Maintaining the benefits following pulmonary rehabilitation: Achievable or not?

Abstract

Pulmonary rehabilitation (PR) improves exercise capacity, health-related quality of life (HRQoL) and dyspnoea in patients with COPD and other lung conditions. Once PR is completed, the benefits gained begin to decline unless patients continue to exercise regularly. Due to limited evidence in other lung conditions, this review aims to examine the current evidence regarding maintenance exercise programmes for patients with COPD and to determine the types of programmes that are able to maintain the benefits gained from PR to 12 months and longer. A number of factors may affect the ability to maintain exercise capacity and HRQoL in the long term including: frequency of supervised maintenance exercise; strategies used to improve adherence to maintenance exercise; facilitators and barriers to long-term exercise training; and initial PR programme itself. The current evidence for maintenance exercise programmes that included supervised maintenance exercise was weak, and for those programmes that included unsupervised maintenance exercise (with and without support) were difficult to interpret and in many instances were no better than usual care. New research using technology has provided some promising results for the future and surveys have revealed important features that may help in the development of maintenance programmes from a participant perspective such as ongoing therapist support. How to best maintain the benefits gained from PR remains unclear. Therefore, it is likely that no one model of maintenance is ideal for all patients with COPD and that individually adapted maintenance exercise programmes need to be considered.

<p>Long-Term Effectiveness of a Home-Based Pulmonary Rehabilitation in Older People with Chronic Obstructive Pulmonary Disease: A Retrospective Study</p>

“…Long-term follow-up following PR is often poorly documented, with an average of less than 50% of participants evaluated 1 year after the PR. 47 In the present study, more than two thirds of the participants were evaluated at 1 year, regardless of the age, suggesting that older age does not specifically impact PR attendance. Eight weeks of home-based intervention follows by one visit 6 months after (M8), seems to facilitate the adherence and maintaining PR benefits up to 1 year after the programme.…”

Maintaining quality of life in patients with chronic obstructive pulmonary disease (COPD) by extending the maintenance phase of community-based pulmonary rehabilitation: protocol for a randomised controlled trial (ComEx3 Study)

“…A meta-analysis of five trials of 445 participants with COPD showed that individuals allocated to a supervised maintenance exercise programme experienced fewer respiratory-cause admissions (risk ratio 0.62; CI 0.47 to 0.81; p<0.001)7 compared with those receiving usual care; however, this finding was heavily influenced by one trial8 that provided the longest programme duration (3 years) of supervised maintenance. The optimal strategy for maintaining the initial benefits from pulmonary rehabilitation remains unclear with the authors of the Australia and New Zealand Pulmonary Rehabilitation Clinical Practice Guidelines calling for further research and economic evaluation of a weekly supervised maintenance programme 4 9. An economic evaluation of a single 2-hour maintenance pulmonary rehabilitation session at 3, 6 and 9 months after the initial programme has shown it to be cost-effective 10.…”

Reducing hospital readmissions for COPD exacerbations: The role of exercise and ongoing support

“…Previous studies have evaluated the effects of ongoing support after PR on the maintenance of benefits and are included in a recent review paper. 11 Most studies used a combination of interventions including pedometers, phone calls and/or supervised exercise at a reduced frequency than in the initial PR programme. A systematic review with meta-analyses 12 demonstrated a significant reduction in the risk of experiencing at least one hospital admission for a respiratory cause in those receiving a supervised maintenance exercise programme compared to usual care (risk ratio: 0.62 (95% CI: 0.47-0.81), n = 278).…”