secondary outcomes were health-related quality of life (HRQoL) and adverse events. Two authors independently screened for inclusion, evaluated risk of bias and extracted data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>76 RCTs were included with 3309 participants, most with a diagnosis of COPD or asthma. Reductions in fatigue measured by the Chronic Respiratory Disease Questionnaire fatigue domain score were demonstrated following GET consisting of aerobic with\/without resistance training (mean difference (MD) 0.53 points, 95% CI 0.41\u20130.65, 11 RCTs, 624 participants) and GET using resistance training alone (MD 0.58 points, 95% CI 0.21\u20130.96, two RCTs, 82 participants) compared with usual care. Although the mean effect exceeded the minimal important difference, the lower end of the confidence intervals did not always exceed this threshold so the clinical significance could not be confirmed. GET consistently improved HRQoL in people with a range of chronic respiratory diseases on multiple HRQoL measures. No serious adverse events related to GET were reported.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>GET may improve fatigue alongside consistent improvements in HRQoL in people with serious respiratory illness. These findings support the use of GET in the care of people with serious respiratory illness.<\/jats:p><\/jats:sec>","DOI":"10.1183\/16000617.0027-2024","type":"journal-article","created":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T08:40:21Z","timestamp":1728463221000},"page":"240027","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["The effect of graded exercise therapy on fatigue in people with serious respiratory illness: a systematic review"],"prefix":"10.1183","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5455-6467","authenticated-orcid":false,"given":"Angela T.","family":"Burge","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adelle M.","family":"Gadowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9884-5463","authenticated-orcid":false,"given":"Lorena","family":"Romero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6733-2809","authenticated-orcid":false,"given":"Guido","family":"Vagheggini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9837-7281","authenticated-orcid":false,"given":"Anna","family":"Spathis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3403-3586","authenticated-orcid":false,"given":"Natasha E.","family":"Smallwood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7227-5113","authenticated-orcid":false,"given":"Magnus","family":"Ekstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2061-845X","authenticated-orcid":false,"given":"Anne E.","family":"Holland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2024,10,9]]},"reference":[{"key":"2024102404240236000_33.174.240027.1","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0298-2020"},{"key":"2024102404240236000_33.174.240027.2","doi-asserted-by":"crossref","first-page":"471","DOI":"10.3390\/jcm7120471","article-title":"Fatigue is highly prevalent in patients with asthma and contributes to the burden of disease","volume":"7","author":"Van Herck","year":"2018","journal-title":"J Clin Med"},{"key":"2024102404240236000_33.174.240027.3","doi-asserted-by":"crossref","first-page":"2026","DOI":"10.1016\/j.chest.2020.04.047","article-title":"Managing fatigue in patients with interstitial lung disease","volume":"158","author":"Kahlmann","year":"2020","journal-title":"Chest"},{"key":"2024102404240236000_33.174.240027.4","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00079-2017"},{"key":"2024102404240236000_33.174.240027.5","doi-asserted-by":"publisher","DOI":"10.1081\/COPD-200050513"},{"key":"2024102404240236000_33.174.240027.6","doi-asserted-by":"publisher","DOI":"10.3109\/15412555.2014.922176"},{"key":"2024102404240236000_33.174.240027.7","doi-asserted-by":"publisher","DOI":"10.1111\/scs.12033"},{"key":"2024102404240236000_33.174.240027.8","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.rmed.2018.06.011","article-title":"COPD-related fatigue: impact on daily life and treatment opportunities from the patient's perspective","volume":"141","author":"Kouijzer","year":"2018","journal-title":"Respir Med"},{"key":"2024102404240236000_33.174.240027.9","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0125-2019"},{"key":"2024102404240236000_33.174.240027.10","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.pulmoe.2020.02.004","article-title":"The impact of exercise training on fatigue in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis","volume":"26","author":"Paneroni","year":"2020","journal-title":"Pulmonology"},{"key":"2024102404240236000_33.174.240027.11","doi-asserted-by":"crossref","first-page":"1479973119894855","DOI":"10.1177\/1479973119894855","article-title":"Comparing the impact of different exercise interventions on fatigue in individuals with COPD: a systematic review and meta-analysis","volume":"16","author":"Li","year":"2019","journal-title":"Chron Respir Dis"},{"key":"2024102404240236000_33.174.240027.12","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00107-2020"},{"key":"2024102404240236000_33.174.240027.13","first-page":"CD011285","article-title":"Exercise-based