Short and long-term effects of ambulatory rehabilitation in patients with COPD: a randomized study

05-07-2018
Long-term rehabilitation programs are effective in patients with severe Chronic Obstructive Pulmonary Disease (COPD), however the long-term effects are unknown. This study examined the short-term and long-term effects of a 6-month rehabilitation program for patients with severe COPD.
One hundred patients were randomly assigned to follow a rehabilitation program consisting of cycling, walking and strength training (n = 50) or usual medical care (n = 50). Thirty-four patients in the rehabilitation group were evaluated after 6 months (end of the intervention), and 26 were evaluated after 18 months of follow-up. In the control group, 28 patients were evaluated at 6 months and 23 at 18 months. The outcome measures are lung function, 6 minutes walking distance, maximum exercise capacity, peripheral and respiratory muscle strength and quality of life (on a scale of 20 to 140 points). An estimate was also made of the cost-effectiveness of the program.

After 6 months the rehabilitation session improved for the 6 minutes walking distance [average difference (training check) of 52 meters; 95% confidence interval (CI), 15 to 89 m], maximum workload (12 W, 95% CI, 6 to 19 W), maximum oxygen uptake (0.26 liters / min, 95% CI, 0.07 to 0.45 liters / min.)), quadriceps force (18 Nm, 95% CI, 7 to 29 Nm), inspiratory muscle strength (11 cm H (2) O; 95% CI, 3 to 20 cm H (2) O), and quality of life (14 points, 95% CI, 6 to 21 points, all P <0.05). After 18 months these differences persisted (P <0.05), except inspiratory muscle strength. Within 6 minutes walking distance and quality of life, the differences between the rehabilitation group and checks after 18 months exceeded the minimum clinically important difference. In patients who completed the 6-month rehabilitation program, significant and clinically relevant changes resulted in 6 minutes walking distance, maximum training performance, peripheral and respiratory muscle strength and quality of life. Most of these effects lasted 18 months after starting the program.

The American Journal of Medicine 109(3):207-12 · August 2000. M. Decramer et al.

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