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Published in: Respiratory Research 1/2012

Open Access 01-12-2012 | Research

Low intensity, long-term outpatient rehabilitation in COPD: a randomised controlled trial

Authors: Hans Jörg Baumann, Stefan Kluge, Katrin Rummel, Hans Klose, Jan K Hennigs, Tibor Schmoller, Andreas Meyer

Published in: Respiratory Research | Issue 1/2012

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Abstract

Background

Most pulmonary rehabilitation programmes currently involve 2–3 sessions per week as recommended by international guidelines. We aimed to investigate whether relevant improvements in physical capabilities and quality of life in patients with chronic obstructive pulmonary disease (COPD) could be achieved by a long-term, low intensity, once weekly rehabilitation programme using limited resources.

Methods

100 patients with moderate to severe COPD were randomised to a continuous outpatient interdisciplinary rehabilitation programme or standard care. Physiotherapy-led supervised outpatient training sessions were performed once weekly in addition to educational elements. Outcome measures at baseline and after 26 weeks were 6-minute-walk-test, cycle ergometry, and health-related quality of life.

Results

37 patients in the training group and 44 patients in the control group completed the study. After 26 weeks there were clinically significant differences between the groups for 6 minute-walk-distance (+59 m, 95% CI 28–89 m), maximum work load (+7.4 Watt, 95% CI 0.5-13.4 Watt) and St. George’s Respiratory Questionnaire score (−5 points, 95% CI −10 to −1 points). Total staff costs of the programme per participant were ≤ €625.