rehabilitation programmes for pulmonary hypertension","volume":"3","author":"Morris","year":"2023","journal-title":"Cochrane Database Syst Rev"},{"key":"2024102404240236000_33.174.240027.14","first-page":"CD013110","article-title":"Exercise training for bronchiectasis","volume":"4","author":"Lee","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"2024102404240236000_33.174.240027.15","first-page":"CD013485","article-title":"Pulmonary rehabilitation versus usual care for adults with asthma","volume":"8","author":"Osadnik","year":"2022","journal-title":"Cochrane Database Syst Rev"},{"key":"2024102404240236000_33.174.240027.16","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"2024102404240236000_33.174.240027.17","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1089\/jpm.2014.0164","article-title":"Defining \u201cserious illness\u201d","volume":"17","author":"Kelley","year":"2014","journal-title":"J Palliat Med"},{"key":"2024102404240236000_33.174.240027.18","unstructured":"National Institute for Health and Care Excellence . Myalgic encephalomyelitis (or encephalopathy)\/chronic fatigue syndrome: diagnosis and management. Date last accessed: 28 April 2024. Date last updated: 29 October 2021. www.nice.org.uk\/guidance\/ng206\/chapter\/recommendations#graded-exercise-therapy"},{"key":"2024102404240236000_33.174.240027.19","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201309-1634ST"},{"key":"2024102404240236000_33.174.240027.20","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j4008"},{"key":"2024102404240236000_33.174.240027.21","doi-asserted-by":"crossref","unstructured":"Higgins JPT , Thomas J , Chandler J , et al. Cochrane Handbook for Systematic Reviews of Interventions. Hoboken, John Wiley & Sons, 2019.","DOI":"10.1002\/9781119536604"},{"key":"2024102404240236000_33.174.240027.22","doi-asserted-by":"publisher","DOI":"10.1053\/rmed.2000.0949"},{"key":"2024102404240236000_33.174.240027.23","first-page":"A4854","article-title":"Effects of exercise twice a week in the peripheral muscle dysfunction in COPD patients","volume":"185","author":"Cebollero","year":"2012","journal-title":"Am J Respir Crit Care Med"},{"key":"2024102404240236000_33.174.240027.24","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00034312"},{"key":"2024102404240236000_33.174.240027.25","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1586\/17476348.2015.1126419","article-title":"A comparison of calisthenic and cycle exercise training in chronic obstructive pulmonary disease patients: a randomized controlled trial","volume":"10","author":"Duruturk","year":"2016","journal-title":"Expert Rev Respir Med"},{"key":"2024102404240236000_33.174.240027.26","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1097\/HCR.0000000000000519","article-title":"Interval versus continuous aerobic exercise training in overweight and obese patients with chronic obstructive pulmonary disease: a randomized controlled study","volume":"40","author":"Ercin","year":"2020","journal-title":"J Cardiopulm Rehabil Prev"},{"key":"2024102404240236000_33.174.240027.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcf.2013.03.003"},{"key":"2024102404240236000_33.174.240027.28","first-page":"571","article-title":"Comparison of high-intensity and anaerobic threshold programs in rehabilitation for patients with moderate to severe chronic obstructive pulmonary disease","volume":"31","author":"Wen","year":"2008","journal-title":"Zhonghua Jie He He Hu Xi Za Zhi"},{"key":"2024102404240236000_33.174.240027.29","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1097\/HCR.0000000000000132","article-title":"Effects of combined resistance and endurance training versus resistance training alone on strength, exercise capacity, and quality of life in patients with COPD","volume":"35","author":"Zambom-Ferraresi","year":"2015","journal-title":"J Cardiopulm Rehabil Prev"},{"key":"2024102404240236000_33.174.240027.30","first-page":"159","article-title":"Physical exercise and resistive breathing in severe chronic airways obstruction \u2013 are they effective?","volume":"67","author":"Jones","year":"1985","journal-title":"Eur J Respir Dis"},{"key":"2024102404240236000_33.174.240027.31","doi-asserted-by":"crossref","first-page":"e1740","DOI":"10.1002\/pri.1740","article-title":"Effectiveness of a community-based exercise training programme to increase physical activity level in patients with chronic obstructive pulmonary disease: a randomized controlled trial","volume":"23","author":"Varas","year":"2018","journal-title":"Physiother Res Int"},{"key":"2024102404240236000_33.174.240027.32","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200305-617OC"},{"key":"2024102404240236000_33.174.240027.33","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2014-206070"},{"key":"2024102404240236000_33.174.240027.34","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.rmed.2007.12.004","article-title":"Different physical therapy interventions on daily physical activities in chronic obstructive pulmonary