BACKGROUND: We investigated the effect of aerobic training and exercise prescription on peak oxygen uptake (VO2peak) in COPD. METHODS: A systematic review was performed using Medline, Embase, CINAHL and Cochrane databases for all studies measuring VO2peak before and after supervised lower limb aerobic training in COPD (PROSPERO CRD42018099300). A random effects meta-analysis limited to randomised controlled trials (RCTs) comparing aerobic training to usual care was conducted. Other study designs were included in a secondary meta-analysis and meta-regression to investigate the influence of programme and patient factors on outcome. RESULTS: 112 studies were included (participants, n = 3,484): 21 controlled trials (n = 489), of which 13 were randomised (n=288), and 91 uncontrolled studies (n = 2,995). Meta-analysis demonstrated a moderate positive change in VO2peak (SMD 0.52; 95%CI 0.34 to 0.69) with the intervention. The change in VO2peak was positively associated with target duration of exercise bout (p = 0.01) and, when studies over one year duration were excluded, greater total volume of exercise training (p = 0.01). Similarly, the change in VO2peak was greater for programmes over 12 weeks compared to 6 to 12 weeks when adjusted for age and gender. However, reported prescribed exercise intensity (p = 0.77), training modality (p > 0.35) and mode (p = 0.29) did not affect VO2peak. Cohorts with more severe airflow obstruction demonstrated smaller improvements in VO2peak (p < 0.001). CONCLUSIONS: Overall, people with COPD achieved moderate improvements in VO2peak through supervised aerobic training. There is sufficient evidence to show that programmes with greater total exercise volume, including duration of exercise bout and programme duration, are more effective. Reduced effects in severe disease suggest alternative aerobic training methods may be needed in this population.

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