Conclusion

Clinically meaningful improvements in physical capabilities and health-related quality of life may be achieved using long-term pulmonary rehabilitation programmes of lower intensity than currently recommended. Trial registration: clinicaltrials.gov NCT01195402.
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Literature
1.
go back to reference Nici L, Donner C, Wouters E, Zuwallack R, Ambrosino N, Bourbeau J, Carone M, Celli B, Engelen M, Fahy B, et al: American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med. 2006, 173: 1390-1413. 10.1164/rccm.200508-1211ST.PubMedCrossRef Nici L, Donner C, Wouters E, Zuwallack R, Ambrosino N, Bourbeau J, Carone M, Celli B, Engelen M, Fahy B, et al: American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med. 2006, 173: 1390-1413. 10.1164/rccm.200508-1211ST.PubMedCrossRef
2.
go back to reference Glaab T, Vogelmeier C, Hellmann A, Buhl R: Guideline-based survey of outpatient COPD management by pulmonary specialists in Germany. Int J Chron Obstruct Pulmon Dis. 2012, 7: 101-108.PubMedPubMedCentralCrossRef Glaab T, Vogelmeier C, Hellmann A, Buhl R: Guideline-based survey of outpatient COPD management by pulmonary specialists in Germany. Int J Chron Obstruct Pulmon Dis. 2012, 7: 101-108.PubMedPubMedCentralCrossRef
3.
go back to reference Meyer A, Wendt G, Taube K, Greten H: Ambulatory sports in asthma improves physical fitness and reduces asthma-induced hospital stay. Pneumologie. 1997, 51: 845-849.PubMed Meyer A, Wendt G, Taube K, Greten H: Ambulatory sports in asthma improves physical fitness and reduces asthma-induced hospital stay. Pneumologie. 1997, 51: 845-849.PubMed
4.
go back to reference Worth H, Meyer A, Folgering H, Kirsten D, Lecheler J, Magnussen H, Pleyer K, Schmidt S, Schmitz M, Taube K, Wettengel R: Recommendations of the German Respiratory League on sports and physical training for patients with obstructive respiratory tract diseases. Pneumologie. 2000, 54: 61-67. 10.1055/s-2000-9066.PubMedCrossRef Worth H, Meyer A, Folgering H, Kirsten D, Lecheler J, Magnussen H, Pleyer K, Schmidt S, Schmitz M, Taube K, Wettengel R: Recommendations of the German Respiratory League on sports and physical training for patients with obstructive respiratory tract diseases. Pneumologie. 2000, 54: 61-67. 10.1055/s-2000-9066.PubMedCrossRef
5.
go back to reference Worth H, Buhl R, Cegla U, Criee CP, Gillissen A, Kardos P, Kohler D, Magnussen H, Meister R, Nowak D, et al: Guidelines for the diagnosis and treatment chronic obstructive Bronchitis and pulmonary emphysema issued by Deutsche Atemwegsliga and Deutsche Gesellschaft für Pneumologie. Pneumologie. 2002, 56: 704-738. 10.1055/s-2002-35553.PubMedCrossRef Worth H, Buhl R, Cegla U, Criee CP, Gillissen A, Kardos P, Kohler D, Magnussen H, Meister R, Nowak D, et al: Guidelines for the diagnosis and treatment chronic obstructive Bronchitis and pulmonary emphysema issued by Deutsche Atemwegsliga and Deutsche Gesellschaft für Pneumologie. Pneumologie. 2002, 56: 704-738. 10.1055/s-2002-35553.PubMedCrossRef
6.
go back to reference Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CP, Gustafsson P, et al: Standardisation of spirometry. Eur Respir J. 2005, 26: 319-338. 10.1183/09031936.05.00034805.PubMedCrossRef Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CP, Gustafsson P, et al: Standardisation of spirometry. Eur Respir J. 2005, 26: 319-338. 10.1183/09031936.05.00034805.PubMedCrossRef
7.
go back to reference ATS: ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002, 166: 111-117.CrossRef ATS: ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002, 166: 111-117.CrossRef
8.
go back to reference Troosters T, Gosselink R, Decramer M: Six minute walking distance in healthy elderly subjects. Eur Respir J. 1999, 14: 270-274.PubMedCrossRef Troosters T, Gosselink R, Decramer M: Six minute walking distance in healthy elderly subjects. Eur Respir J. 1999, 14: 270-274.PubMedCrossRef
9.
go back to reference ERS Task Force on Standardization of Clinical Exercise Testing: Clinical exercise testing with reference to lung diseases: indications, standardization and interpretation strategies. Eur Respir J. 1997, 10: 2662-2689.CrossRef ERS Task Force on Standardization of Clinical Exercise Testing: Clinical exercise testing with reference to lung diseases: indications, standardization and interpretation strategies. Eur Respir J. 1997, 10: 2662-2689.CrossRef
10.
go back to reference Jones PW, Quirk FH, Baveystock CM, Littlejohns P: A self-complete measure of health status for chronic airflow limitation. The St. George’s Respiratory Questionnaire. Rev Respir Dis. 1992, 145: 1321-1327.CrossRef Jones PW, Quirk FH, Baveystock CM, Littlejohns P: A self-complete measure of health status for chronic airflow limitation. The St. George’s Respiratory Questionnaire. Rev Respir Dis. 1992, 145: 1321-1327.CrossRef
11.
go back to reference Jenkinson C, Layte R, Jenkinson D, Lawrence K, Petersen S, Paice C, Stradling J: A shorter form health survey: can the SF-12 replicate results from the SF-36 in longitudinal studies?. J Public Health Med. 1997, 19: 179-186. 10.1093/oxfordjournals.pubmed.a024606.PubMedCrossRef Jenkinson C, Layte R, Jenkinson D, Lawrence K, Petersen S, Paice C, Stradling J: A shorter form health survey: can the SF-12 replicate results from the SF-36 in longitudinal studies?. J Public Health Med. 1997, 19: 179-186. 10.1093/oxfordjournals.pubmed.a024606.PubMedCrossRef
