Clinical benefits of a combined hospital and home-based exercise programme over 18 months in patients with severe COPD.

BACKGROUND

Long-term exercise training is capable of improving exercise performance and quality of life in patients with severe COPD. In the present study we examined the effects of an 18-month home-based training on the rate of hospital admissions and bronchodilator use as primary end-points. Secondary end-points were exercise capacity and quality of life.

METHODS

The study comprised 26 patients with severe COPD (20m/6f; mean +/- SD FEV1, 37 +/- 6% pred) who were recruited in a previous trial and randomised into a training (n = 14) and a control group (n = 12). After initial recovery from an exacerbation the training group had performed a 10-day walking training in the hospital. This was followed by 18 months of individually defined, supervised training at home that was integrated into the patients' daily activities. The control group had no exercise programme, neither in hospital nor at home.

RESULTS

During the 18-month period patients of the training group showed a lower number of hospital admissions (total, n = 3 vs n = 14, p = 0.026; disease-related, n = 3 vs n = 12, p = 0.050) and used less short-acting beta 2-agonists (mean [95% CI], 2.4 [1.4-3.4] vs 5.7 [4.2-7.2] puffs per day; p < 0.001) than the control group. Furthermore, the improvements in 6-min treadmill distance and quality of life (CRQ) achieved in the hospital were fully maintained in the training group, whereas the control group did not show significant improvements at any time but a tendency toward deterioration.

CONCLUSIONS

Our data indicate that an individually defined, home-based, long-term walking programme initiated by a short hospital-based training can reduce disease-related medical consumption, in addition to sustained benefits in exercise performance and quality of life.