Home-Based Exercise Training as Maintenance after Outpatient Pulmonary Rehabilitation

Abstract

Background: Pulmonary rehabilitation is successful in improving exercise capacity and quality of life in patients with chronic obstructive pulmonary disease (COPD). However, training effects diminish over time. Objectives:We evaluated the effects of simple, daily, structured, self-monitored, home-based exercise training for patients with moderate COPD after a 3-week outpatient rehabilitation. Methods: We conducted a randomized, controlled, observer-blind trial. Twenty patients were recruited. Ten patients performed home-based exercise training (mean age 67 years, 95% confidence interval [CI] 63–72; FEV₁ 58.6%, 95% CI 53.8–63.4), and 10 patients served as controls (mean age 72 years, 95% CI 69–77; FEV₁ 62.5%, 95% CI 57.7–67.3). At baseline, and after 3 and 6 months, we assessed exercise capacity (6-min walk test, 6MWT, primary endpoint), health-related quality of life (Chronic Respiratory Questionnaire, CRQ) and lung function. An intention-to-treat analysis was performed using two-way ANOVA models for comparison of time trends between random groups. Results: The training group had better results than the control group in 6MWT (p = 0.033), in CRQ total (p = 0.027), CRQ dyspnea (p = 0.014) and CRQ fatigue (p = 0.016). Improvement in FEV₁ was also better in the intervention group than in the control group (p = 0.007). Conclusions: We demonstrated that training effects obtained from an outpatient rehabilitation program can be maintained by home-based exercise training in patients with moderate COPD.

Home or community-based pulmonary rehabilitation for individuals with chronic obstructive pulmonary disease: a systematic review and meta-analysis

“…Of these, 58 were considered potentially relevant and 23 studies 17,18,19,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50 met the eligibility criteria and were included in this review. One of the selected studies appeared in two distinct publications 49,50 in which the same intervention was applied to the same patients but describing different outcomes.…”

“…Thirteen studies were done in Europe 17,19,21,31,33,38,42,43,45,46,48,49,50 , six in Asia 30,36,39,40,44,47 , two in Australasia 34,35 , one in North America 41 , and one in South America 32 . Among the studies included in the review, 19 17,18,19,30,31,32,33,34,36,38,39,40,42,43,44,46,47,48,49,50 compared HCPR to control group (n = total 893; n HCPR = 485), while four 35,37,41,45 compared HCPR to OPR (n total = 375; n HCPR = 178). No studies reported harmful effects related to HCPR during interventions.…”

“…• Analysis 1: HCPR vs. control group (a) Functional Capacity and Dyspnea: Ten studies 30,31,33,36,40,44,46,47,48,50 (n = 461) assessed functional capacity with the 6MWT and seven used the ISWT 18,32,34,38,39,42,43 (n = 321). Four studies 19,38,43,48 (n = 280) evaluated dyspnea using the MRC.…”

“…Finally, there was a significant decrease in sensation of dyspnea assessed by MRC in HCPR compared to controls (-0.21, 95%CI: -0.42 to -0.00, I 2 = 0%) ( Figure 6). (b) Quality of Life: Thirteen studies 17,18,19,31,33,34,36,38,42,44,46,47,49 (n = 521) assessed quality of life with CRQ and four 18,30,39,48 (n = 281) with SGRQ. The meta-analysis showed that participants who received the intervention showed significant improvement in the four quality of life domains as- Figure 3 Graph on risk of bias for each selected study.…”

Efeitos de um treinamento resistido com tubos elásticos sobre a força muscular, qualidade de vida e dispneia de pacientes com doença pulmonar obstrutiva crônica

“…However, the behavior of these variables is not yet fully clarified for resistance training with the use of elastic tubing 24 .…”