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Original Research: COPD |

Systematic Review of Supervised Exercise Programs After Pulmonary Rehabilitation in Individuals With COPDMaintenance Exercise Review

Marla K. Beauchamp, PhD, PT; Rachael Evans, MD; Tania Janaudis-Ferreira, PhD; Roger S. Goldstein, MD, FCCP; Dina Brooks, PhD
Author and Funding Information

From the Department of Physical Medicine and Rehabilitation (Dr Beauchamp), Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA; Respiratory Medicine (Drs Beauchamp, Evans, Janaudis-Ferreira, Goldstein, and Brooks), West Park Healthcare Centre, Toronto, ON, Canada; St. John’s Rehab Research Program (Dr Janaudis-Ferreira), Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; the Department of Physical Therapy (Drs Goldstein and Brooks) and the Department of Medicine (Drs Evans and Goldstein), University of Toronto, Toronto, ON, Canada; and the Department of Infection, Immunity and Inflammation (Dr Evans), University of Leicester, Leicester, England.

Correspondence to: Dina Brooks, PhD, Department of Physical Therapy, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada; e-mail: dina.brooks@utoronto.ca


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.


Chest. 2013;144(4):1124-1133. doi:10.1378/chest.12-2421
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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.

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