IMPACT OF PHYSICAL ACTIVITY ON
QUALITY OF LIFE IN PATIENTS WITH
PULMONARY TUBERCULOSIS SEQUELAE:
A LITERATURE REVIEW
IMPACTO DE LA ACTIVIDAD FÍSICA EN LA CALIDAD DE VIDA DE
PACIENTES CON SECUELAS DE TUBERCULOSIS PULMONAR: UNA
REVISIÓN DE LA LITERATURA
Brenda Katherine Rios Cedeño MS
Fundación Universitaria Navarra, Colombia
Maria Camila Cuesta Mera MS
Fundación Universitaria Navarra, Colombia
Laura Valentina Claros Losada MS
Fundación Universitaria Navarra, Colombia
Eison Andrés Barrera Cerón MS
Fundación Universitaria Navarra, Colombia
Ricardo Andrés Novoa-Álvarez PhD
Sport Sciences and Technologies Manuela Beltrán University, Colombia
Jose Daniel Charry Cuellar PH
Fundación Universitaria Navarra, Colombia
pág. 2204
DOI: https://doi.org/10.37811/cl_rcm.v10i3.24203
Impact of Physical Activity on Quality of Life in Patients with Pulmonary
Tuberculosis Sequelae: A Literature Review
Brenda Katherine Rios Cedeño MS1
brenda.rios@uninavarra.edu.co
https://orcid.org/0000-0003-2245-2887
Faculty of medicine and basic sciences
Fundacion Universitaria Navarra
UNINAVARRA
Neiva, Colombia
Maria Camila Cuesta Mera MS
maria.cuesta@uninavarra.edu.co
https://orcid.org/0009-0001-5923-8350
Faculty of medicine and basic sciences
Fundacion Universitaria Navarra
UNINAVARRA
Neiva, Colombia
Laura Valentina Claros Losada MS
valentina.claros@uninavarra.edu.co
https://orcid.org/0000-0003-1234-3134
Faculty of medicine and basic sciences
Fundacion Universitaria Navarra
UNINAVARRA
Neiva, Colombia
Eison Andrés Barrera Cerón MS
eison.barrera@uninavarra.edu.co
https://orcid.org/0009-0000-9094-2867
Faculty of medicine and basic sciences
Fundacion Universitaria Navarra
UNINAVARRA
Neiva, Colombia
Ricardo Andrés Novoa-Álvarez PhD
ra.novoa@uninavarra.edu.co
https://orcid.org/0000-0001-9892-3468
PhD in Physical Activity and
Sport Sciences and Technologies
Manuela Beltrán University, Bogotá D.C.
Colombia
Jose Daniel Charry Cuellar PH
jd.charry@uninavarra.edu.co
https://orcid.org/0000-0002-8789-7281
Center for Research and
Innovation Uninavarra – CIINA
Fundacion Universitaria Navarra
UNINAVARRA Neiva
Colombia
ABSTRACT
Introduction: Pulmonary tuberculosis (PTB) remains a significant cause of global morbidity and
mortality. Despite successful treatment, chronic sequelae often diminish patients' quality of life.
Physical activity has emerged as a promising therapeutic strategy in this context. Objective: The aim of
this literature review is to synthesize scientific evidence regarding the impact of physical activity and
pulmonary rehabilitation on the quality of life of patients with post-PTB sequelae. Methods: A narrative
systematic review with a comparative approach was conducted, adhering to the PRISMA statement.
Searches were performed in databases such as PubMed, ClinicalKey, and Scopus, using a combination
of descriptors in English and Spanish. Studies in adults with post-TB sequelae that evaluated the impact
of physical activity were included. Strict inclusion and exclusion criteria were applied, and the quality
of evidence of the 15 final articles was assessed. Results: The reviewed studies consistently show a
positive effect of physical activity in post-TB patients. Significant improvements were identified in
pulmonary function (FEV₁), functional capacity (6MWT), and quality of life (measured with SF-36,
SGRQ). The evidence also suggests benefits in mental health (reduced anxiety and depression) and
indicates that short-duration programs (4-6 weeks) are effective. Conclusion: Physical activity and
pulmonary rehabilitation are effective and cost-effective interventions to improve the quality of life of
patients with pulmonary tuberculosis sequelae. Their inclusion in post-TB management guidelines is
recommended, although more longitudinal research is needed.
Keywords: pulmonary tuberculosis, post-tuberculosis sequelae, physical activity, pulmonary
rehabilitation, quality of life
1 Autor principal
Correspondencia: jd.charry@uninavarra.edu.co
DOI: https://doi.org/10.37811/cl_rcm.v10i3.24203
Impact of Physical Activity on Quality of Life in Patients with Pulmonary
Tuberculosis Sequelae: A Literature Review
Brenda Katherine Rios Cedeño MS1
brenda.rios@uninavarra.edu.co
https://orcid.org/0000-0003-2245-2887
Faculty of medicine and basic sciences
Fundacion Universitaria Navarra
UNINAVARRA
Neiva, Colombia
Maria Camila Cuesta Mera MS
maria.cuesta@uninavarra.edu.co
https://orcid.org/0009-0001-5923-8350
Faculty of medicine and basic sciences
Fundacion Universitaria Navarra
UNINAVARRA
Neiva, Colombia
Laura Valentina Claros Losada MS
valentina.claros@uninavarra.edu.co
https://orcid.org/0000-0003-1234-3134
Faculty of medicine and basic sciences
Fundacion Universitaria Navarra
UNINAVARRA
Neiva, Colombia
Eison Andrés Barrera Cerón MS
eison.barrera@uninavarra.edu.co
https://orcid.org/0009-0000-9094-2867
Faculty of medicine and basic sciences
Fundacion Universitaria Navarra
UNINAVARRA
Neiva, Colombia
Ricardo Andrés Novoa-Álvarez PhD
ra.novoa@uninavarra.edu.co
https://orcid.org/0000-0001-9892-3468
PhD in Physical Activity and
Sport Sciences and Technologies
Manuela Beltrán University, Bogotá D.C.
Colombia
Jose Daniel Charry Cuellar PH
jd.charry@uninavarra.edu.co
https://orcid.org/0000-0002-8789-7281
Center for Research and
Innovation Uninavarra – CIINA
Fundacion Universitaria Navarra
UNINAVARRA Neiva
Colombia
ABSTRACT
Introduction: Pulmonary tuberculosis (PTB) remains a significant cause of global morbidity and
mortality. Despite successful treatment, chronic sequelae often diminish patients' quality of life.
Physical activity has emerged as a promising therapeutic strategy in this context. Objective: The aim of
this literature review is to synthesize scientific evidence regarding the impact of physical activity and
pulmonary rehabilitation on the quality of life of patients with post-PTB sequelae. Methods: A narrative
systematic review with a comparative approach was conducted, adhering to the PRISMA statement.
Searches were performed in databases such as PubMed, ClinicalKey, and Scopus, using a combination
of descriptors in English and Spanish. Studies in adults with post-TB sequelae that evaluated the impact
of physical activity were included. Strict inclusion and exclusion criteria were applied, and the quality
of evidence of the 15 final articles was assessed. Results: The reviewed studies consistently show a
positive effect of physical activity in post-TB patients. Significant improvements were identified in
pulmonary function (FEV₁), functional capacity (6MWT), and quality of life (measured with SF-36,
SGRQ). The evidence also suggests benefits in mental health (reduced anxiety and depression) and
indicates that short-duration programs (4-6 weeks) are effective. Conclusion: Physical activity and
pulmonary rehabilitation are effective and cost-effective interventions to improve the quality of life of
patients with pulmonary tuberculosis sequelae. Their inclusion in post-TB management guidelines is
recommended, although more longitudinal research is needed.
Keywords: pulmonary tuberculosis, post-tuberculosis sequelae, physical activity, pulmonary
rehabilitation, quality of life
1 Autor principal
Correspondencia: jd.charry@uninavarra.edu.co
pág. 2205
Impact of Physical Activity on Quality of Life in Patients with Pulmonary
Tuberculosis Sequelae: A Literature Review
RESUMEN
Introducción: La tuberculosis pulmonar (TBP) sigue siendo una causa importante de morbilidad y
mortalidad a nivel mundial. A pesar del éxito del tratamiento, las secuelas crónicas suelen disminuir la
calidad de vida de los pacientes. La actividad física ha surgido como una estrategia terapéutica
prometedora en este contexto. Objetivo: El objetivo de esta revisión bibliográfica es sintetizar la
evidencia científica sobre el impacto de la actividad física y la rehabilitación pulmonar en la calidad de
vida de los pacientes con secuelas post-TBP. Métodos: Se realizó una revisión sistemática narrativa con
un enfoque comparativo, siguiendo la declaración PRISMA. Se realizaron búsquedas en bases de datos
como PubMed, ClinicalKey y Scopus, utilizando una combinación de descriptores en inglés y español.
Se incluyeron estudios en adultos con secuelas post-TB que evaluaron el impacto de la actividad física.
Se aplicaron criterios estrictos de inclusión y exclusión, y se evaluó la calidad de la evidencia de los 15
artículos finales. Resultados: Los estudios revisados muestran consistentemente un efecto positivo de
la actividad física en pacientes post-TB. Se observaron mejoras significativas en la función pulmonar
(FEV₁), la capacidad funcional (prueba de marcha de 6 minutos) y la calidad de vida (medida con el
SF-36 y el SGRQ). La evidencia también sugiere beneficios en la salud mental (reducción de la ansiedad
y la depresión) e indica que los programas de corta duración (4-6 semanas) son efectivos. Conclusión:
La actividad física y la rehabilitación pulmonar son intervenciones efectivas y rentables para mejorar
la calidad de vida de los pacientes con secuelas de tuberculosis pulmonar. Se recomienda su inclusión
en las guías de manejo post-tuberculosis, aunque se necesita más investigación longitudinal.
