Abstract
Background: Pulmonary rehabilitation (PR) is a highly effective intervention for individuals with chronic obstructive pulmonary disease (COPD). Physical activity (PA) has been shown to increase after a centre-based programme, yet it is not clear if a home-based programme can offer the same benefit. This study aimed to evaluate the effect of home-based PR compared with the centre-based PR on the PA levels post 7 weeks of PR and 6 months follow-up.Method: In this study, 51 participants with COPD, of them, 36 (71%) men completed physical activity monitoring with a SenseWear Armband, at three time points (baseline, 7 weeks, and 6 months). The participants were randomly assigned to either centre-based supervised PR (n = 25; 69 ± 6 years; FEV1 55 ± 20% predicted) or home-based PR (n = 26; 68 ± 7 years; FEV1 42 ± 19% predicted) programmes lasting 7 weeks. The home-based programme includes one hospital visit, a self-management manual, and two telephone calls. The PA was measured as step count, time in moderate PA (3–6 metabolic equivalent of tasks [METs]) in bouts of more than 10 min and sedentary time (<2 METs).Results: Home-based PR increased step count significantly more than the centre-based PR after 7 weeks (mean difference 1,463 steps: 95% CI 280–2,645, p = 0.02). There was no difference in time spent in moderate PA was observed (mean difference 62 min: 95% CI −56 to 248, p = 0.24). Sedentary behaviour was also significantly different between the centre and home-based groups. The home group spent 52 min less time sedentary compared with the centre-based (CI −106 to 2, p = 0.039). However, after 6 months, the step count and time spent in moderate PA returned to baseline in both the groups.Conclusion: This study provides an important insight into the role of home-based PR which has the potential to be offered as an alternative to the centre-based PR. Understanding who may best respond from the centre or home-based PR warrants further exploration and how to maintain these initial benefits for the long-term.Trial Registry: ISRCTN: No.: ISRCTN81189044; URL: isrctn.com.
Highlights
The international guidelines support the effectiveness of pulmonary rehabilitation (PR) in the treatment and management of patients with chronic obstructive pulmonary disease (COPD) [1]
We have previously described a non-inferiority randomised trial comparing home-based rehabilitation facilitated by a manual (SPACE for COPD) vs. centre-based PR [14]
At 6 months postintervention, there was no significant difference in change between the two groups, even though the homebased patients with PR had significantly increased time spent over 3 METs and reduced sedentary time whilst the centrebased patients with PR did not
Summary
The international guidelines support the effectiveness of pulmonary rehabilitation (PR) in the treatment and management of patients with chronic obstructive pulmonary disease (COPD) [1]. Despite PR being highly effective at improving exercise performance [6], it has limited effect on how much patients with PA daily perform [9]. Those studies which investigated PA post PR showed some improvement in the terms of step count, activity counts, and reduced sedentary time [10], whilst others did not find any significant difference [11]. Pulmonary rehabilitation (PR) is a highly effective intervention for individuals with chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the effect of home-based PR compared with the centre-based PR on the PA levels post 7 weeks of PR and 6 months follow-up
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