BACKGROUND: The short-term efficacy of pulmonary rehabilitation (PR) in patients with chronic obstructive pulmonary disease (COPD) has been established. Although continuous follow-up and sustained exercise training is important to maintain the effects, the long-term efficacy of PR without frequent supervised training remains unclear. The aim of this meta-analysis was to investigate the long-term efficacy of PR with home-based or low frequent maintenance program on exercise capacity and health related quality of life (HRQOL) in patients with COPD. METHODS: We identified randomized controlled trials (RCTs) comparing long-term efficacy of PR with home-based or low frequent maintenance and no maintenance program from PubMed and the Cochrane Library. Primary outcomes were exercise capacity (6-minute walking distance (6MWD), incremental shuttle walking test (ISWT)) and HRQOL (St George's Respiratory Questionnaire (SGRQ)). Outcomes were combined using a random-effects model. This study is registered with PROSPERO, number CRD42019109718. RESULTS: Seven RCTs with a total of 492 patients with COPD met the inclusion criteria. PR with maintenance significantly improved 6MWD (mean difference (MD) 27.00; 95% CI 1.04 to 52.96; p = 0.01) and ISWT (MD 44.48; 95% CI 30.70 to 58.25; p < 0.01), however no statistical evidence of improvement in HRQOL (MD -1.32; 95% CI -7.71 to 5.08, p = 0.69) was observed. CONCLUSIONS: PR with maintenance programs appears to be more effective than without maintenance for preserving exercise capacity in the long-term in patients with COPD. No long-term efficacy on HRQOL were noted. To maintain the efficacy of PR on exercise capacity and HRQOL over a long duration, it might be necessary to reexamine the contents and frequency of maintenance programs.

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