Palabras clave: tuberculosis pulmonar, secuelas post-tuberculosis, actividad física, rehabilitación
pulmonar, calidad de vida
Artículo recibido 25 marzo 2026
Aceptado para publicación: 25 abril 2026
Impact of Physical Activity on Quality of Life in Patients with Pulmonary
Tuberculosis Sequelae: A Literature Review
RESUMEN
Introducción: La tuberculosis pulmonar (TBP) sigue siendo una causa importante de morbilidad y
mortalidad a nivel mundial. A pesar del éxito del tratamiento, las secuelas crónicas suelen disminuir la
calidad de vida de los pacientes. La actividad física ha surgido como una estrategia terapéutica
prometedora en este contexto. Objetivo: El objetivo de esta revisión bibliográfica es sintetizar la
evidencia científica sobre el impacto de la actividad física y la rehabilitación pulmonar en la calidad de
vida de los pacientes con secuelas post-TBP. Métodos: Se realizó una revisión sistemática narrativa con
un enfoque comparativo, siguiendo la declaración PRISMA. Se realizaron búsquedas en bases de datos
como PubMed, ClinicalKey y Scopus, utilizando una combinación de descriptores en inglés y español.
Se incluyeron estudios en adultos con secuelas post-TB que evaluaron el impacto de la actividad física.
Se aplicaron criterios estrictos de inclusión y exclusión, y se evaluó la calidad de la evidencia de los 15
artículos finales. Resultados: Los estudios revisados muestran consistentemente un efecto positivo de
la actividad física en pacientes post-TB. Se observaron mejoras significativas en la función pulmonar
(FEV₁), la capacidad funcional (prueba de marcha de 6 minutos) y la calidad de vida (medida con el
SF-36 y el SGRQ). La evidencia también sugiere beneficios en la salud mental (reducción de la ansiedad
y la depresión) e indica que los programas de corta duración (4-6 semanas) son efectivos. Conclusión:
La actividad física y la rehabilitación pulmonar son intervenciones efectivas y rentables para mejorar
la calidad de vida de los pacientes con secuelas de tuberculosis pulmonar. Se recomienda su inclusión
en las guías de manejo post-tuberculosis, aunque se necesita más investigación longitudinal.
Palabras clave: tuberculosis pulmonar, secuelas post-tuberculosis, actividad física, rehabilitación
pulmonar, calidad de vida
Artículo recibido 25 marzo 2026
Aceptado para publicación: 25 abril 2026
pág. 2206
INTRODUCTION
Pulmonary tuberculosis (PTB) remains one of the most prevalent infectious diseases and one of the
greatest challenges to global public health. According to the most recent report from the World Health
Organization (WHO), in 2023 approximately 10.6 million new cases and 1.3 million deaths from
tuberculosis were reported, positioning this disease as the second leading cause of death from an
infectious agent after COVID-19 (WHO, 2023). Although antituberculosis treatment achieves cure in
most cases, many patients experience chronic respiratory sequelae, functional impairment,
psychological disorders, and persistent social limitations that significantly reduce their quality of life
after completing treatment [1].
Post-tuberculosis sequelae have been associated with the development of obstructive or restrictive
patterns, reduced lung capacity, and the onset of conditions such as bronchiectasis or pulmonary
fibrosis, which prevent full recovery of respiratory function [2]. In this context, physical activity and
pulmonary rehabilitation have emerged as promising complementary therapeutic strategies, especially
in chronic respiratory diseases such as COPD, asthma, or idiopathic pulmonary fibrosis. However, their
systematic application in patients with a history of PTB has been scarcely documented, despite the
physiological, psychological, and social benefits already demonstrated in other populations [3].
In the last past years, clinical studies and systematic reviews have begun to show that structured physical
activity improves not only pulmonary function but also functional capacity, mental health, and quality
of life in patients with pulmonary tuberculosis sequelae [4-5]. Despite these advances, gaps persist in
the implementation of formal post-TB rehabilitation programs, partly due to the lack of specific
guidelines and the limited visibility of this issue within health systems.
The purpose of this article is to review and synthesize recent scientific evidence on the impact of
physical activity and pulmonary rehabilitation in adults who have recovered from pulmonary
tuberculosis, with an emphasis on outcomes related to quality of life. To achieve this, a systematic
review with a narrative-comparative approach was conducted, based on studies located in indexed
databases such as PubMed, ClinicalKey, and Scopus. This review was developed in accordance with
PRISMA guidelines, applying robust methodological criteria and using reference frameworks such as
INTRODUCTION
Pulmonary tuberculosis (PTB) remains one of the most prevalent infectious diseases and one of the
greatest challenges to global public health. According to the most recent report from the World Health
Organization (WHO), in 2023 approximately 10.6 million new cases and 1.3 million deaths from
tuberculosis were reported, positioning this disease as the second leading cause of death from an
infectious agent after COVID-19 (WHO, 2023). Although antituberculosis treatment achieves cure in
most cases, many patients experience chronic respiratory sequelae, functional impairment,
psychological disorders, and persistent social limitations that significantly reduce their quality of life
after completing treatment [1].
Post-tuberculosis sequelae have been associated with the development of obstructive or restrictive
patterns, reduced lung capacity, and the onset of conditions such as bronchiectasis or pulmonary
fibrosis, which prevent full recovery of respiratory function [2]. In this context, physical activity and
pulmonary rehabilitation have emerged as promising complementary therapeutic strategies, especially
in chronic respiratory diseases such as COPD, asthma, or idiopathic pulmonary fibrosis. However, their
systematic application in patients with a history of PTB has been scarcely documented, despite the
physiological, psychological, and social benefits already demonstrated in other populations [3].
In the last past years, clinical studies and systematic reviews have begun to show that structured physical
activity improves not only pulmonary function but also functional capacity, mental health, and quality
of life in patients with pulmonary tuberculosis sequelae [4-5]. Despite these advances, gaps persist in
the implementation of formal post-TB rehabilitation programs, partly due to the lack of specific
guidelines and the limited visibility of this issue within health systems.
The purpose of this article is to review and synthesize recent scientific evidence on the impact of
physical activity and pulmonary rehabilitation in adults who have recovered from pulmonary
tuberculosis, with an emphasis on outcomes related to quality of life. To achieve this, a systematic
review with a narrative-comparative approach was conducted, based on studies located in indexed
databases such as PubMed, ClinicalKey, and Scopus. This review was developed in accordance with
PRISMA guidelines, applying robust methodological criteria and using reference frameworks such as
pág. 2207
EQUATOR and Oxford CEBM, with the goal of providing a critical and updated overview that
contributes to the integration of more comprehensive therapeutic strategies in post-TB care.
METHODOLOGY
A literature review was conducted in accordance with the PRISMA (Preferred Reporting Items for
Systematic Reviews and Meta-Analyses) guidelines. A literature review was conducted in accordance
with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines..
The combinations of descriptors in English included "pulmonary tuberculosis", "rehabilitation",
"exercise", "physical activity", and "quality of life". The search strategy was designed to maximize both
sensitivity and specificity in retrieving relevant articles, combining terms through Boolean operators
(AND, OR). For example, the PubMed search strategy was: ("pulmonary tuberculosis" [Mesh]
OR "tuberculosis, pulmonary" [TIAB]) AND ("rehabilitation" [Mesh] OR "exercise" [TIAB]
OR "physical activity" [TIAB]) AND ("quality of life"[Mesh] OR "quality of life" [TIAB]).
Bibliographic references were managed using specialized software to identify and remove duplicates.
Selection and Quality Assessment Criteria
Rigorous inclusion and exclusion criteria were applied for the selection of studies.
The inclusion criteria were:
▪ Studies in human adults aged 18 years and older.
▪ Articles published in English or Spanish.
▪ Research evaluating the effects of physical activity programs or pulmonary rehabilitation in patients
with pulmonary tuberculosis or its sequelae..
▪ Studies were excluded if they involved children, patients in the active phase of the disease who had
not completed treatment, or did not report measurements of quality of life or functional outcomes.
The methodological quality of the studies was assessed using specific tools to mitigate the risk of bias.
For clinical trials, the Cochrane Collaboration tool was used; for observational studies, the Newcastle-
Ottawa Scale; and for systematic reviews, the AMSTAR 2 instrument. This rigorous assessment process
ensured that the studies included were of moderate to high quality.
EQUATOR and Oxford CEBM, with the goal of providing a critical and updated overview that
contributes to the integration of more comprehensive therapeutic strategies in post-TB care.
METHODOLOGY
A literature review was conducted in accordance with the PRISMA (Preferred Reporting Items for
Systematic Reviews and Meta-Analyses) guidelines. A literature review was conducted in accordance
with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines..
The combinations of descriptors in English included "pulmonary tuberculosis", "rehabilitation",
"exercise", "physical activity", and "quality of life". The search strategy was designed to maximize both
sensitivity and specificity in retrieving relevant articles, combining terms through Boolean operators
(AND, OR). For example, the PubMed search strategy was: ("pulmonary tuberculosis" [Mesh]
OR "tuberculosis, pulmonary" [TIAB]) AND ("rehabilitation" [Mesh] OR "exercise" [TIAB]
OR "physical activity" [TIAB]) AND ("quality of life"[Mesh] OR "quality of life" [TIAB]).
Bibliographic references were managed using specialized software to identify and remove duplicates.
Selection and Quality Assessment Criteria
Rigorous inclusion and exclusion criteria were applied for the selection of studies.
The inclusion criteria were:
▪ Studies in human adults aged 18 years and older.
▪ Articles published in English or Spanish.
▪ Research evaluating the effects of physical activity programs or pulmonary rehabilitation in patients
with pulmonary tuberculosis or its sequelae..
▪ Studies were excluded if they involved children, patients in the active phase of the disease who had
not completed treatment, or did not report measurements of quality of life or functional outcomes.
The methodological quality of the studies was assessed using specific tools to mitigate the risk of bias.
