COPD

Home based pulmonary rehab not as effective as supervised programs


Home-based pulmonary rehab exercise programs are less effective than supervised outpatient programs for COPD patients, a study from the UK has shown.

While producing some perceived benefit for patients, home-based exercise fell short in the primary outcome of exercise capacity.

The findings come from a study involving  154 patients with COPD who did an 8-week home-based exercise program or a supervised pulmonary rehab organised along the standard outpatient model in settings such as gyms and community halls.

The home-based pulmonary rehab was a structured programme with weekly telephone follow-up that included individually tailored exercise at least 3 days per week, as well as educational material. Aerobic exercise such as walking was encouraged  along with upper and lower limb resistance training.

On completion of the program, both groups achieved significant improvements in exercise capacity, but the home-based group had smaller increases (59m vs 29m incremental shuttle walk distance).

More than half (54%) of the standard outpatient rehab group achieved the minimum clinically important difference of the exercise capacity, compared with 34% in the home-based group.

Similarly, for self-reported perception of the intervention effect, 53% of patients in the standard group reported feeling ‘much better’ in contrast to 37% of the home-based group. Nevertheless, in the home-based group 83% of patients reported feeling ‘much’ or ‘a little better’ following intervention.

Both groups had similar improvement in secondary outcomes of dyspnoea and  fatigue. Completion rates were modest in both groups:  64% for the supervised program and 56% for the home exercise program.

Writing in Thorax, the UK researchers said their findings showed that real world outcomes were better with traditional pulmonary rehab.

“We propose that supervised pulmonary rehabilitation (PR) remains the standard of care, with home-based exercise a less effective alternative for those unable to attend PR,” they concluded.

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