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A Meta-analysis on the Effectiveness of Exercise in Improving Lung Function in Children with Post-operative
Kevin L Bautista1, Angelica Niña F Datingaling1
1Division of Pediatric Pulmonology, Department of Pediatrics, Philippine General Hospital, University of the Philippines Manila.
Insights
Exercise interventions show promise in improving lung function for pediatric patients after congenital diaphragmatic hernia (CDH) surgery. This meta-analysis suggests exercise can enhance vital capacity and expiratory volume in children with post-operative CDH.
Area of Science:
- Pediatric Pulmonology
- Exercise Physiology
- Surgical Outcomes
Background:
- Pediatric patients with congenital diaphragmatic hernia (CDH) often experience reduced pulmonary function post-surgery.
- These pulmonary deficits can lead to persistent respiratory symptoms.
- Exercise is a potential strategy to mitigate these functional impairments.
Purpose of the Study:
- To determine the effectiveness of exercise interventions in improving lung function in pediatric post-operative CDH patients.
- To synthesize evidence from randomized controlled trials (RCTs) on exercise and pediatric CDH outcomes.
Main Methods:
- A comprehensive electronic literature search was conducted across multiple databases (e.g., PubMed, Cochrane Library, Embase) in May 2023.
- Included studies focused on pediatric patients with surgically corrected CDH, excluding those with contraindications.
- Data from three RCTs involving 124 participants were meta-analyzed using RevMan 5.4 software, with bias assessment following Cochrane guidelines.
Main Results:
- The meta-analysis revealed a statistically significant improvement in functional vital capacity (FVC) (MD=6.12, p<0.00001) and forced expiratory volume in 1 second (FEV1) (MD=6.25, p<0.0001) in the exercise group compared to controls.
- These findings indicate a positive impact of exercise on key lung function parameters.
Conclusions:
- Exercise interventions appear effective for enhancing lung function in pediatric post-operative CDH patients.
- Limitations include small sample size, varied exercise protocols, and lack of long-term outcome data.
- Further research is recommended to optimize exercise regimens and assess long-term effects.
Background And Objective:
Pediatric post-operative congenital diaphragmatic hernia (CDH) patients have been shown to encounter reduced pulmonary function tests (PFT) potentially leading to respiratory symptoms. Strategies involving exercise have been used to improve PFT. This meta-analysis aims to determine the effectiveness of exercise in improving lung function in pediatric post-operative CDH patients.
Methods:
An electronic search was done on May 2023 in MEDLINE via Pubmed, Cochrane Library, Embase, ClinicalKey, Scopus, Google Scholar, and Herdin Plus, using the search terms "exercise" and "congenital diaphragmatic hernia" and "children" or "pediatric" and "pulmonary function" or "lung function". The study included pediatric patients in whom CDH has been surgically corrected, and excluded patients who were unable to perform the test maneuvers, have cardiopulmonary instability, and have serious associated anomalies. Randomized controlled trials (RCT) were identified and independently assessed by two review authors. Each RCT was independently assessed for bias by two review authors using the Cochrane Handbook for Systematic Reviews of Interventions. The RevMan 5.4 software was used for statistical analysis.
Results:
A total of 124 participants from three studies were included in the meta-analysis. The pooled mean difference showed a significantly higher mean functional vital capacity (FVC) (MD=6.12, 95%CI=3.91 to 8.33, p-value <0.00001) and forced expiratory volume in 1 second (FEV1) (MD=6.25, 95%CI=3.39 to 9.10, p-value <0.0001) in the study group compared to the control group.
Conclusion:
Exercise may be effective in improving lung function in children with pediatric post-operative CDH. However, the study is limited by its small sample size, the lack of assessment of long-term outcomes, and the difference in exercise regimens used in each RCT. Further studies are recommended to determine the most optimal exercise regimen and to measure its effect on the other outcomes for this population.
