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Randomized controlled trial of community-based, post-rehabilitation exercise in COPD - 18/11/20

Doi : 10.1016/j.rmed.2020.106195 
Stacey J. Butler a, b, , Laura Desveaux a, Annemarie L. Lee a, d, Marla K. Beauchamp a, e, Natasha K. Brusco f, Wei Wang g, h, Roger S. Goldstein a, b, c, Dina Brooks a, c, e
a Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada 
b Department of Medicine, University of Toronto, Toronto, Ontario, Canada 
c Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada 
d Department of Physiotherapy, Monash University, Frankston, Victoria, Australia 
e School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada 
f Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Victoria, Australia 
g Cabrini Health, Malvern, Victoria, Australia 
h School of Public Health and Preventive Medicine, Monash University, Australia 

Corresponding author. Stacey Butler, West Park Healthcare Centre, 82 Buttonwood Avenue, Toronto, Ontario, M6M 2J5, Canada.Stacey ButlerWest Park Healthcare Centre82 Buttonwood AvenueTorontoOntarioM6M 2J5Canada

Abstract

Purpose

Although pulmonary rehabilitation (PR) improves function in people with chronic obstructive pulmonary disease (COPD), a community-based exercise program may be necessary to maintain functional capacity. We aimed to determine the effectiveness of a post-rehabilitation, community-based maintenance program on exercise tolerance, functional capacity and quality of life.

Methods

Patients with COPD who completed PR were randomized to receive a community-based maintenance program (intervention) or usual care (control). The primary outcome was 6-min walk distance (6MWD), measured immediately post-PR, 6 months and 12 months later. Secondary outcomes included self-reported functional capacity, health-related quality of life, self-efficacy, program cost, and lower extremity muscle strength.

Results

Ninety-seven patients (69 ± 9 years) were enrolled. There was a non-significant trend of an intervention effect on 6MWD over time (β = 42, 95% CI: 0.06 to 83.93, p = 0.053). There was no significant impact of group on any of the secondary outcomes. Restricting the analysis to those who attended ≥50% of the exercise sessions showed a significant intervention effect for 6MWD (β = 69.19, 95% CI = 10.16 to 128.22, p = 0.03). The cost of participating in the community maintenance program for the intervention group was $374.77 (SD 142.12) and membership renewal was highest at community centres offering twice weekly, supervised exercise classes.

Conclusions

A post rehabilitation, community-based exercise program, will maintain exercise capacity in people with COPD who attend at least 50% of available sessions over one year. An increased focus on factors that determine adherence would help inform improvements in maintenance program design.

Il testo completo di questo articolo è disponibile in PDF.

Highlights

Benefits from pulmonary rehabilitation are not sustained over the long-term.
Maintenance exercise programs could prolong benefits from pulmonary rehabilitation.
Adherence to community based programs is essential to maintain exercise capacity.

Il testo completo di questo articolo è disponibile in PDF.

Keywords : COPD, Community, Exercise

Abbreviations : PR, COPD, 6MWD, FEV1, HRQoL, 6MWT, ATS, DASI, CRQ, CSES, CPI, NPV, ICER, HUI, MRC, FEV1, QALYs, MID


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