Chest
Volume 144, Issue 4, October 2013, Pages 1124-1133
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Original Research
COPD
Systematic Review of Supervised Exercise Programs After Pulmonary Rehabilitation in Individuals With COPD

https://doi.org/10.1378/chest.12-2421Get rights and content

Background

The success of pulmonary rehabilitation (PR) is established, but how to sustain benefits over the long term is less clear. The aim of this systematic review was to determine the effect of supervised exercise programs after primary PR on exercise capacity and health-related quality of life (HRQL) in individuals with COPD.

Methods

Randomized controlled trials of postrehabilitation supervised exercise programs vs usual care for individuals with COPD were identified after searches of six databases and reference lists of appropriate studies. Two reviewers independently assessed study quality. Standardized mean differences (SMDs) with 95% CIs were calculated using a fixed-effect model for measures of exercise capacity and HRQL.

Results

Seven randomized controlled trials, with a total of 619 individuals with moderate to severe COPD, met the inclusion criteria. At 6-month follow-up there was a significant difference in exercise capacity in favor of the postrehabilitation interventions (SMD, −0.20; 95% CI, −0.39 to −0.01), which was not sustained at 12 months (SMD, −0.09; 95% CI, −0.29 to 0.11). There was no difference between postrehabilitation interventions and usual care with respect to HRQL at any time point.

Conclusions

Supervised exercise programs after primary PR appear to be more effective than usual care for preserving exercise capacity in the medium term but not in the long term. In this review, there was no effect on HRQL. The small number of studies precludes a definitive conclusion as to the impact of postrehabilitation exercise maintenance on longer-term benefits in individuals with COPD.

Section snippets

Materials and Methods

The methodology is consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.17

Search Results

Of a possible 463 studies, seven were included (Fig 1).13, 14, 15, 16, 19, 20, 21 Two studies reported different outcomes from the same trial.13, 20 In total, 619 individuals were randomized to postrehabilitation supervised exercise or usual care following PR. Table 1 shows the study characteristics. Patients were elderly (mean, 67 years of age) with moderate to severe COPD (mean FEV1 32%-59% predicted).

There was consistent agreement between reviewers for study quality. All studies were judged

Discussion

This meta-analysis suggests that post-PR supervised exercise programs are superior to usual care for sustaining benefits in exercise capacity in the medium term for patients with moderate to severe COPD. However, this effect was not sustained at 12 months, and no between-group differences for HRQL were noted at any time. Our results should be interpreted with caution given the heterogeneity in interventions, follow-up intervals, and outcome measures.

Several factors may have accounted for the

Conclusions

The seven studies included in this review suggest that supervised postrehabilitation exercise conferred a medium-term benefit (6 months) in exercise capacity that was not sustained at 12 months in patients with moderate to severe COPD. No between-group differences in HRQL were noted at any time. Reaching more definitive conclusions is limited by the small number of studies and their methodologic shortcomings. The optimal postrehabilitation maintenance exercise program for individuals with COPD

Acknowledgments

Author contributions: Dr Brooks had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr. Beauchamp: contributed to the concept and design of the study; data acquisition, analysis, and interpretation; and drafting and revision of the manuscript.

Dr. Evans: contributed to the concept and design of the study, data acquisition and interpretation, and revision of the manuscript.

Dr. Janaudis-Ferreira: contributed

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    For editorial comment see page 1091

    Funding/Support: Dr Beauchamp is supported by a fellowship from the Canadian Institutes of Health Research, Dr Evans by a UK National Institute for Health Research clinical lectureship, Dr Goldstein by the National Sanitarium Association University of Toronto Chair in Respiratory Rehabilitation Research, and Dr Brooks by a Canada Research Chair.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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