title: Effects of controlled breathing exercises and respiratory muscle training in people with chronic obstructive pulmonary disease: results from evaluating the quality of evidence in systematic reviews.
abstract: BACKGROUND
  This paper reviews evidence and quality of Systematic Reviews (SRs) on the effects of breathing control exercises (BCEs) and respiratory muscle training (RMT) on breathlessness/dyspnea and other symptoms, and quality of life (QOL) for individuals with chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  A search for BCE and RMT literature in COPD published between January 1, 2002 and December 31, 2013 was performed in the following databases: PubMed, Ovid, CINAHL, PsycINFO, AMED, Cochrane and PEDro. The AMSTAR criteria were used to evaluate quality.
  
  
  RESULTS
  After reviewing 642 reports, seven SRs were identified on RMT and BCEs. Three SRs were of high quality, three were of moderate quality, and one was of low quality. Two high-quality SRs reported significantly beneficial effects of RMT on dyspnea, and one reported significant effects on disease-specific QOL and fatigue. In these SRs, pooled data analyses were performed with three to fourteen single randomised control trials (RCTs) included in the analysis. In one of the SRs the quality of the single RCTs were rated by the authors to be between 5-7 (with10 best) and in the other one the quality of the single RCTs were rated to be between 30-83% of the maximum score.One high-quality SR found a significant positive effect of BCE based on pooled data analysis with two single RCTs in regard to pursed-lip breathing (PLB) on breathlessness. In this SR, one single RCT on diaphragmatic breathing (DB) and another one on yoga breathing (YB) showed effect on disease-specific QOL. The single RCTs included in the SR were rated by the authors in the SRs to be of low and moderate quality.
  
  
  CONCLUSIONS
  Based on three high-quality SRs performing pooled data analyses, there is evidence that RMT has effect on breathlessness, fatigue and disease-specific QOL and PLB on breathlessness. There is also evidence that single studies on DB and YB has effect on disease-specific QOL. Few RCTs are available and the variable quality of the single RCTs in the SRs, seem to require more RCTs in particular for BCEs, but also RMT before conclusions regarding effects and high quality SRs can be written.
authors.affiliation: Department of Health Sciences, University of Oslo, Oslo, Norway. c.r.borge@medisin.uio.no.
authors.forename: Christine Råheim
authors.initials: CR
authors.lastname: Borge
authors.forename: Kåre Birger
authors.initials: KB
authors.lastname: Hagen
authors.forename: Anne Marit
authors.initials: AM
authors.lastname: Mengshoel
authors.forename: Ernst
authors.initials: E
authors.lastname: Omenaas
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Moum
authors.forename: Astrid Klopstad
authors.initials: AK
authors.lastname: Wahl
mesh_terms: D001945:Breathing Exercises; D004417:Dyspnea / Q000209:etiology / Q000628:therapy*; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000628:therapy*; D011788:Quality of Life; D012196:Review Literature as Topic; D015013:Yoga