For clinical trials, the Cochrane Collaboration tool was used; for observational studies, the Newcastle-
Ottawa Scale; and for systematic reviews, the AMSTAR 2 instrument. This rigorous assessment process
ensured that the studies included were of moderate to high quality.
pág. 2208
Data analysis
Due to the clinical and methodological heterogeneity of the selected studies, which included diverse
populations, intervention designs, and measurement scales, a formal meta-analysis could not be
performed. Instead, a comparative narrative review approach was adopted, in which the findings of each
study were synthesized and discussed. To determine the relevance of the results, the concept of Minimal
Clinically Important Difference (MCID) was applied, considering effects as significant when they
exceeded predefined thresholds, such as an improvement of 30 meters in the 6MWT or a reduction of
4 points in the SGRQ. This strategy allowed for a critical and contextualized interpretation of the
available evidence
Data Extraction and Synthesis
The primary and secondary outcomes of interest were grouped into five key domains to allow for a
comprehensive assessment of the impact of physical activity. These included:
1. Pulmonary function: Forced Expiratory Volume in one second (FEV₁), Forced Vital Capacity
(FVC), and Diffusing Capacity for Carbon Monoxide (DLCO).
2. Functional capacity: Six-Minute Walk Test (6MWT) and Incremental Shuttle Walk Test (ISWT).
3. Quality of life: Disease-specific and generic questionnaires such as the St. George’s Respiratory
Questionnaire (SGRQ), EQ-5D, Short Form-36 Health Survey (SF-36), and Generic Quality of Life
Inventory-74 (GQOL-74).
4. Mental health: Anxiety and depression scales such as the Generalized Anxiety Disorder-7 (GAD-
7) and Patient Health Questionnaire-9 (PHQ-9).
5. Nutritional parameters: Body Mass Index (BMI) and lean body mass
Data extraction and quality Assessment
Data extraction was carried out independently by two reviewers (B.R. and M.C.), who used a
standardized form to collect key information from each study, including: authors, country of origin,
methodological design, sample characteristics, type and duration of the intervention, and main
outcomes. Any discrepancies between reviewers were resolved by consensus, or, if disagreement
persisted, through the involvement of a third reviewer.
Data analysis
Due to the clinical and methodological heterogeneity of the selected studies, which included diverse
populations, intervention designs, and measurement scales, a formal meta-analysis could not be
performed. Instead, a comparative narrative review approach was adopted, in which the findings of each
study were synthesized and discussed. To determine the relevance of the results, the concept of Minimal
Clinically Important Difference (MCID) was applied, considering effects as significant when they
exceeded predefined thresholds, such as an improvement of 30 meters in the 6MWT or a reduction of
4 points in the SGRQ. This strategy allowed for a critical and contextualized interpretation of the
available evidence
Data Extraction and Synthesis
The primary and secondary outcomes of interest were grouped into five key domains to allow for a
comprehensive assessment of the impact of physical activity. These included:
1. Pulmonary function: Forced Expiratory Volume in one second (FEV₁), Forced Vital Capacity
(FVC), and Diffusing Capacity for Carbon Monoxide (DLCO).
2. Functional capacity: Six-Minute Walk Test (6MWT) and Incremental Shuttle Walk Test (ISWT).
3. Quality of life: Disease-specific and generic questionnaires such as the St. George’s Respiratory
Questionnaire (SGRQ), EQ-5D, Short Form-36 Health Survey (SF-36), and Generic Quality of Life
Inventory-74 (GQOL-74).
4. Mental health: Anxiety and depression scales such as the Generalized Anxiety Disorder-7 (GAD-
7) and Patient Health Questionnaire-9 (PHQ-9).
5. Nutritional parameters: Body Mass Index (BMI) and lean body mass
Data extraction and quality Assessment
Data extraction was carried out independently by two reviewers (B.R. and M.C.), who used a
standardized form to collect key information from each study, including: authors, country of origin,
methodological design, sample characteristics, type and duration of the intervention, and main
outcomes. Any discrepancies between reviewers were resolved by consensus, or, if disagreement
persisted, through the involvement of a third reviewer.
pág. 2209
To assess the quality of evidence and risk of bias, validated tools specific to each study design were
applied.
The Cochrane Collaboration tool was used for randomized clinical trials, the Newcastle-Ottawa Scale
for observational studies, and the AMSTAR 2 tool for systematic reviews. This process confirmed that
most of the included studies demonstrated moderate to high methodological quality.
Analysis and Synthesis of Evidence
Given the considerable clinical and methodological heterogeneity of the selected studies—reflected in
the diversity of populations, types of interventions, durations, and measurement tools—it was not
feasible to perform a formal meta-analysis. Consequently, a comparative narrative synthesis approach
was adopted, in which the findings were qualitatively contextualized and discussed. To interpret the
clinical significance of the results, the concept of Minimal Clinically Important Difference (MCID) was
applied, considering effects as positive when they exceeded predefined thresholds, such as an
improvement of >30 meters in the 6-Minute Walk Test (6MWT) or a reduction of >4 points in the St.
George’s Respiratory Questionnaire (SGRQ).
RESULTS
The results of the study selection process, conducted in accordance with the PRISMA statement, are
presented in Figure 1, which provides a detailed and transparent visual representation of the information
flow. This flow diagram outlines the number of records initially identified in the databases, the
subsequent removal of duplicates, and the eligibility assessment process of the articles. Through this
systematic method, studies were first screened by title and abstract, followed by a comprehensive full-
text review to confirm compliance with the inclusion criteria.
Ultimately, this diagram not only summarizes the trajectory of the articles leading to their final inclusion
but also illustrates the reasons for exclusion of other studies, thereby ensuring the replicability and rigor
of the review process.
To assess the quality of evidence and risk of bias, validated tools specific to each study design were
applied.
The Cochrane Collaboration tool was used for randomized clinical trials, the Newcastle-Ottawa Scale
for observational studies, and the AMSTAR 2 tool for systematic reviews. This process confirmed that
most of the included studies demonstrated moderate to high methodological quality.
Analysis and Synthesis of Evidence
Given the considerable clinical and methodological heterogeneity of the selected studies—reflected in
the diversity of populations, types of interventions, durations, and measurement tools—it was not
feasible to perform a formal meta-analysis. Consequently, a comparative narrative synthesis approach
was adopted, in which the findings were qualitatively contextualized and discussed. To interpret the
clinical significance of the results, the concept of Minimal Clinically Important Difference (MCID) was
applied, considering effects as positive when they exceeded predefined thresholds, such as an
improvement of >30 meters in the 6-Minute Walk Test (6MWT) or a reduction of >4 points in the St.
George’s Respiratory Questionnaire (SGRQ).
RESULTS
The results of the study selection process, conducted in accordance with the PRISMA statement, are
presented in Figure 1, which provides a detailed and transparent visual representation of the information
flow. This flow diagram outlines the number of records initially identified in the databases, the
subsequent removal of duplicates, and the eligibility assessment process of the articles. Through this
systematic method, studies were first screened by title and abstract, followed by a comprehensive full-
text review to confirm compliance with the inclusion criteria.
Ultimately, this diagram not only summarizes the trajectory of the articles leading to their final inclusion
but also illustrates the reasons for exclusion of other studies, thereby ensuring the replicability and rigor
of the review process.
pág. 2210
Figure 1. PRISMA Flow Diagram of the Study Selection Process.
The selected studies show consistent results regarding the positive impact of pulmonary rehabilitation
(PR) programs and structured physical activity in adults who have recovered from pulmonary
tuberculosis (PTB). In the multicenter study by Silva et al. (2025), improvements were observed in the
FEV1/FVC ratio and quality of life, measured using the SF-36 questionnaire, after five weeks of PR
Figure 1. PRISMA Flow Diagram of the Study Selection Process.
The selected studies show consistent results regarding the positive impact of pulmonary rehabilitation
(PR) programs and structured physical activity in adults who have recovered from pulmonary
tuberculosis (PTB). In the multicenter study by Silva et al. (2025), improvements were observed in the
FEV1/FVC ratio and quality of life, measured using the SF-36 questionnaire, after five weeks of PR
pág. 2211
compared to a control group without intervention. Similarly, Jones et al. (2017), in Uganda, reported
significant improvements in the Incremental Shuttle Walk Test (ISWT), with an increase of 90 meters,
and in the COPD Clinical Questionnaire (CCQ), with a reduction of -0.95. In Tanzania, Maleche-
Obimbo et al. (2024) implemented a community-based PR program that led to notable benefits in mental
health and functional status.
From PubMed, Ahmed et al. (2022) and Xie et al. (2023) demonstrated that early structured pulmonary
rehabilitation (PR) programs lead to significant improvements in functional capacity (assessed using
the 6-Minute Walk Test, 6MWT), FEV1, and quality of life, measured with the EQ-5D and GQOL-74
questionnaires. Similarly, Biagini et al (2022) and Khan et al. (2020) found that physical activity during
and after antituberculosis treatment benefits both the physical and mental dimensions of the SF-36.
In another prospective study published in ClinicalKey, Fernández and Cairme (2022) reported
significant improvements in patients with post-TB bronchiectasis in the Philippines after four weeks of
pulmonary rehabilitation (PR). An average increase of 114.6 meters in the 6-Minute Walk Test (6MWT)
was observed (p = 0.0001), along with a significant improvement in quality of life, evidenced by a
reduction in the total St. George’s Respiratory Questionnaire (SGRQ) score from 39.0 to 25.0 (p =
0.008). No significant changes were reported in FEV₁ or FVC, supporting the notion that rehabilitation
enhances functionality beyond basal spirometric variables. Likewise, the systematic review by Tolba et
al. (2021) in treated TB patients demonstrated consistent benefits of pulmonary rehabilitation on quality
of life and functional parameters. In their analysis of eight studies, they reported average improvements
of 65 meters in the 6MWT and reductions of more than 10 points in the SGRQ.
Finally, the multicenter study by Aytaç et al. (2024), conducted in reference centers in Brazil, Italy, and
France, evaluated the effect of pulmonary rehabilitation (PR) in patients with and without COPD.
