r e s p i r a t o r y m e d i c i n e : c o p d u p d a t e 5 ( 2 0 0 9 ) 9 0 e 9 796

Maintaining benefits following pulmonary rehabilitation: a randomised controlled trial

This randomised control trial compares a supervised exercise class with a home unsupervised pulmonary rehabilitation maintenance

programme.

Abstract of Original Article

Introduction: The aim of this study was to determine if weekly,supervised, outpatient-based exercise plus unsupervisedhome exercise following an eight-week pulmonary rehabilita-tion program would maintain functional exercise capacityand quality of life at twelve months better than standardcare of unsupervised home exercise training.Methods: COPD subjects completed an eight-week pulmonaryrehabilitation program, were randomised to an InterventionGroup (IG) of weekly, supervised, exercise plus home exerciseor to a Control Group (CG) of unsupervised home exercise andfollowed for twelve months. Outcome measurements at base-line (post PR), 3, 6 and 12 months included the six-minutewalk test (6MWT) and St George’s Respiratory Questionnaire(SGRQ).

Results: Fifty-nine subjects with moderate COPD (GOLD StageII) were recruited and 48 subjects completed the study.Twelve month mean difference (95%CI) showed no significant change from baseline in 6MWD [IG Z -11 m (-21 to 10);CG Z - 6 m (-34 to 11)] or total SGRQ score [IG Z 3 (-0.8 to7); CG Z -3 (-7 to 3)].Conclusion: Twelve months following pulmonary rehabilita-tion both weekly, supervised, outpatient-based exercise plusunsupervised home exercise and standard care of unsuper-vised home exercise successfully maintained six-minutewalk distance and quality of life in subjects with moderateCOPD.Reproduced with permission from European RespiratorySociety Journals Ltd.

Commentary by Christine MikelsonsRoyal Free NHS Trust, London, UK

This study is an important contribution to identifying how maintenance of the positive outcomes of pulmonary rehabili-tation are realised for patients with chronic obstructive pulmonary disease.

In this randomised controlled trial 59 participants, who had undertaken an initial programme of pulmonary rehabilitation,were randomised to either a maintenance regime of a once weekly supervised exercise session plus home exercise or anunsupervised home exercise programme, for 12 months. Primary outcomes were the 6 minute walk and the St George’sRespiratory Questionnaire measured at 3, 6 and 12 months.

The results identified that in both the supervised exercise and the home exercise groups, there was no change in eitherprimary outcome at 12 months compared to measurements taken directly after the initial pulmonary rehabilitation pro-gramme had been performed. This indicates that either type of programme would provide positive benefits in maintainingthe improvements first gained in performing a pulmonary rehabilitation programme. This is a key finding as studies havepreviously struggled to identify any benefit in maintenance by performing monthly exercise sessions.1,2 It is important tonote that the control group in this study were a stable group in term of lung function with few exacerbations and lowreported levels of anxiety and depression during the study period which could have contributed to the high levels ofcompliance with the unsupervised programme.

One further point for consideration is the potential importance of a third limb with no follow-up at 3 and 6 month intervalsto see if this had the same beneficial effects. It is likely that contact with clinicians (even though participants may not haveperformed any exercise element) would have had an impact in terms of motivation to keep up progress already made.

References1. Ries AL, Kaplan RM, Myers R, Prewitt LM. Maintenance after pulmonary rehabilitation in chronic lung disease. American

Journal of Respiratory and Critical Care Medicine 2003; 167: 880-888.2. Brooks D, Krip B, Mangovski-Alzamora S, Goldstein RS. The effect of post rehabilitation programmes among individuals with

chronic obstructive pulmonary disease. European Respiratory Journal 2002; 20: 20-29.

Original article reference: Spencer LM, Alison JA, McKeough ZJ. Maintaining benefits following pulmonary rehabilitation:a randomised controlled trial. European Respiratory Journal 2009; doi: 10.1183/09031936.00073609.

doi:10.1016/j.rmedu.2009.10.017