The long-term effects of pulmonary rehabilitation in patients with asthma and chronic obstructive pulmonary disease: A research synthesis

Objective: To present a critical review and meta-analysis of studies evaluating the long-term effects of pulmonary rehabilitation in patients with asthma and chronic obstructive pulmonary disease (COPD). Data Sources: A database of articles published over the last 45 years, compiled by using medical subject heading key words pulmonary, obstructive, rehabilitation, and exercise. Articles not written in English, Dutch, or German and abstracts were excluded. Study Selection: Selected studies (1) evaluated the effects of pulmonary rehabilitation, (2) included patients with asthma or COPD older than 18 years, (3) evaluated outcome measures of exercise capacity or health related quality of life (HRQL), and (4) included a control condition lacking exercise training. Data Extraction: Independent extraction by two reviewers. Data Synthesis: For each outcome, summary effects were computed by pooling standardized mean differences as well as raw mean differences. Significant improvements were found for all outcomes (p < .001). Sensitivity analyses for methodological quality of the selected studies did not change summary effect sizes. Effect sizes were significantly heterogeneous for the outcome endurance time (p < .0001). Pooling raw mean differences revealed overall effects in 6-minute walking distance (49 +/- 26m) and all 4 dimensions of the chronic respiratory questionnaire (range, 0.5 +/- 0.3 to 0.8 +/- 0.3 points), indicating substantial improvements in these outcomes. Significant summary effect sizes were found up to g months after finishing rehabilitation for maximal exercise capacity (p < .003) and 6-minute walking distance (p < .005). Conclusions: Patients with asthma and COPD benefit from pulmonary rehabilitation. (C) 1999 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.