Unsupervised home exercise effective for maintaining pulmonary rehabilitation benefits
MedWire News: Unsupervised home exercise is just as effective as a weekly, supervised, outpatient-based exercise program for maintaining the benefits of pulmonary rehabilitation among patients with chronic obstructive pulmonary disease (COPD), Australian researchers have found.
Writing in the European Respiratory Journal, L Spencer (Royal Prince Alfred Hospital, Camperdown, New South Wales) and team explain: “Pulmonary rehabilitation programs, involving at least 4–6 weeks of exercise training with or without education, have been shown to improve functional exercise capacity and quality of life, and to reduce dyspnea and hospital length of stay. These benefits have been shown to last for up to 9 months, however, the benefits appear to decline by 12 months.”
They add: “Recently, there has been increased interest in ways to maintain exercise capacity and quality of life following pulmonary rehabilitation.”
To compare the effectiveness of two approaches for maintaining such benefits, the researchers recruited 59 patients with moderate COPD who had completed an 8-week pulmonary rehabilitation program.
The participants were randomly assigned to weekly, supervised, exercise plus unsupervised home exercise (intervention group) or unsupervised home exercise alone (control group) and were followed-up for 12 months.
Patients in the intervention group performed supervised, outpatient-based exercise, including walking, cycling, and upper and lower limb strength training, 1 day per week plus unsupervised home exercise on four other days. Patients in the control group were encouraged to exercise 5 days per week. Both groups received a home exercise booklet and diary.
At baseline (after completion of pulmonary rehabilitation) all patients showed significant improvements in mean 6-minute walk test (6MWT) distance and St George's Respiratory Questionnaire (SGRQ) scores.
Twelve months after randomization, 6MWT distance had fallen by a non-significant 11 m in the intervention group and by a non-significant 6 m in the control group. Scores on the SGRQ had worsened by a nonsignificant 3 points in the intervention group and improved by a nonsignificant -3 points in the control group at 12 months.
The differences between the two groups regarding changes in 6MWT distance and SGRQ at 12 months were nonsignificant, the researchers note.
Spencer and team conclude: “Twelve months following pulmonary rehabilitation both weekly, supervised, outpatient-based exercise plus unsupervised home exercise and standard care of unsupervised home exercise successfully maintained 6-minute walk distance and quality of life in subjects with moderate COPD.”
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By Mark Cowen