BACKGROUND: Although the benefits of comprehensive pulmonary rehabilitation have been demonstrated in patients with COPD, the effects of exercise sessions within self-management programs remain unclear. We hypothesized that 8 supervised exercise sessions incorporated in a 1-month self-management education program in COPD patients would be effective to improve health outcomes and to reduce direct medical costs after one year, compared to usual care. METHODS: In this randomized controlled trial, 38 moderate-to-severe COPD patients were assigned either to an intervention group or to a usual care group. The hospital-based intervention program provided a combination of 8 sessions of supervised exercise with 8 self-management education sessions over a 1-month period. The primary end-point was the 6-min walking distance (6MWD), with secondary outcomes being health-related quality of life (HRQoL) -- using the St George's Respiratory Questionnaire (SGRQ) and Nottingham Health Profile (NHP), maximal exercise capacity and healthcare utilization. Data were collected before and one year after the program. RESULTS: After 12 months, we found statistically significant between-group differences in favor of the intervention group in 6MWD (+50.5m (95%CI 2 to 99)), in two domains of NHP (energy -19.8 (-38 to -1); emotional reaction -10.4 (-20 to 0)); in SGRQ-symptoms (-14.0 (-23 to -5)), and in cost of COPD medication (-480.7 Euro (CI -891 to -70) per patient per year). CONCLUSION: The present hospital-based intervention combining supervised exercise with self-management education provides significant improvements in patient's exercise tolerance and HRQoL, and significant decrease of COPD medication costs, compared to usual care.

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