Significant improvements were observed in FEV₁, FVC, diffusing capacity of the lungs (DLCO), and
6-Minute Walk Test (6MWT) performance, with more pronounced benefits among patients with
moderate to severe COPD, although positive effects were also noted in patients without COPD. No
changes were found in arterial blood gases or in parameters such as total lung capacity (TLC) or residual
volume (RV).
compared to a control group without intervention. Similarly, Jones et al. (2017), in Uganda, reported
significant improvements in the Incremental Shuttle Walk Test (ISWT), with an increase of 90 meters,
and in the COPD Clinical Questionnaire (CCQ), with a reduction of -0.95. In Tanzania, Maleche-
Obimbo et al. (2024) implemented a community-based PR program that led to notable benefits in mental
health and functional status.
From PubMed, Ahmed et al. (2022) and Xie et al. (2023) demonstrated that early structured pulmonary
rehabilitation (PR) programs lead to significant improvements in functional capacity (assessed using
the 6-Minute Walk Test, 6MWT), FEV1, and quality of life, measured with the EQ-5D and GQOL-74
questionnaires. Similarly, Biagini et al (2022) and Khan et al. (2020) found that physical activity during
and after antituberculosis treatment benefits both the physical and mental dimensions of the SF-36.
In another prospective study published in ClinicalKey, Fernández and Cairme (2022) reported
significant improvements in patients with post-TB bronchiectasis in the Philippines after four weeks of
pulmonary rehabilitation (PR). An average increase of 114.6 meters in the 6-Minute Walk Test (6MWT)
was observed (p = 0.0001), along with a significant improvement in quality of life, evidenced by a
reduction in the total St. George’s Respiratory Questionnaire (SGRQ) score from 39.0 to 25.0 (p =
0.008). No significant changes were reported in FEV₁ or FVC, supporting the notion that rehabilitation
enhances functionality beyond basal spirometric variables. Likewise, the systematic review by Tolba et
al. (2021) in treated TB patients demonstrated consistent benefits of pulmonary rehabilitation on quality
of life and functional parameters. In their analysis of eight studies, they reported average improvements
of 65 meters in the 6MWT and reductions of more than 10 points in the SGRQ.
Finally, the multicenter study by Aytaç et al. (2024), conducted in reference centers in Brazil, Italy, and
France, evaluated the effect of pulmonary rehabilitation (PR) in patients with and without COPD.
Significant improvements were observed in FEV₁, FVC, diffusing capacity of the lungs (DLCO), and
6-Minute Walk Test (6MWT) performance, with more pronounced benefits among patients with
moderate to severe COPD, although positive effects were also noted in patients without COPD. No
changes were found in arterial blood gases or in parameters such as total lung capacity (TLC) or residual
volume (RV).
pág. 2212
Table 1. Comparision of selected studies.
Author(s) Country Desing Main findings Instruments
Ahmed et al.
(2022) [5]
India RCT Improvement in FEV1, FVC,
EQ-5D, and 6MWT
EQ-5D, SGRQ
Silva et al. (2025)
[6]
Brazil, Italy,
France
Multicenter
prospective
Improvement in FEV₁/FVC,
6MWT, and quality of life
SF-36
Jones et al.
(2017) [7]
Uganda Pre-post
intervention
Improvement in ISWT (+90
m) and CCQ (-0.95)
CCQ, ISWT,
Karnofsky
Maleche-Obimbo
et al. [8]
Tanzania Cohort Improvement in 6MWT,
anxiety, and depression
SGRQ
Xie et al. (2023)
[12]
China Quasi-
experimental
Reduction in fatigue,
improvement in FEV₁ and
quality of life
GQOL-74
Tolba et al.
(2021) [13]
Brazil, Italy,
France
Multicenter
prospective
↑ FEV1, FVC, DLCO and
6MWT. no changes in blood
gases or TLC
Spirometry,
DLCO, 6MWT
Aytaç et al.
(2024) [14]
Turkey RCT Significant reduction in
fatigue
Piper Fatigue
Scale
Fernandez &
Cairme (2022)
[15]
Philiphines Quasi-
experimental
Improvement in SGRQ and
+114.6 m in 6MWT
SGRQ, 6MWT
Figure 2. Estimated Mean Improvement Post-Intervention in Post-TB Patients.
Based on the analysis of the studies included in this review, recommendations are proposed to
strengthen the clinical management of patients with pulmonary tuberculosis sequelae through the
implementation of physical activity and pulmonary rehabilitation programs. Firstly, the systematic
inclusion of structured pulmonary rehabilitation programs in post-tuberculosis management is
recommended. Evidence from high-quality randomized clinical trials and systematic reviews (Ahmed
Table 1. Comparision of selected studies.
Author(s) Country Desing Main findings Instruments
Ahmed et al.
(2022) [5]
India RCT Improvement in FEV1, FVC,
EQ-5D, and 6MWT
EQ-5D, SGRQ
Silva et al. (2025)
[6]
Brazil, Italy,
France
Multicenter
prospective
Improvement in FEV₁/FVC,
6MWT, and quality of life
SF-36
Jones et al.
(2017) [7]
Uganda Pre-post
intervention
Improvement in ISWT (+90
m) and CCQ (-0.95)
CCQ, ISWT,
Karnofsky
Maleche-Obimbo
et al. [8]
Tanzania Cohort Improvement in 6MWT,
anxiety, and depression
SGRQ
Xie et al. (2023)
[12]
China Quasi-
experimental
Reduction in fatigue,
improvement in FEV₁ and
quality of life
GQOL-74
Tolba et al.
(2021) [13]
Brazil, Italy,
France
Multicenter
prospective
↑ FEV1, FVC, DLCO and
6MWT. no changes in blood
gases or TLC
Spirometry,
DLCO, 6MWT
Aytaç et al.
(2024) [14]
Turkey RCT Significant reduction in
fatigue
Piper Fatigue
Scale
Fernandez &
Cairme (2022)
[15]
Philiphines Quasi-
experimental
Improvement in SGRQ and
+114.6 m in 6MWT
SGRQ, 6MWT
Figure 2. Estimated Mean Improvement Post-Intervention in Post-TB Patients.
Based on the analysis of the studies included in this review, recommendations are proposed to
strengthen the clinical management of patients with pulmonary tuberculosis sequelae through the
implementation of physical activity and pulmonary rehabilitation programs. Firstly, the systematic
inclusion of structured pulmonary rehabilitation programs in post-tuberculosis management is
recommended. Evidence from high-quality randomized clinical trials and systematic reviews (Ahmed
pág. 2213
et al., 2022; Aytaç et al., 2024; Tolba et al., 2021) demonstrates consistent benefits in pulmonary
function (FEV₁, FVC), functional capacity (6MWT), and quality of life (assessed with instruments such
as EQ-5D and SGRQ). These findings support a recommendation with level I evidence and grade A
strength.
Likewise, it is recommended to promote regular physical activity during and after antituberculosis
treatment, since quasi-experimental and observational studies (Biagini et al., 2022; Xie et al., 2023;
Fernández & Cairme, 2022) have shown significant improvements in both physical and mental
dimensions of quality of life, even within short-term intervention programs. Although these studies
present methodological heterogeneity, they provide clinically relevant results, supporting a level II
evidence and Grade B recommendation. Similarly, it is noteworthy that even pulmonary rehabilitation
programs lasting four to six weeks, implemented in community-based or low-resource settings, can lead
to significant improvements in functionality, mental health, and subjective well-being. This finding is
supported by multicenter prospective studies and observational cohorts (Kirakosyan et al., 2026;
Maleche-Obimbo et al., 2024), which are assigned level II–III evidence and a Grade B recommendation.
Another relevant finding concerns the efficacy of pulmonary rehabilitation in patients with and without
chronic obstructive pulmonary disease (COPD). The study by Kirakosyan et al. (2025) demonstrated
objective improvements in functional parameters such as FEV₁, DLCO, and 6MWT in both populations,
thereby expanding the applicability of this intervention even in the absence of bronchial obstruction.
This result carries level II evidence and a Grade B recommendation. In contexts where the
implementation of a full pulmonary rehabilitation program is not feasible, the promotion of supervised
physical activity is suggested as a valid therapeutic alternative. Although this recommendation is
supported by studies with lower methodological rigor (case series and expert consensus), it remains
applicable and pragmatic across multiple healthcare settings and is therefore classified as Level IV
evidence with a Grade C-GESEN recommendation.
Overall, these recommendations help guide clinical practice and health policies toward a more
comprehensive approach in the care of patients with post-TB sequelae, promoting the implementation
of exercise and rehabilitation strategies that have been shown to significantly improve quality of life
and functional capacity in this population.
et al., 2022; Aytaç et al., 2024; Tolba et al., 2021) demonstrates consistent benefits in pulmonary
function (FEV₁, FVC), functional capacity (6MWT), and quality of life (assessed with instruments such
as EQ-5D and SGRQ). These findings support a recommendation with level I evidence and grade A
strength.
Likewise, it is recommended to promote regular physical activity during and after antituberculosis
treatment, since quasi-experimental and observational studies (Biagini et al., 2022; Xie et al., 2023;
Fernández & Cairme, 2022) have shown significant improvements in both physical and mental
dimensions of quality of life, even within short-term intervention programs. Although these studies
present methodological heterogeneity, they provide clinically relevant results, supporting a level II
evidence and Grade B recommendation. Similarly, it is noteworthy that even pulmonary rehabilitation
programs lasting four to six weeks, implemented in community-based or low-resource settings, can lead
to significant improvements in functionality, mental health, and subjective well-being. This finding is
supported by multicenter prospective studies and observational cohorts (Kirakosyan et al., 2026;
Maleche-Obimbo et al., 2024), which are assigned level II–III evidence and a Grade B recommendation.
Another relevant finding concerns the efficacy of pulmonary rehabilitation in patients with and without
chronic obstructive pulmonary disease (COPD). The study by Kirakosyan et al. (2025) demonstrated
objective improvements in functional parameters such as FEV₁, DLCO, and 6MWT in both populations,
thereby expanding the applicability of this intervention even in the absence of bronchial obstruction.
