Maintaining exercise capacity and quality of life following pulmonary rehabilitation

Objective: 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. Methods: 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. Results: 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) FEV1% 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 in (15.7-66.5)), distance walked in 20 min (195.1 in (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. Conclusion: 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.