Study objectives: To answer the following
questions: in patients with chronic airway obstruction (CAO), (1) can
pulmonary rehabilitation lead to similar short-term gains at
successive, yearly interventions, and (2) is there any real clinical or
physiologic long-term benefit by yearly repetition of pulmonary
rehabilitation programs (PRPs)?
controlled clinical study.
Patients: Sixty-one CAO
patients studied 1 year after completing an initial 8-week outpatient
Intervention: Patients were randomly
classified into two groups. A second PRP (PRP2) was completed by the
first group (group 1) but not by the second group (group 2). One year
later, a third PRP (PRP3) was performed by both groups.
Measurements: Lung function, cycloergometry, walking test,
dyspnea, and health-related quality of life (HRQL) were assessed before
and after PRP2, and before and after PRP3. The numbers of
hospitalizations and exacerbations over the year were also
Results: Complete data sets were obtained
from 36 patients (17 patients in group 1 and 19 patients in group 2).
The two groups did not differ in any parameter either before PRP1,
after PRP1, or at randomization. There was no significant change over
time for airway obstruction in either group. After PRP2, exercise
tolerance, dyspnea, and HRQL improved in group 1. Nevertheless, 1 year
later, patients of group 1 did not differ from patients of group 2 in
any outcome parameter, such that in comparison to before PRP1, only
HRQL was still better in both groups 24 months after PRP1. Yearly
hospitalizations and exacerbations per patient significantly decreased
in both groups in the 2 years following PRP1, when compared to the 2
years prior. Nevertheless, at the 24-month follow-up visit, a further
reduction in yearly exacerbations was observed only in group 1 but not
in group 2 in comparison to what was observed at the 12-month follow-up
visit. The PRP3 resulted in improvement in exercise tolerance in both
Conclusion: In patients with CAO, an
outpatient PRP can achieve benefits in HRQL and a decreased number of
hospitalizations, which persist for a period of 2 years.
Successive, yearly interventions lead to similar short-term gains but
do not result in additive long-term physiologic benefits. Further
reduction in yearly exacerbations seems to be the main benefit of an