A novel approach to long-term respiratory care: Results of a community-based post-rehabilitation maintenance program in COPD

BACKGROUND: Although the short-term benefits of pulmonary rehabilitation (PR) are well established, improvements in exercise tolerance and health status diminish over time. The objectives of this study were to determine the feasibility and within-subject effects of a 1-year community-based maintenance exercise program for patients with COPD following completion of hospital-based PR. METHODS: A single-arm longitudinal study was undertaken. After completion of PR, consecutive patients with COPD were recruited to attend a twice weekly exercise program supervised by fitness consultants at a local community centre. The transition from hospital to the community was facilitated by a case manager. Outcome measurements at baseline (pre-PR), post-PR, 6-months and 1-year included the 6-minute walk test (6MWT) for exercise capacity and the Chronic Respiratory Questionnaire (CRQ) for health-related quality of life. Feasibility was assessed primarily through subject adherence. RESULTS: A total of 29 patients (mean age 66.8 ± 7.8 years, mean FEV1 45.1 ± 18.8 percent predicted) were enrolled in the program. Mean compliance to twice weekly exercise was 70%. No adverse events were reported. Statistically significant and clinically important improvements in the 6MWT and CRQ total and dyspnea domain were observed at 6-months and 1-year after PR compared to baseline (all p < 0.01). CONCLUSIONS: A community-based maintenance exercise program is feasible and can successfully preserve exercise capacity and health-related quality of life following institutionally-based PR in patients with moderate to severe COPD. A more formal evaluation of this approach is warranted.