This result carries level II evidence and a Grade B recommendation. In contexts where the
implementation of a full pulmonary rehabilitation program is not feasible, the promotion of supervised
physical activity is suggested as a valid therapeutic alternative. Although this recommendation is
supported by studies with lower methodological rigor (case series and expert consensus), it remains
applicable and pragmatic across multiple healthcare settings and is therefore classified as Level IV
evidence with a Grade C-GESEN recommendation.
Overall, these recommendations help guide clinical practice and health policies toward a more
comprehensive approach in the care of patients with post-TB sequelae, promoting the implementation
of exercise and rehabilitation strategies that have been shown to significantly improve quality of life
and functional capacity in this population.
pág. 2214
Table 2. Levels of Evidence and Grades of Recommendation (GRADE).
Recommendation Levels of
evidence
Grades of
recommendation
Rationale
Include structured
pulmonary rehabilitation
programs in post-
tuberculosis
management.
High (1) Strong (A) High-quality evidence from randomized
controlled trials and systematic reviews
consistently shows that pulmonary
rehabilitation programs significantly and
clinically improve lung function (FEV1, FVC),
functional capacity (6MWT), and quality of life
(SGRQ, EQ-5D). The benefits clearly outweigh
potential risks.
Promote regular physical
activity during and after
anti-tuberculosis
treatmen.
Moderate
(2)
Strong (B) Evidence from quasi-experimental and
observational studies, despite methodological
heterogeneity, demonstrates improvements in
both physical and mental dimensions of quality
of life. These findings are clinically relevant
and replicated in different settings, suggesting a
probable positive effect, although confidence in
the effect may be moderate.
Implement short-term
pulmonary rehabilitation
programs (4–6 weeks) in
community settings.
Low (2–3) Conditional (B) Prospective multicenter and cohort studies in
low-resource settings have shown significant
benefits in functionality and mental health with
short-term interventions. Although the evidence
quality is limited, the high priority of the
problem and the feasibility of the intervention
justify the recommendation.
Apply pulmonary
rehabilitation in post-TB
patients with and without
COPD.
Moderate
(2)
Strong (B) The pulmonary rehabilitation is effective even
in the absence of bronchial obstruction,
broadening its clinical applicability. Functional
benefits (FEV1, DLCO, 6MWT) are relevant in
both populations, supporting a strong
recommendation.
Promote supervised
physical activity as an
alternative when full
rehabilitation programs
are not feasible.
Very low
(4)
Conditional (C) This recommendation is based on evidence
from studies with lower methodological rigor
(case series and expert consensus). Although
the evidence is very limited, the high clinical
priority and the practicality of the intervention
in resource-limited settings justify its
implementation.
DISCUSSION
Physical activity has demonstrated positive effects in individuals with a history of tuberculosis. The
identified benefits span physiological dimensions (such as improvements in FEV₁, FVC, and the six-
minute walk test), psychological aspects (reduction in anxiety and depression), and social outcomes
(facilitation of functional reintegration) (Silva et al., 2025).
Table 2. Levels of Evidence and Grades of Recommendation (GRADE).
Recommendation Levels of
evidence
Grades of
recommendation
Rationale
Include structured
pulmonary rehabilitation
programs in post-
tuberculosis
management.
High (1) Strong (A) High-quality evidence from randomized
controlled trials and systematic reviews
consistently shows that pulmonary
rehabilitation programs significantly and
clinically improve lung function (FEV1, FVC),
functional capacity (6MWT), and quality of life
(SGRQ, EQ-5D). The benefits clearly outweigh
potential risks.
Promote regular physical
activity during and after
anti-tuberculosis
treatmen.
Moderate
(2)
Strong (B) Evidence from quasi-experimental and
observational studies, despite methodological
heterogeneity, demonstrates improvements in
both physical and mental dimensions of quality
of life. These findings are clinically relevant
and replicated in different settings, suggesting a
probable positive effect, although confidence in
the effect may be moderate.
Implement short-term
pulmonary rehabilitation
programs (4–6 weeks) in
community settings.
Low (2–3) Conditional (B) Prospective multicenter and cohort studies in
low-resource settings have shown significant
benefits in functionality and mental health with
short-term interventions. Although the evidence
quality is limited, the high priority of the
problem and the feasibility of the intervention
justify the recommendation.
Apply pulmonary
rehabilitation in post-TB
patients with and without
COPD.
Moderate
(2)
Strong (B) The pulmonary rehabilitation is effective even
in the absence of bronchial obstruction,
broadening its clinical applicability. Functional
benefits (FEV1, DLCO, 6MWT) are relevant in
both populations, supporting a strong
recommendation.
Promote supervised
physical activity as an
alternative when full
rehabilitation programs
are not feasible.
Very low
(4)
Conditional (C) This recommendation is based on evidence
from studies with lower methodological rigor
(case series and expert consensus). Although
the evidence is very limited, the high clinical
priority and the practicality of the intervention
in resource-limited settings justify its
implementation.
DISCUSSION
Physical activity has demonstrated positive effects in individuals with a history of tuberculosis. The
identified benefits span physiological dimensions (such as improvements in FEV₁, FVC, and the six-
minute walk test), psychological aspects (reduction in anxiety and depression), and social outcomes
(facilitation of functional reintegration) (Silva et al., 2025).
pág. 2215
These findings are consistent with recent studies advocating for a rigorous methodological integration
and contextualization of results under an evidence-based research framework (Calderón et al 2025;
Johnson et al., 2019; Tawfik et al., 2019; Thompson et al., 2012). The assessment of methodological
quality and heterogeneity, following Cochrane (2024) guidelines, strengthens the validity of these
conclusions. Furthermore, there is a growing need to adopt implementation models such as Learning
Health Systems (LHS) (Rosenthal et al., 2023; Psek et al., 2015), incorporating evidence hierarchies
such as those proposed by the Oxford Centre for Evidence-Based Medicine (CEBM, 2023). In addition,
community-based participatory research (CBPR) and pro-social public health interventions can further
enrich post-TB rehabilitation strategies (Byrne et al., 2023).
Likewise, the analyzed studies explore barriers and facilitators to participation in exercise programs, in
alignment with the specific objectives of the project. It is noteworthy that one of the articles included
in the review (Silva et al., 2025) appeared in all three databases consulted, supporting its relevance and
the academic consensus regarding its findings. However, to avoid duplication, it was counted only once.
Across all evaluated contexts —both in resource-limited settings and specialized clinical
environments— physical activity proved to be an effective, feasible, and adaptable intervention (Jones
et al., 2017; Maleche-Obimbo et al., 2024). Moreover, several studies employed assessment instruments
such as the SF-36, EQ-5D, SGRQ, and the Piper Fatigue Scale, tools that are also included in the
institutional project proposal (Jones et al., 2017; Xie et al., 2023).
Furthermore, recent studies conducted in the Philippines (Fernández & Cairme, 2022) and in a
multicenter context across Europe and Latin America Aytaç et al. (2024) enrich the evidence regarding
the effectiveness of pulmonary rehabilitation (PR) in post-TB patients. The former demonstrates that
even short programs of four weeks, implemented by multidisciplinary teams in resource-limited
settings, can produce clinically meaningful improvements in functionality and quality of life. In turn,
the latter provides a comparative analysis between patients with and without COPD, concluding that
PR is beneficial even in the absence of evident bronchial obstruction, thereby supporting its systematic
inclusion in post-TB management. Additionally, studies such as Tolba et al. (2021) offer a broader
perspective through high-quality systematic reviews, reinforcing the methodological support for
pulmonary rehabilitation interventions.
These findings are consistent with recent studies advocating for a rigorous methodological integration
and contextualization of results under an evidence-based research framework (Calderón et al 2025;
Johnson et al., 2019; Tawfik et al., 2019; Thompson et al., 2012). The assessment of methodological
quality and heterogeneity, following Cochrane (2024) guidelines, strengthens the validity of these
conclusions. Furthermore, there is a growing need to adopt implementation models such as Learning
Health Systems (LHS) (Rosenthal et al., 2023; Psek et al., 2015), incorporating evidence hierarchies
such as those proposed by the Oxford Centre for Evidence-Based Medicine (CEBM, 2023). In addition,
community-based participatory research (CBPR) and pro-social public health interventions can further
enrich post-TB rehabilitation strategies (Byrne et al., 2023).
Likewise, the analyzed studies explore barriers and facilitators to participation in exercise programs, in
alignment with the specific objectives of the project. It is noteworthy that one of the articles included
in the review (Silva et al., 2025) appeared in all three databases consulted, supporting its relevance and
the academic consensus regarding its findings. However, to avoid duplication, it was counted only once.
Across all evaluated contexts —both in resource-limited settings and specialized clinical
environments— physical activity proved to be an effective, feasible, and adaptable intervention (Jones
et al., 2017; Maleche-Obimbo et al., 2024). Moreover, several studies employed assessment instruments
such as the SF-36, EQ-5D, SGRQ, and the Piper Fatigue Scale, tools that are also included in the
institutional project proposal (Jones et al., 2017; Xie et al., 2023).
Furthermore, recent studies conducted in the Philippines (Fernández & Cairme, 2022) and in a
multicenter context across Europe and Latin America Aytaç et al. (2024) enrich the evidence regarding
the effectiveness of pulmonary rehabilitation (PR) in post-TB patients. The former demonstrates that
even short programs of four weeks, implemented by multidisciplinary teams in resource-limited
settings, can produce clinically meaningful improvements in functionality and quality of life. In turn,
the latter provides a comparative analysis between patients with and without COPD, concluding that
PR is beneficial even in the absence of evident bronchial obstruction, thereby supporting its systematic
inclusion in post-TB management. Additionally, studies such as Tolba et al. (2021) offer a broader
perspective through high-quality systematic reviews, reinforcing the methodological support for
pulmonary rehabilitation interventions.
pág. 2216
Likewise, the research conducted by Jones et al. (2017) in India —one of the countries with the highest
global burden of tuberculosis— provides contextually relevant evidence in high-prevalence settings,
showing substantial improvements in both physical and mental dimensions of the SF-36 following
physical activity interventions.
