Purpose

Although pulmonary rehabilitation (PR) improves function in people with chronic obstructive pulmonary disease (COPD), a community-based exercise program may be necessary to maintain functional capacity. We aimed to determine the effectiveness of a post-rehabilitation, community-based maintenance program on exercise tolerance, functional capacity and quality of life.

Methods

Patients with COPD who completed PR were randomized to receive a community-based maintenance program (intervention) or usual care (control). The primary outcome was 6-min walk distance (6MWD), measured immediately post-PR, 6 months and 12 months later. Secondary outcomes included self-reported functional capacity, health-related quality of life, self-efficacy, program cost, and lower extremity muscle strength.

Results

Ninety-seven patients (69 ± 9 years) were enrolled. There was a non-significant trend of an intervention effect on 6MWD over time (β = 42, 95% CI: 0.06 to 83.93, p = 0.053). There was no significant impact of group on any of the secondary outcomes. Restricting the analysis to those who attended ≥50% of the exercise sessions showed a significant intervention effect for 6MWD (β = 69.19, 95% CI = 10.16 to 128.22, p = 0.03). The cost of participating in the community maintenance program for the intervention group was $374.77 (SD 142.12) and membership renewal was highest at community centres offering twice weekly, supervised exercise classes.

Conclusions

A post rehabilitation, community-based exercise program, will maintain exercise capacity in people with COPD who attend at least 50% of available sessions over one year. An increased focus on factors that determine adherence would help inform improvements in maintenance program design.

中文翻译：

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COPD社区康复后运动的随机对照试验

目的

尽管肺康复（PR）改善了慢性阻塞性肺疾病（COPD）患者的功能，但基于社区的锻炼计划对于维持功能能力可能是必要的。我们旨在确定康复后，基于社区的运动耐力，功能能力和生活质量维护计划的有效性。

方法

完成PR的COPD患者被随机分配接受社区维护计划（干预）或常规护理（对照）。主要结果是在PR后，6个月和12个月后立即测量的6分钟步行距离（6MWD）。次要结果包括自我报告的功能能力，与健康相关的生活质量，自我效能，计划成本和下肢肌肉力量。

结果

入选了97例患者（69±9岁）。随着时间的推移，对6MWD的干预效果没有显着趋势（β  = 42，95％CI：0.06至83.93，p = 0.053）。小组对任何次要结局均无明显影响。将分析限制在参加≥50％锻炼的人群中显示出对6MWD有显着干预作用（β  = 69.19，95％CI = 10.16至128.22，p = 0.03）。参加干预组的社区维护计划的费用为374.77美元（SD 142.12），而在每周两次接受监督的健身班的社区中心，会员资格更新最高。

结论

康复后的社区锻炼计划将维持COPD患者的运动能力，这些患者在一年中至少参加了50％的可用课程。更加关注确定遵守性的因素将有助于改进维护程序设计。