Maintaining exercise capacity and quality of life following pulmonary rehabilitation

The optimum method for sustaining the benefits gained from pulmonary rehabilitation (PR) has not been determined. In this report the authors describe the 4-year referral and uptake patterns to a hospital-based outpatient PR programme, and the sustained benefits of PR in patients with COPD attending a community-based maintenance exercise programme.

Entry and exit data were mapped for all patients referred to the PR service over the review period. All eligible patients were offered a community-based maintenance exercise programme upon completion of PR. A total of 21 patients underwent follow-up assessment of functional exercise capacity, quality of life (QOL) and health-care utilization.

Over a 4-year period, 467 patients (80% with COPD) were referred to the programme, of whom 230 entered PR. In total, 172 patients completed PR, with attrition (25%) being mostly due to medical problems. Of the 84 patients who elected for the community-based programme, 46 were still attending at follow up and 21 patients with moderate-to-severe COPD (44.9 +/- 12.6 (mean +/- SD) FEV(1)% predicted) were reassessed at 18.4 +/- 11.9 months post PR. Significant improvements (mean change (95% confidence interval)) persisted in 6-min walk distance (41.1 m (15.7-66.5)), distance walked in 20 min (195.1 m (82.3-308)) and in QOL (Chronic Respiratory Disease Questionnaire) (11.0 points (4.4-17.6)) (P < 0.01). The QOL improvements exceeded the minimum clinically important difference. A trend towards a reduction in COPD-related hospital admissions, bed-days and emergency department presentations was observed in the 12 months following PR. Self-reported adherence with the home exercise programme indicated that 67% of patients were exercising at least 3-5 days each week in addition to attending a class.

For patients with moderate-to-severe COPD, a weekly community-based maintenance exercise class, supervised by a physiotherapist, combined with a home exercise programme is an effective intervention for maintaining improvements following PR.