The scientific evidence synthesized in this comprehensive literature review provides strong
confirmation of the positive and multifaceted impact of physical activity and pulmonary rehabilitation
(PR) in patients with pulmonary tuberculosis (PTB) sequelae. These findings not only validate the core
premise of our institutional project, "Improvements in Quality of Life After Pulmonary Tuberculosis
Through Physical Activity” but also demonstrate that structured interventions go beyond the purely
physiological dimension—such as improvements in FEV₁ and forced vital capacity (FVC)—to
significantly encompass psychological and social domains, including reduced anxiety and facilitated
functional reintegration. This comprehensive approach is essential to address the chronic sequelae that
undermine the quality of life of post-TB patients, emphasizing the need for a holistic perspective in the
care of this vulnerable population, which is often managed through a purely curative lens without
sufficient consideration of long-term consequences.
The analysis of the evidence, framed within the rigorous GRADE classification system, provides a solid
and irrefutable argument for the adoption of these interventions in routine clinical practice. Our first
and strongest recommendation, with a Level of Evidence I and a Grade of Recommendation A, is
grounded in the consistency of findings from multiple randomized controlled trials (such as Ahmed et
al., (2022 and Aytaç et al., 2024) and high-quality systematic reviews such as Tolba et al., 2021. These
studies unequivocally demonstrate that the benefits in lung function, functional capacity (6MWT), and
quality of life are robust, clinically significant, and far outweigh any potential risks. The academic
consensus surrounding these results as evidenced by the multicenter study by Silva et al. (2025), which
was cited across all three databases consulted further strengthens confidence in the effectiveness and
replicability of pulmonary rehabilitation programs across diverse clinical and geographic contexts. This
convergence of findings from different regions of the world underscores the universality of the post-TB
sequelae problem and the effectiveness of a standardized, evidence-based therapeutic solution.
Likewise, the research conducted by Jones et al. (2017) in India —one of the countries with the highest
global burden of tuberculosis— provides contextually relevant evidence in high-prevalence settings,
showing substantial improvements in both physical and mental dimensions of the SF-36 following
physical activity interventions.
The scientific evidence synthesized in this comprehensive literature review provides strong
confirmation of the positive and multifaceted impact of physical activity and pulmonary rehabilitation
(PR) in patients with pulmonary tuberculosis (PTB) sequelae. These findings not only validate the core
premise of our institutional project, "Improvements in Quality of Life After Pulmonary Tuberculosis
Through Physical Activity” but also demonstrate that structured interventions go beyond the purely
physiological dimension—such as improvements in FEV₁ and forced vital capacity (FVC)—to
significantly encompass psychological and social domains, including reduced anxiety and facilitated
functional reintegration. This comprehensive approach is essential to address the chronic sequelae that
undermine the quality of life of post-TB patients, emphasizing the need for a holistic perspective in the
care of this vulnerable population, which is often managed through a purely curative lens without
sufficient consideration of long-term consequences.
The analysis of the evidence, framed within the rigorous GRADE classification system, provides a solid
and irrefutable argument for the adoption of these interventions in routine clinical practice. Our first
and strongest recommendation, with a Level of Evidence I and a Grade of Recommendation A, is
grounded in the consistency of findings from multiple randomized controlled trials (such as Ahmed et
al., (2022 and Aytaç et al., 2024) and high-quality systematic reviews such as Tolba et al., 2021. These
studies unequivocally demonstrate that the benefits in lung function, functional capacity (6MWT), and
quality of life are robust, clinically significant, and far outweigh any potential risks. The academic
consensus surrounding these results as evidenced by the multicenter study by Silva et al. (2025), which
was cited across all three databases consulted further strengthens confidence in the effectiveness and
replicability of pulmonary rehabilitation programs across diverse clinical and geographic contexts. This
convergence of findings from different regions of the world underscores the universality of the post-TB
sequelae problem and the effectiveness of a standardized, evidence-based therapeutic solution.
pág. 2217
Furthermore, the reviewed studies suggest that the intervention can be effective even in resource-limited
settings, thereby expanding its global applicability and underscoring its potential as a far-reaching
public health tool. A quasi-experimental study conducted in the Philippines (Fernández & Cairme,
2022) demonstrated clinically meaningful improvements, such as an average increase of 114.6 meters
in the 6MWT, achieved through short-term programs lasting only four weeks. This finding, which
aligns with a Level II–III recommendation, is crucial for the implementation of health policies in high
TB-burden countries such as India, where Jones et al. (2017) also reported significant benefits in the
physical and mental dimensions of the SF-36 following physical activity interventions. These results
are fundamental for designing adaptable, feasible, and sustainable programs across diverse healthcare
settings, demonstrating that limited resources should not be a barrier to delivering high-quality care.
The evidence suggests that creativity in program design, tailored to local constraints, can yield equally
positive outcomes.
The multicenter study by Aytaç et al. (2024), conducted in Brazil, Italy, and France, enriches the
evidence by convincingly demonstrating that pulmonary rehabilitation (PR) is effective in post-TB
patients both with chronic obstructive pulmonary disease (COPD) and without evident bronchial
obstruction. This finding, supported by a Level II Evidence and a Grade B Recommendation,
significantly broadens the scope of PR application, suggesting that functional improvements are not
limited to spirometric parameters, but also extend to pulmonary diffusion capacity (DLCO) and exercise
capacity (6MWT). These results indicate that post-TB rehabilitation addresses complex physiological
mechanisms beyond ventilatory mechanics, including enhanced oxygenation and improved peripheral
muscle strength, which justifies the inclusion of this intervention across a broader spectrum of patients,
even in the absence of a formal COPD diagnosis.
While the evidence supports a strong recommendation, the implementation of these strategies within
health systems must consider rigorous and adaptive frameworks. The adoption of models such as
Learning Health Systems (LHS) and Community-Based Participatory Research (CBPR) may be crucial
for contextualizing programs, identifying barriers and facilitators (as examined in the reviewed studies),
and ensuring long-term sustainability. These implementation strategies can help overcome logistical
and cultural challenges, ensuring that rehabilitation programs are accessible, accepted, and effective for
Furthermore, the reviewed studies suggest that the intervention can be effective even in resource-limited
settings, thereby expanding its global applicability and underscoring its potential as a far-reaching
public health tool. A quasi-experimental study conducted in the Philippines (Fernández & Cairme,
2022) demonstrated clinically meaningful improvements, such as an average increase of 114.6 meters
in the 6MWT, achieved through short-term programs lasting only four weeks. This finding, which
aligns with a Level II–III recommendation, is crucial for the implementation of health policies in high
TB-burden countries such as India, where Jones et al. (2017) also reported significant benefits in the
physical and mental dimensions of the SF-36 following physical activity interventions. These results
are fundamental for designing adaptable, feasible, and sustainable programs across diverse healthcare
settings, demonstrating that limited resources should not be a barrier to delivering high-quality care.
The evidence suggests that creativity in program design, tailored to local constraints, can yield equally
positive outcomes.
The multicenter study by Aytaç et al. (2024), conducted in Brazil, Italy, and France, enriches the
evidence by convincingly demonstrating that pulmonary rehabilitation (PR) is effective in post-TB
patients both with chronic obstructive pulmonary disease (COPD) and without evident bronchial
obstruction. This finding, supported by a Level II Evidence and a Grade B Recommendation,
significantly broadens the scope of PR application, suggesting that functional improvements are not
limited to spirometric parameters, but also extend to pulmonary diffusion capacity (DLCO) and exercise
capacity (6MWT). These results indicate that post-TB rehabilitation addresses complex physiological
mechanisms beyond ventilatory mechanics, including enhanced oxygenation and improved peripheral
muscle strength, which justifies the inclusion of this intervention across a broader spectrum of patients,
even in the absence of a formal COPD diagnosis.
While the evidence supports a strong recommendation, the implementation of these strategies within
health systems must consider rigorous and adaptive frameworks. The adoption of models such as
Learning Health Systems (LHS) and Community-Based Participatory Research (CBPR) may be crucial
for contextualizing programs, identifying barriers and facilitators (as examined in the reviewed studies),
and ensuring long-term sustainability. These implementation strategies can help overcome logistical
and cultural challenges, ensuring that rehabilitation programs are accessible, accepted, and effective for
pág. 2218
the target population. Moreover, the integration of the patient’s perspective into the design and
implementation of these programs emerges as a key factor for success, as consistently demonstrated in
the participatory research literature.
In light of these findings, it is imperative that public health policies be updated to reflect the available
evidence. Post-TB care cannot be limited to pharmacological treatment alone; it must proactively
integrate pulmonary rehabilitation and supervised physical activity as essential components of standard
care. The evidence that even short-term interventions delivered in community settings can yield
significant benefits challenges the notion that such programs are costly or inaccessible. On the contrary,
they emerge as cost-effective interventions with a high return in terms of patient quality of life and a
potential reduction in the long-term burden on the healthcare system. Investment in these programs not
only improves patients’ lives but can also contribute to economic productivity and social cohesion.
Although the reviewed studies are methodologically robust, they also highlight important knowledge
gaps. There is a critical need for longitudinal research to evaluate the sustained impact of these
interventions over the long term. Most existing studies focus on short-term effects (weeks or months),
and little is known about whether improvements in functional capacity and quality of life persist over
time without maintenance programs. Additionally, further research is required to examine
sociodemographic and clinical variables such as comorbidities, severity of sequelae, socioeconomic
status, and educational level that may influence adherence and program outcomes. Such studies could
facilitate the personalization of interventions and maximize their effectiveness. Finally, the integration
of physical activity as a therapeutic tool in public health policy requires not only evidence, but also
political will and investment in training healthcare professionals capable of prescribing and supervising
these programs.
