Background

Most patients with COPD do not maintain exercise training after pulmonary rehabilitation (PR).

Research Question

Does a 12-month home-based, minimal-equipment strength training program after PR have an effect on dyspnea, exercise capacity, and patient-reported outcomes in patients with COPD?

Study Design and Methods

In a parallel-arm multicenter study across four Swiss PR clinics, patients with COPD were allocated randomly (1:1 ratio) into an intervention group (IG; home-based strength training program) or control group (CG; usual care). The primary outcome was change in Chronic Respiratory Questionnaire (CRQ) dyspnea scale score from baseline to 12 months. Secondary outcomes were change in exercise capacity (1-min sit-to-stand-test [1MSTST], 6-min walk test [6MWT]), health-related quality of life, exacerbations, and symptoms. We assessed the IG’s experience by interviews at study end. Main analyses were based on the intention-to-treat approach, and adjusted linear regression models were used.

Results

One hundred twenty-three patients with COPD (IG, n = 61; CG, n = 62) were randomized, 61 of whom were women and whose mean ± SD age was 66.8 ± 8.1 years and mean ± SD FEV₁ was 39.3 ± 15.3% predicted. One hundred four participants completed 12 months of follow-up (IG, n= 53; CG, n= 51). Of the 53 IG participants, 37 participants (70%) conducted the training until study end. We found no difference in change in CRQ dyspnea scale score over 12 months (adjusted mean difference, 0.28; 95% CI, –0.23 to 0.80; P = .27). We found moderate evidence for a difference in 1MSTST repetitions favoring the IG (adjusted mean difference, 2.6; 95% CI, 0.22-5.03; P = .033), but no evidence for an effect in other outcomes. Seventy-nine percent of the IG reported positive effects that they attributed to the training.

Interpretation

The home exercise program had no effect on dyspnea, but improved 1MSTST performance and patient-perceived fitness. The supported program was well accepted by patients with COPD and may facilitate continued exercise training at home.

Trial Registry

ClinicalTrials.gov; No.: NCT03461887; URL: www.clinicaltrials.gov

中文翻译：

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慢性阻塞性肺病患者肺康复后长期居家运动训练计划的有效性

背景

大多数 COPD 患者在肺康复 (PR) 后不会继续进行运动训练。

研究问题

PR 后为期 12 个月的以家庭为基础的最少设备力量训练计划是否对 COPD 患者的呼吸困难、运动能力和患者报告的结果有影响？

研究设计和方法

在一项跨越四个瑞士 PR 诊所的平行臂多中心研究中，COPD 患者被随机（1:1 的比例）分配到干预组（IG；家庭力量训练计划）或对照组（CG；常规护理）。主要结果是慢性呼吸问卷 (CRQ) 呼吸困难量表评分从基线到 12 个月的变化。次要结果是运动能力的变化（1 分钟坐立测试 [1MSTST]、6 分钟步行测试 [6MWT]）、与健康相关的生活质量、恶化和症状。我们在研究结束时通过访谈评估了 IG 的经验。主要分析基于意向治疗方法，并使用调整后的线性回归模型。

结果

123 名 COPD 患者（IG，n = 61；CG，​​n = 62）被随机分配，其中 61 名女性，平均年龄 ± SD 为 66.8 ± 8.1 岁，平均 ± SD FEV ₁为 39.3 ± 15.3 ％ 预料到的。104 名参与者完成了 12 个月的随访（IG，n=53；CG，n=51）。在 53 名 IG 参与者中，37 名参与者 (70%) 进行了培训直至研究结束。我们发现 CRQ 呼吸困难量表评分在 12 个月内的变化没有差异（调整后的平均差异为 0.28；95% CI，–0.23 至 0.80；P  = .27）。我们发现有利于 IG 的 1MSTST 重复次数差异的适度证据（调整后的平均差异，2.6；95% CI，0.22-5.03；P = .033)，但没有证据表明对其他结果有影响。79% 的 IG 报告了他们认为培训带来的积极影响。

解释

家庭锻炼计划对呼吸困难没有影响，但改善了 1MSTST 表现和患者对健康的感知。支持的项目被 COPD 患者很好地接受，并可能有助于在家中继续进行运动训练。

试用注册表

临床试验.gov；编号：NCT03461887；网址：www.clinicaltrials.gov