disease","volume":"102","author":"Marraraa","year":"2008","journal-title":"Respir Med"},{"key":"2024102404240236000_33.174.240027.35","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1164\/rccm.201603-0446OC","article-title":"The role of exercise in a weight-loss program on clinical control in obese adults with asthma. A randomized controlled trial","volume":"1195","author":"Freitas","year":"2017","journal-title":"Am J Respir Crit Care Med"},{"key":"2024102404240236000_33.174.240027.36","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2466-14-180"},{"key":"2024102404240236000_33.174.240027.37","first-page":"16","article-title":"Effectiveness of a combined exercise training and home-based walking programme on physical activity compared with standard medical care in moderate COPD: a randomised controlled trial","volume":"106","author":"de Roos","year":"2018","journal-title":"Physiotherapy"},{"key":"2024102404240236000_33.174.240027.38","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2016-208638"},{"key":"2024102404240236000_33.174.240027.39","doi-asserted-by":"publisher","DOI":"10.1378\/chest.118.1.106"},{"key":"2024102404240236000_33.174.240027.40","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2007.088070"},{"key":"2024102404240236000_33.174.240027.41","doi-asserted-by":"publisher","DOI":"10.1186\/1465-9921-15-44"},{"key":"2024102404240236000_33.174.240027.42","doi-asserted-by":"publisher","DOI":"10.1111\/resp.12966"},{"key":"2024102404240236000_33.174.240027.43","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00078014"},{"key":"2024102404240236000_33.174.240027.44","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-4356(96)00206-5"},{"key":"2024102404240236000_33.174.240027.45","doi-asserted-by":"publisher","DOI":"10.1016\/0197-2456(89)90005-6"},{"key":"2024102404240236000_33.174.240027.46","doi-asserted-by":"publisher","DOI":"10.2340\/16501977-0308"},{"key":"2024102404240236000_33.174.240027.47","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1097\/00008483-200603000-00012","article-title":"Impact of customized videotape education on quality of life in patients with chronic obstructive pulmonary disease","volume":"26","author":"Petty","year":"2006","journal-title":"J Cardiopulm Rehabil"},{"key":"2024102404240236000_33.174.240027.48","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2013.02.006"},{"key":"2024102404240236000_33.174.240027.49","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00021-2021"},{"key":"2024102404240236000_33.174.240027.50","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00036912"},{"key":"2024102404240236000_33.174.240027.51","doi-asserted-by":"publisher","DOI":"10.1016\/S0004-9514(07)70003-X"},{"key":"2024102404240236000_33.174.240027.52","doi-asserted-by":"publisher","DOI":"10.1249\/01.mss.0000246989.48729.39"},{"key":"2024102404240236000_33.174.240027.53","first-page":"223","article-title":"Assessment of the effects of inspiratory muscle training (IMT) and aerobic training on the quality of life of patients with chronic obstructive pulmonary disease","volume":"18","author":"Abedi Yekta","year":"2019","journal-title":"Tanaffos"},{"key":"2024102404240236000_33.174.240027.54","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2012.06.022"},{"key":"2024102404240236000_33.174.240027.55","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1586\/17476348.2015.1126419","article-title":"A comparison of calisthenic and cycle exercise training in chronic obstructive pulmonary disease patients: a randomized controlled trial","volume":"10","author":"Duruturk","year":"2016","journal-title":"Expert Rev Respir"},{"key":"2024102404240236000_33.174.240027.56","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1590\/S1413-35552012005000151","article-title":"Costs and benefits of pulmonary rehabilitation in chronic obstructive pulmonary disease: a randomized controlled trial","volume":"18","author":"Farias","year":"2014","journal-title":"Braz J Phys Ther"},{"key":"2024102404240236000_33.174.240027.57","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1097\/HCR.0000000000000352","article-title":"Effects of water-based aerobic interval training in patients with COPD","volume":"39","author":"Gallo-Silva","year":"2019","journal-title":"J Cardiopulm Rehabil Prev"},{"key":"2024102404240236000_33.174.240027.58","doi-asserted-by":"publisher","DOI":"10.3109\/15412555.2012.685664"},{"key":"2024102404240236000_33.174.240027.59","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1843.2007.01205.x"},{"key":"2024102404240236000_33.174.240027.60","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.02994"},{"key":"2024102404240236000_33.174.240027.61","doi-asserted-by":"publisher","DOI":"10.1159\/000367899"},{"key":"2024102404240236000_33.174.240027.62","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1111\/crj.12714","article-title":"Efficacy of patients\u2019 preferred exercise modalities in chronic obstructive pulmonary disease: a parallel-group, randomized, clinical trial","volume":"12","author":"Wu","year":"2018","journal-title":"Clin Respir J"},{"key":"2024102404240236000_33.174.240027.63","first-page":"529","article-title":"Benefits