CONCLUSIONS
The systematic review of the literature demonstrates that physical activity and pulmonary rehabilitation
have a clear and consistent positive impact on the quality of life of patients who have recovered from
pulmonary tuberculosis. This evidence validates the relevance and significance of the proposed research
project and establishes a solid foundation for clinical and public health action.
the target population. Moreover, the integration of the patient’s perspective into the design and
implementation of these programs emerges as a key factor for success, as consistently demonstrated in
the participatory research literature.
In light of these findings, it is imperative that public health policies be updated to reflect the available
evidence. Post-TB care cannot be limited to pharmacological treatment alone; it must proactively
integrate pulmonary rehabilitation and supervised physical activity as essential components of standard
care. The evidence that even short-term interventions delivered in community settings can yield
significant benefits challenges the notion that such programs are costly or inaccessible. On the contrary,
they emerge as cost-effective interventions with a high return in terms of patient quality of life and a
potential reduction in the long-term burden on the healthcare system. Investment in these programs not
only improves patients’ lives but can also contribute to economic productivity and social cohesion.
Although the reviewed studies are methodologically robust, they also highlight important knowledge
gaps. There is a critical need for longitudinal research to evaluate the sustained impact of these
interventions over the long term. Most existing studies focus on short-term effects (weeks or months),
and little is known about whether improvements in functional capacity and quality of life persist over
time without maintenance programs. Additionally, further research is required to examine
sociodemographic and clinical variables such as comorbidities, severity of sequelae, socioeconomic
status, and educational level that may influence adherence and program outcomes. Such studies could
facilitate the personalization of interventions and maximize their effectiveness. Finally, the integration
of physical activity as a therapeutic tool in public health policy requires not only evidence, but also
political will and investment in training healthcare professionals capable of prescribing and supervising
these programs.
CONCLUSIONS
The systematic review of the literature demonstrates that physical activity and pulmonary rehabilitation
have a clear and consistent positive impact on the quality of life of patients who have recovered from
pulmonary tuberculosis. This evidence validates the relevance and significance of the proposed research
project and establishes a solid foundation for clinical and public health action.
pág. 2219
The integration of physical exercise strategies into post-TB care should be considered by health systems
as a cost-effective intervention that significantly improves the physical, mental, and social well-being
of patients. As shown in the GRADE table, the recommendations for implementing structured
rehabilitation programs have a high level of evidence (I), which justifies a strong recommendation grade
(A). This implies that the benefits far outweigh the risks, making their implementation a public health
imperative.
Furthermore, it is noteworthy that even short-term rehabilitation programs and those conducted in low-
resource settings can produce functional and quality-of-life improvements. This is reflected in
recommendations with a moderate level of evidence (II–III) but a conditional recommendation grade
(B). This demonstrates that a lack of resources should not be a barrier to providing comprehensive care.
Nevertheless, the study highlights the need for more longitudinal research to evaluate the sustained
long-term impact of these interventions, as most of the current evidence focuses on short-term effects.
Research is also needed to consider different sociodemographic and clinical variables to strengthen the
available evidence, as well as the implementation of public policies that integrate physical activity as
an essential therapeutic tool in the management of tuberculosis sequelae.
Limitations
Despite the robust and consistent findings, this review presents some inherent methodological
limitations. The main limitation is the clinical and statistical heterogeneity of the primary studies, which
prevented the performance of a formal meta-analysis. Variations in the duration and type of
interventions, study populations, diversity of measurement tools for quality of life and physical
function, and differing geographical and socioeconomic contexts make it difficult to directly generalize
the results. Moreover, most studies focus on the short-term effects of the interventions, leaving a
knowledge gap regarding the sustainability of long-term benefits. Finally, although a comprehensive
search was conducted across major databases, it is possible that some non-indexed studies or those
published in other languages were omitted.
BIBLIOGRAPHIC REFERENCES
1. Dheda K, Barry CE, Maartens G. Tuberculosis. Lancet. 2016; 387(10024): 1211-26. Available
from: https//doi.org/10.1016/S0140-6736(15)00151-8
The integration of physical exercise strategies into post-TB care should be considered by health systems
as a cost-effective intervention that significantly improves the physical, mental, and social well-being
of patients. As shown in the GRADE table, the recommendations for implementing structured
rehabilitation programs have a high level of evidence (I), which justifies a strong recommendation grade
(A). This implies that the benefits far outweigh the risks, making their implementation a public health
imperative.
Furthermore, it is noteworthy that even short-term rehabilitation programs and those conducted in low-
resource settings can produce functional and quality-of-life improvements. This is reflected in
recommendations with a moderate level of evidence (II–III) but a conditional recommendation grade
(B). This demonstrates that a lack of resources should not be a barrier to providing comprehensive care.
Nevertheless, the study highlights the need for more longitudinal research to evaluate the sustained
long-term impact of these interventions, as most of the current evidence focuses on short-term effects.
Research is also needed to consider different sociodemographic and clinical variables to strengthen the
available evidence, as well as the implementation of public policies that integrate physical activity as
an essential therapeutic tool in the management of tuberculosis sequelae.
Limitations
Despite the robust and consistent findings, this review presents some inherent methodological
limitations. The main limitation is the clinical and statistical heterogeneity of the primary studies, which
prevented the performance of a formal meta-analysis. Variations in the duration and type of
interventions, study populations, diversity of measurement tools for quality of life and physical
function, and differing geographical and socioeconomic contexts make it difficult to directly generalize
the results. Moreover, most studies focus on the short-term effects of the interventions, leaving a
knowledge gap regarding the sustainability of long-term benefits. Finally, although a comprehensive
search was conducted across major databases, it is possible that some non-indexed studies or those
published in other languages were omitted.
BIBLIOGRAPHIC REFERENCES
1. Dheda K, Barry CE, Maartens G. Tuberculosis. Lancet. 2016; 387(10024): 1211-26. Available
from: https//doi.org/10.1016/S0140-6736(15)00151-8
pág. 2220
2. Allwood BW, Byrne A, Meghji J, et al. Post-tuberculosis lung disease: Clinical review of an under-
recognised global challenge. Respiration. 2021; 100(8): 751–763. Available from:
https://doi.org/10.1159/000512531
3. Gloeckl R, Schneeberger T, Jarosch I, et al. Pulmonary Rehabilitation and Exercise Training in
Chronic Obstructive Pulmonary Disease. Dtsch Arztebl Int. 2018; 115(8): 117–123. Available from:
https://doi.org/10.1016/j.rmed.2023.107170
4. Sinha S, Titiyal R, Mounika P, et al. Effectiveness of pulmonary rehabilitation on functional
exercise capacity & health related quality of life (HRQOL) among individuals with post
tuberculosis lung disease: A multicentric pre & post-interventional study. Indian J Med Res. 2022;
161(5): 540-551. Available from: https://doi.org/10.25259/IJMR_1643_2024
5. Ahmed S, Sharma N, Patrikar S, et al. Efficacy of early structured pulmonary rehabilitation program
in pulmonary function, exercise capacity, and health-related quality of life for patients with post-
tubercular sequelae: A pilot study. Med J Armed Forces India. 2022; 78(2): 164-169. Available
from: https://doi.org/10.1016/j.mjafi.2020.09.001
6. Silva R, Senna-Galvão T, Dalcolmo M, et al. Pulmonary rehabilitation in patients with post-
tuberculosis lung disease: A Prospective Multicentre Study. Arch Bronconeumol. 2025; 61(10):
603-609. Available from: https://doi.org/10.1016/j.arbres.2025.02.007
7. Jones R, Kirenga BJ, Katagira W, et al. A pre-post intervention study of pulmonary rehabilitation
for adults with post-tuberculosis lung disease in Uganda. Int J Chron Obstruct Pulmon Dis. 2017;
12: 3533–3539. Available from: https://doi.org/10.2147/COPD.S146659
8. Maleche-Obimbo E, Odhiambo MA, Njeri L, et al. Magnitude and factors associated with post-
tuberculosis lung disease in low- and middle-income countries: A systematic review and meta-
analysis. PLOS Glob Public Health. 2022; 2(12): e0000805.
https://doi.org/10.1371/journal.pgph.0000805
9. Tada A, Matsumoto H, Soda R. Effects of pulmonary rehabilitation in patients with pulmonary
tuberculosis sequelae. Nihon Kokyuki Gakkai Zasshi. 2002; 40(4): 275-81.
2. Allwood BW, Byrne A, Meghji J, et al. Post-tuberculosis lung disease: Clinical review of an under-
recognised global challenge. Respiration. 2021; 100(8): 751–763. Available from:
https://doi.org/10.1159/000512531
3. Gloeckl R, Schneeberger T, Jarosch I, et al. Pulmonary Rehabilitation and Exercise Training in
Chronic Obstructive Pulmonary Disease. Dtsch Arztebl Int. 2018; 115(8): 117–123. Available from:
https://doi.org/10.1016/j.rmed.2023.107170
4. Sinha S, Titiyal R, Mounika P, et al. Effectiveness of pulmonary rehabilitation on functional
exercise capacity & health related quality of life (HRQOL) among individuals with post
tuberculosis lung disease: A multicentric pre & post-interventional study. Indian J Med Res. 2022;
161(5): 540-551. Available from: https://doi.org/10.25259/IJMR_1643_2024
5. Ahmed S, Sharma N, Patrikar S, et al. Efficacy of early structured pulmonary rehabilitation program
in pulmonary function, exercise capacity, and health-related quality of life for patients with post-
tubercular sequelae: A pilot study. Med J Armed Forces India. 2022; 78(2): 164-169. Available
from: https://doi.org/10.1016/j.mjafi.2020.09.001
6. Silva R, Senna-Galvão T, Dalcolmo M, et al. Pulmonary rehabilitation in patients with post-
tuberculosis lung disease: A Prospective Multicentre Study. Arch Bronconeumol. 2025; 61(10):
603-609. Available from: https://doi.org/10.1016/j.arbres.2025.02.007
7. Jones R, Kirenga BJ, Katagira W, et al. A pre-post intervention study of pulmonary rehabilitation
for adults with post-tuberculosis lung disease in Uganda. Int J Chron Obstruct Pulmon Dis. 2017;
12: 3533–3539. Available from: https://doi.org/10.2147/COPD.S146659
8. Maleche-Obimbo E, Odhiambo MA, Njeri L, et al. Magnitude and factors associated with post-
tuberculosis lung disease in low- and middle-income countries: A systematic review and meta-
analysis. PLOS Glob Public Health. 2022; 2(12): e0000805.
