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Home-based exercise training as maintenance after outpatient pulmonary rehabilitation
du Moulin M, Taube K, Wegscheider K, Behnke M, van den Bussche H
Respiration 2009 Feb;77(2):139-145
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

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 to 72; FEV1 58.6%, 95% CI 53.8 to 63.4), and 10 patients served as controls (mean age 72 years, 95% CI 69 to 77; FEV1 62.5%, 95% CI 57.7 to 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.

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