Comparison of outpatient and home‐based exercise training programmes for COPD: A systematic review and meta‐analysis

Abstract

Chronic obstructive pulmonary disease is a common, preventable and treatable disease. Exercise training programmes (ETPs) improve symptoms, health-related quality of life (HRQoL) and exercise capacity, but the optimal setting is unknown. In this review, we compared the effects of ETPs in different settings on HRQoL and exercise capacity. We searched (5 July 2016) the Cochrane Airways Group Specialised Register, ClinicalTrials.gov and World Health Organization trials portal. We selected studies, extracted data and assessed risk of bias with two independent reviewers. We calculated mean differences (MD) with 95% CI. We assessed the quality of evidence using Grades of Recommendation, Assessment, Development and Evaluation. Ten trials (934 participants) were included. Hospital (outpatient) and home-based ETPs (seven trials) were equally effective at improving HRQoL on the Chronic Respiratory Questionnaire (CRQ) (dyspnoea: MD −0.09, 95% CI: −0.28 to 0.10; fatigue: MD −0.00, 95% CI: −0.18 to 0.17; emotional: MD 0.10, 95% CI: −0.24 to 0.45; and mastery: MD −0.02, 95% CI: −0.28 to 0.25; moderate quality) and on the St George's Respiratory Questionnaire (SGRQ) (MD −0.82, 95% CI: −7.47 to 5.83, low quality). Hospital (outpatient) and community-based ETPs (three trials) were equally effective at improving HRQoL (CRQ dyspnoea: MD 0.29, 95% CI: −0.05 to 0.62, moderate quality; fatigue: MD −0.02, 95% CI: −1.09 to 1.05, low quality; emotional: MD 0.10, 95% CI: −0.40 to 0.59, moderate quality; and mastery: MD −0.08, 95% CI: −0.45 to 0.28, moderate quality). There was no difference in exercise capacity. There was low to moderate evidence that outpatient and home-based ETPs are equally effective.

Advances in rehabilitation for chronic diseases: improving health outcomes and function

“…Using technology to deliver an exercise program to patients in their own homes increases access but may do so at the expense of delivering a “watered down” and less effective form of rehabilitation. A recent meta-analysis of 10 clinical trials that compared facility based and home based programs showed similar improvements in HRQL and exercise capacity 92. An additional clinical trial randomized 287 participants with COPD who were referred for pulmonary rehabilitation to either traditional facility based rehabilitation or a structured unsupervised home based exercise program with outpatient and telephone delivered behavioral counseling.…”

Respiratory Muscle Training Improves Speech and Pulmonary Function in COPD Patients in a Home Health Setting - a Pilot Study

“…Home-based exercise regimes offer a valuable alternative, and have proven to be as effective as hospital-based or outpatient pulmonary rehabilitation [5][6][7] . Home-based COPD management interventions such as patient activation, active monitoring of adherence, care coordination and medical management reduce sedentary behavior and increase physical activity levels.…”

Organizational aspects of pulmonary rehabilitation in chronic respiratory diseases

“…Home‐based ‘pulmonary rehabilitation’ is emerging as a new format of pulmonary rehabilitation, which mostly consist of a home‐based exercise training programme (i.e. walking, stationary cycling and/or resistance exercises using body weight, resistance bands and/or water‐filled bottles), education by providing a self‐management manual and sometimes coaching using motivational interviewing.…”