BACKGROUND: The success of pulmonary rehabilitation (PR) is established, but how to sustain benefits over the long-term is less clear. The aim of this systematic review was to determine the effect of supervised exercise programs after primary PR on exercise capacity and health-related quality of life (HRQL) in individuals with COPD. METHODS: Randomized controlled trials (RCTs) of post-rehabilitation supervised exercise programs versus usual care for individuals with COPD were identified after searches of six databases and reference lists of appropriate studies. Two reviewers independently assessed study quality. Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated using a fixed-effect model for measures of exercise capacity and HRQL. RESULTS: Seven RCTs, with a total of 619 individuals with moderate to severe COPD, met the inclusion criteria. At 6-months follow-up there was a significant difference in exercise capacity in favor of the post-rehabilitation interventions (SMD -0.20, 95%CI -0.39 to -0.01), which was not sustained at 12 months (SMD -0.09 95%CI -0.29 to 0.11). There was no difference between post-rehabilitation interventions and usual care with respect to HRQL at any time-point. CONCLUSIONS: Supervised exercise programs after primary PR appear to be more effective than usual care for preserving exercise capacity in the medium-term but not the long-term. In this review, there was no effect on HRQL. The small number of studies precludes a definitive conclusion as to the impact of post rehabilitation exercise maintenance on longer term benefits in individuals with COPD.

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