https://doi.org/10.1371/journal.pgph.0000805
9. Tada A, Matsumoto H, Soda R. Effects of pulmonary rehabilitation in patients with pulmonary
tuberculosis sequelae. Nihon Kokyuki Gakkai Zasshi. 2002; 40(4): 275-81.
pág. 2221
10. Biagini A, Bastiani L, Sebastiani L. The impact of physical activity on the quality of life of a sample
of Italian people with physical disability. Front Sports Act Living. 2022; 4: 884074. Available from:
https://doi.org/10.3389/fspor.2022.884074
11. Khan R, Malik NI, Razaque A. Imaging of Pulmonary Post-Tuberculosis Sequelae. Pak J Med Sci.
2020; 36(1): S75–S82. Available from: https://doi.org/10.12669/pjms.36.ICON-Suppl.1722
12. Xie L, Wang D, Xie X. Development and evaluation of an early rehabilitation nursing program for
patients with pulmonary tuberculosis. Medicine (Baltimore). 2023; 102(36): e34991. Available
from: https://doi.org/10.1097/MD.0000000000034991
13. Tolba SK, El-Hady A, Moussa H, et al. Efficacy of pulmonary rehabilitation program in patients
with treated pulmonary tuberculosis. Syst Rev Pharm. 2021; 12(3): 516-521. Available from:
https://doi.org/10.31838/srp.2021.3.75
14. Aytaç S, Ovayolu Ö, Dogru S. The effect of breathing exercises on fatigue in tuberculosis patients:
a randomized controlled trial. Rev Assoc Med Bras. 2024; 70(2): e20240888. Available from:
https://doi.org/10.1590/1806-9282.20240888
15. Fernández LC, Cairme GB. The benefits of pulmonary rehabilitation program on post-tuberculosis
bronchiectasis. Int J Clin Med [Internet]. 2022; 13(12). Available from:
https://doi.org/10.4236/ijcm.2022.1312042
16. Mahler B, Croitoru A. Pulmonary rehabilitation and tuberculosis: a new approach for an old disease.
Pneumologia. 2019; 68(3): 107–113. Available from: https://doi.org/10.2478/pneum-2019-0024
17. Kirakosyan O, Verbree H, van der Zalm MM, et al. Rehabilitation for individuals with post-
tuberculosis lung disease. Breathe. 2026; 22(1): 250056. Available from:
https://doi.org/10.1183/20734735.0056-2025
18. Johnson BT, Hennessy EA. Systematic reviews and meta-analyses in the health sciences: Best
practice methods for research syntheses. Soc Sci Med. 2019; 233: 237-251. Available from:
https//doi.org/10.1016/j.socscimed.2019.05.035
10. Biagini A, Bastiani L, Sebastiani L. The impact of physical activity on the quality of life of a sample
of Italian people with physical disability. Front Sports Act Living. 2022; 4: 884074. Available from:
https://doi.org/10.3389/fspor.2022.884074
11. Khan R, Malik NI, Razaque A. Imaging of Pulmonary Post-Tuberculosis Sequelae. Pak J Med Sci.
2020; 36(1): S75–S82. Available from: https://doi.org/10.12669/pjms.36.ICON-Suppl.1722
12. Xie L, Wang D, Xie X. Development and evaluation of an early rehabilitation nursing program for
patients with pulmonary tuberculosis. Medicine (Baltimore). 2023; 102(36): e34991. Available
from: https://doi.org/10.1097/MD.0000000000034991
13. Tolba SK, El-Hady A, Moussa H, et al. Efficacy of pulmonary rehabilitation program in patients
with treated pulmonary tuberculosis. Syst Rev Pharm. 2021; 12(3): 516-521. Available from:
https://doi.org/10.31838/srp.2021.3.75
14. Aytaç S, Ovayolu Ö, Dogru S. The effect of breathing exercises on fatigue in tuberculosis patients:
a randomized controlled trial. Rev Assoc Med Bras. 2024; 70(2): e20240888. Available from:
https://doi.org/10.1590/1806-9282.20240888
15. Fernández LC, Cairme GB. The benefits of pulmonary rehabilitation program on post-tuberculosis
bronchiectasis. Int J Clin Med [Internet]. 2022; 13(12). Available from:
https://doi.org/10.4236/ijcm.2022.1312042
16. Mahler B, Croitoru A. Pulmonary rehabilitation and tuberculosis: a new approach for an old disease.
Pneumologia. 2019; 68(3): 107–113. Available from: https://doi.org/10.2478/pneum-2019-0024
17. Kirakosyan O, Verbree H, van der Zalm MM, et al. Rehabilitation for individuals with post-
tuberculosis lung disease. Breathe. 2026; 22(1): 250056. Available from:
https://doi.org/10.1183/20734735.0056-2025
18. Johnson BT, Hennessy EA. Systematic reviews and meta-analyses in the health sciences: Best
practice methods for research syntheses. Soc Sci Med. 2019; 233: 237-251. Available from:
https//doi.org/10.1016/j.socscimed.2019.05.035
pág. 2222
19. Tawfik G, Surya Dila KA, Fadlelmola-Mohamed MY, et al. A step-by-step guide to conducting a
systematic review and meta-analysis with simulation data. Trop Med Health. 2019; 47: 46.
Available from: https://doi.org/10.1186/s41182-019-0165-6
20. Calderon-Martinez E, Ghattas-Hasbun PE, Salolin-Vargas VP, et al. A comprehensive guide to
conduct a systematic review and meta-analysis in medical research. Medicine (Baltimore). 2025;
104(33): e41868. Available from: https://doi.org/10.1097/MD.0000000000041868
21. Groves T. Enhancing the QUAlity and Transparency Of Health Research. BMJ. 2008; 337(7661):
66. Available from: https://doi.org/10.1136/bmj.a718
22. Wadsworth DP, Craswell A, Ward A. Characteristics of contemporary health research practice:
collaborative, diverse, and authentic. Res Eval [Internet]. 2024. Available from:
https://doi.org/10.1093/reseval/rvae006
23. Thompson M, Tiwari A, Fu R, et al. A Framework To Facilitate the Use of Systematic
Reviews and Meta-Analyses in the Design of Primary Research Studies. Res Whit Pap. 2012.
PMID: 22299187.
24. Rosenthal GE, McClain DA, High KP, et al. Learning Health Systems in practice: a framework for
implementation. Acad Med. 2023; 98(9):1002–1007. Available from:
https://doi.org/10.2196/34907
25. Psek WA, Stametz RA, Bailey-Davis LD, et al. Operationalizing the Learning Health Care System
in an Integrated Delivery System. EGEMS (Wash DC). 2015; 3(1):1122. Available from:
https://doi.org/10.13063/2327-9214.1122
26. Byrne M, Jin-Tan RK, Wu D, et al. Prosocial Interventions and Health Outcomes: A Systematic
Review and Meta-Analysis. JAMA Netw Open. 2023; 6(12): e232720.
https://doi.org/10.1001/jamanetworkopen.2023.46789
27. Levels of Evidence. Oxford Centre for Evidence-Based Medicine [Internet]. 2023. Available from:
https://www.cebm.ox.ac.uk/resources/levels-of-evidence
28. Global Tuberculosis Report 2023. World Health Organization (WHO). 2023. Disponible en:
https://www.who.int/publications/i/item/9789240077663
19. Tawfik G, Surya Dila KA, Fadlelmola-Mohamed MY, et al. A step-by-step guide to conducting a
systematic review and meta-analysis with simulation data. Trop Med Health. 2019; 47: 46.
Available from: https://doi.org/10.1186/s41182-019-0165-6
20. Calderon-Martinez E, Ghattas-Hasbun PE, Salolin-Vargas VP, et al. A comprehensive guide to
conduct a systematic review and meta-analysis in medical research. Medicine (Baltimore). 2025;
104(33): e41868. Available from: https://doi.org/10.1097/MD.0000000000041868
21. Groves T. Enhancing the QUAlity and Transparency Of Health Research. BMJ. 2008; 337(7661):
66. Available from: https://doi.org/10.1136/bmj.a718
22. Wadsworth DP, Craswell A, Ward A. Characteristics of contemporary health research practice:
collaborative, diverse, and authentic. Res Eval [Internet]. 2024. Available from:
https://doi.org/10.1093/reseval/rvae006
23. Thompson M, Tiwari A, Fu R, et al. A Framework To Facilitate the Use of Systematic
Reviews and Meta-Analyses in the Design of Primary Research Studies. Res Whit Pap. 2012.
PMID: 22299187.
24. Rosenthal GE, McClain DA, High KP, et al. Learning Health Systems in practice: a framework for
implementation. Acad Med. 2023; 98(9):1002–1007. Available from:
https://doi.org/10.2196/34907
25. Psek WA, Stametz RA, Bailey-Davis LD, et al. Operationalizing the Learning Health Care System
in an Integrated Delivery System. EGEMS (Wash DC). 2015; 3(1):1122. Available from:
https://doi.org/10.13063/2327-9214.1122
26. Byrne M, Jin-Tan RK, Wu D, et al. Prosocial Interventions and Health Outcomes: A Systematic
Review and Meta-Analysis. JAMA Netw Open. 2023; 6(12): e232720.
https://doi.org/10.1001/jamanetworkopen.2023.46789
27. Levels of Evidence. Oxford Centre for Evidence-Based Medicine [Internet]. 2023. Available from:
https://www.cebm.ox.ac.uk/resources/levels-of-evidence
28. Global Tuberculosis Report 2023. World Health Organization (WHO). 2023. Disponible en:
https://www.who.int/publications/i/item/9789240077663
pág. 2223