OBJECTIVE: To compare the effects of comprehensive pulmonary rehabilitation with those of education alone on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease. DESIGN: Randomized clinical trial. SETTING: University medical center. PATIENTS: 119 outpatients with chronic obstructive pulmonary disease that was stable while patients received a standard medical regimen. INTERVENTION: Patients were randomly assigned to either an 8-week comprehensive pulmonary rehabilitation program or to an 8-week education program. Pulmonary rehabilitation consisted of twelve 4-hour sessions that included education, physical and respiratory care instruction, psychosocial support, and supervised exercise training. Monthly reinforcement sessions were held for 1 year. The education group attended four 2-hour sessions that included video-tapes, lectures, and discussions but not individual instruction or exercise training. MEASUREMENTS: Pulmonary function, maximum exercise tolerance and endurance, gas exchange, symptoms of perceived breathlessness and muscle fatigue with exercise, shortness of breath, self-efficacy for walking, depression, general quality of well-being, and hospitalizations associated with pulmonary diseases. Patients were followed for 6 years. RESULTS: Compared with education alone, comprehensive pulmonary rehabilitation produced a significantly greater increase in maximal exercise tolerance (+1.5 metabolic equivalents (METS) compared with +0.6 METS (p < 0.001); maximal oxygen uptake, +0.11 L/min compared with +0.03 L/min (p = 0.06)), exercise endurance (+10.5 minutes compared with +1.3 minutes (p < 0.001)), symptoms of perceived breathlessness (score of -1.5 compared with +0.2 (p < 0.001)) and muscle fatigue (score of -1.4 compared with -0.2 (p < 0.01)), shortness of breath (score of -7.0 compared with +0.6 (p < 0.01)), and self-efficacy for walking (score of +1.4 compared with +0.1 (p < 0.05)). There were slight but nonsignificant differences in survival (67% compared with 56% (p = 0.32)) and duration of hospital stay (-2.4 days/patient per year compared with +1.3 days/patient per year (p = 0.20)). Measures of lung function, depression, and general quality of life did not differ between groups. Differences tended to diminish after 1 year of follow-up. CONCLUSIONS: Comprehensive pulmonary rehabilitation significantly improved exercise performance and symptoms for patients with moderate to severe chronic obstructive pulmonary disease. Benefits were partially maintained for at least 1 year and tended to diminish after that time.

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