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Pulmonary rehabilitation network meta-analysis (PR NMA)

Investigating the effective components of pulmonary rehabilitation: a systematic review and network meta-analysis

What is already known about the subject

Pulmonary rehabilitation including an exercise intervention is proven to be effective in the treatment of COPD and other chronic respiratory diseases with consistent improvements in breathlessness, quality of life and exercise capacity. It is used routinely in the care of people with COPD throughout the UK, usually in the form of a 6-8 week course for which patients meet face to face in a group with a specialist twice a week.

Why the research is needed

The make-up of pulmonary rehabilitation programmes varies considerably, and it is unclear which parts of pulmonary rehabilitation are the most important for improving patient’s symptoms and exercise capacity.  

Who we will be working with

The analysis for this study will be conducted by a small team at the University of Leicester in the UK. We will draw data from studies looking at the effects of Pulmonary Rehabilitation from around the world.

How patients and the public are involved

The Leicester Patient and Public Involvement group have reviewed this study in the design phase. Stakeholders including representatives of Pulmonary Rehabilitation services will be help to interpret and share the results.

What we will do

There are a lot of published studies looking at different elements of pulmonary rehabilitation but each of these studies only assesses one individual element in isolation. A ‘systematic review and meta-analysis’ is a type of study that collects lots of published papers on the same topic and tries to combine their individual results into one pooled result. Previous systematic reviews have looked at individual components of pulmonary rehabilitation, for example the intensity or type of exercise performed or the addition of breathing techniques. But it would be more helpful to combine all these studies into one analysis. This technique is called ‘network meta-analysis’ and allows us to use studies that are already available to compare different parts of pulmonary rehabilitation and understand which are most important.

What the benefits will be

This research should help us to work out which elements of pulmonary rehabilitation are the most beneficial for patients (e.g. type of exercise training done) and also to work out which is the most effective way to deliver pulmonary rehabilitation (e.g. attending a group class or following an online programme at home).

When the findings will be available

We aim to share the findings by the end of March 2023.

How we are planning for implementation

We are planning to share the findings with groups that set international guidelines for pulmonary rehabilitation best parctice, and also to share with decision-makers in the UK who plan how treatments are provided. Specific groups who we aim to reach with the findings of this work include national NHS clinical service commissioners; NHS-England and the authors of the anticipated update in pulmonary rehabilitation best practice from the American Thoracic Society.


Dr Tom Ward,