of a multimodular outpatient training program for patients with COPD","volume":"60","author":"Gohl","year":"2006","journal-title":"Pneumologie"},{"key":"2024102404240236000_33.174.240027.64","doi-asserted-by":"publisher","DOI":"10.1111\/crj.12141"},{"key":"2024102404240236000_33.174.240027.65","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2009.04.015"},{"key":"2024102404240236000_33.174.240027.66","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1093\/ptj\/68.4.469","article-title":"Effects of a supervised home exercise program on patients with severe chronic obstructive pulmonary disease","volume":"68","author":"Busch","year":"1998","journal-title":"Phys Ther"},{"key":"2024102404240236000_33.174.240027.67","doi-asserted-by":"publisher","DOI":"10.1080\/02640414.2017.1364402"},{"key":"2024102404240236000_33.174.240027.68","doi-asserted-by":"publisher","DOI":"10.1159\/000315142"},{"key":"2024102404240236000_33.174.240027.69","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1016\/j.jaip.2017.09.028","article-title":"Effects of exercise and diet in nonobese asthma patients \u2013 a randomized controlled trial","volume":"6","author":"Toennesen","year":"2018","journal-title":"J Allergy Clin Immunol Pract"},{"key":"2024102404240236000_33.174.240027.70","doi-asserted-by":"crossref","first-page":"468","DOI":"10.5535\/arm.20100","article-title":"Exercise program improves functional capacity and quality of life in uncorrected atrial septal defect-associated pulmonary arterial hypertension: a randomized-control pilot study","volume":"44","author":"Rakhmawati","year":"2020","journal-title":"Ann Rehabil Med"},{"key":"2024102404240236000_33.174.240027.71","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.amjcard.2022.03.040","article-title":"Effect of ground-based walk training in pulmonary hypertension","volume":"174","author":"Ertan","year":"2022","journal-title":"Am J Cardiol"},{"key":"2024102404240236000_33.174.240027.72","doi-asserted-by":"crossref","first-page":"8870615","DOI":"10.1155\/2021\/8870615","article-title":"Long-term effect of an exercise training program on physical functioning and quality of life in pulmonary hypertension: a randomized controlled trial","volume":"2021","author":"Kagioglou","year":"2021","journal-title":"Biomed Res Int"},{"key":"2024102404240236000_33.174.240027.73","doi-asserted-by":"crossref","first-page":"2284","DOI":"10.1093\/eurheartj\/ehaa696","article-title":"Standardized exercise training is feasible, safe, and effective in pulmonary arterial and chronic thromboembolic pulmonary hypertension: results from a large European multicentre randomized controlled trial","volume":"42","author":"Grunig","year":"2021","journal-title":"Eur Heart J"},{"key":"2024102404240236000_33.174.240027.74","first-page":"74","article-title":"Effects of exercise training on exercise capacity and quality of life in pulmonary arterial hypertension","volume":"18","author":"Ganderton","year":"2013","journal-title":"Respirology"},{"key":"2024102404240236000_33.174.240027.75","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1249\/MSS.0000000000001104","article-title":"Combined exercise training improves glycemic control in adult with cystic fibrosis","volume":"49","author":"Beaudoin","year":"2017","journal-title":"Med Sci Sports Exerc"},{"key":"2024102404240236000_33.174.240027.76","doi-asserted-by":"crossref","first-page":"3098","DOI":"10.3390\/jcm9103098","article-title":"High-intensity interval training is effective at increasing exercise endurance capacity and is well tolerated by adults with cystic fibrosis","volume":"9","author":"Sawyer","year":"2020","journal-title":"J Clin Med"},{"key":"2024102404240236000_33.174.240027.77","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1111\/crj.12422","article-title":"Arm strength training improves activities of daily living and occupational performance in patients with COPD","volume":"11","author":"Calik-Kutukcu","year":"2017","journal-title":"Clin Respir J"},{"key":"2024102404240236000_33.174.240027.78","doi-asserted-by":"publisher","DOI":"10.1136\/thx.32.3.307"},{"key":"2024102404240236000_33.174.240027.79","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g1687"},{"key":"2024102404240236000_33.174.240027.80","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c332"}],"container-title":["European Respiratory Review"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1183\/16000617.0027-2024","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T05:07:48Z","timestamp":1740373668000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.ersnet.org\/lookup\/doi\/10.1183\/16000617.0027-2024"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10]]},"references-count":80,"journal-issue":{"issue":"174","published-online":{"date-parts":[[2024,10,9]]},"published-print":{"date-parts":[[2024,10]]}},"alternative-id":["10.1183\/16000617.0027-2024"],"URL":"https:\/\/doi.org\/10.1183\/16000617.0027-2024","relation":{},"ISSN":["0905-9180","1600-0617"],"issn-type":[{"value":"0905-9180","type":"print"},{"value":"1600-0617","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10]]}}}