12.
go back to reference Bullinger M: German translation and psychometric testing of the SF-36 Health Survey: preliminary results from the IQOLA Project. International Quality of Life Assessment. Soc Sci Med. 1995, 41: 1359-1366. 10.1016/0277-9536(95)00115-N.PubMedCrossRef Bullinger M: German translation and psychometric testing of the SF-36 Health Survey: preliminary results from the IQOLA Project. International Quality of Life Assessment. Soc Sci Med. 1995, 41: 1359-1366. 10.1016/0277-9536(95)00115-N.PubMedCrossRef
13.
go back to reference Dhein Y, Munks-Lederer C, Worth H: Evaluation of a structured education programme for patients with COPD under outpatient conditions-- a pilot study. Pneumologie. 2003, 57: 591-597.PubMedCrossRef Dhein Y, Munks-Lederer C, Worth H: Evaluation of a structured education programme for patients with COPD under outpatient conditions-- a pilot study. Pneumologie. 2003, 57: 591-597.PubMedCrossRef
14.
go back to reference Jerman A, Campbell Haggerty M: Relaxation and biofeedback: coping skills training. Principles and practice of pulmonary rehabilitation. Edited by: Casaburi R, Petty TL. 1993, W.B. Saunders Co, Philadelphia, 366-381. Jerman A, Campbell Haggerty M: Relaxation and biofeedback: coping skills training. Principles and practice of pulmonary rehabilitation. Edited by: Casaburi R, Petty TL. 1993, W.B. Saunders Co, Philadelphia, 366-381.
15.
go back to reference Borg GA: Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982, 14: 377-381.PubMed Borg GA: Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982, 14: 377-381.PubMed
16.
go back to reference Troosters T, Gosselink R, Decramer M: Short- and long-term effects of outpatient rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Am J Med. 2000, 109: 207-212. 10.1016/S0002-9343(00)00472-1.PubMedCrossRef Troosters T, Gosselink R, Decramer M: Short- and long-term effects of outpatient rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Am J Med. 2000, 109: 207-212. 10.1016/S0002-9343(00)00472-1.PubMedCrossRef
17.
go back to reference Guell R, Casan P, Belda J, Sangenis M, Morante F, Guyatt GH, Sanchis J: Long-term effects of outpatient rehabilitation of COPD: A randomized trial. Chest. 2000, 117: 976-983. 10.1378/chest.117.4.976.PubMedCrossRef Guell R, Casan P, Belda J, Sangenis M, Morante F, Guyatt GH, Sanchis J: Long-term effects of outpatient rehabilitation of COPD: A randomized trial. Chest. 2000, 117: 976-983. 10.1378/chest.117.4.976.PubMedCrossRef
18.
go back to reference Cambach W, Chadwick-Straver RV, Wagenaar RC, van Keimpema AR, Kemper HC: The effects of a community-based pulmonary rehabilitation programme on exercise tolerance and quality of life: a randomized controlled trial. Eur Respir J. 1997, 10: 104-113. 10.1183/09031936.97.10010104.PubMedCrossRef Cambach W, Chadwick-Straver RV, Wagenaar RC, van Keimpema AR, Kemper HC: The effects of a community-based pulmonary rehabilitation programme on exercise tolerance and quality of life: a randomized controlled trial. Eur Respir J. 1997, 10: 104-113. 10.1183/09031936.97.10010104.PubMedCrossRef
19.
go back to reference Redelmeier DA, Bayoumi AM, Goldstein RS, Guyatt GH: Interpreting small differences in functional status: the Six Minute Walk test in chronic lung disease patients. Am J Respir Crit Care Med. 1997, 155: 1278-1282.PubMedCrossRef Redelmeier DA, Bayoumi AM, Goldstein RS, Guyatt GH: Interpreting small differences in functional status: the Six Minute Walk test in chronic lung disease patients. Am J Respir Crit Care Med. 1997, 155: 1278-1282.PubMedCrossRef
20.
go back to reference Puhan MA, Chandra D, Mosenifar Z, Ries A, Make B, Hansel NN, Wise RA, Sciurba F: The minimal important difference of exercise tests in severe COPD. Eur Respir J. 2011, 37: 784-790. 10.1183/09031936.00063810.PubMedCrossRef Puhan MA, Chandra D, Mosenifar Z, Ries A, Make B, Hansel NN, Wise RA, Sciurba F: The minimal important difference of exercise tests in severe COPD. Eur Respir J. 2011, 37: 784-790. 10.1183/09031936.00063810.PubMedCrossRef
21.
go back to reference Jones PW: Interpreting thresholds for a clinically significant change in health status in asthma and COPD. Eur Respir J. 2002, 19: 398-404. 10.1183/09031936.02.00063702.PubMedCrossRef Jones PW: Interpreting thresholds for a clinically significant change in health status in asthma and COPD. Eur Respir J. 2002, 19: 398-404. 10.1183/09031936.02.00063702.PubMedCrossRef
22.
go back to reference Ringbaek T, Brondum E, Martinez G, Thogersen J, Lange P: Long-term effects of 1-year maintenance training on physical functioning and health status in patients with COPD: A randomized controlled study. J Cardiopulm Rehabil Prev. 2010, 30: 47-52.PubMedCrossRef Ringbaek T, Brondum E, Martinez G, Thogersen J, Lange P: Long-term effects of 1-year maintenance training on physical functioning and health status in patients with COPD: A randomized controlled study. J Cardiopulm Rehabil Prev. 2010, 30: 47-52.PubMedCrossRef
23.
go back to reference Spencer LM, Alison JA, Mckeough ZJ: Maintaining benefits following pulmonary rehabilitation: a randomised controlled trial. Eur Respir J. 2010, 35: 571-577. 10.1183/09031936.00073609.PubMedCrossRef Spencer LM, Alison JA, Mckeough ZJ: Maintaining benefits following pulmonary rehabilitation: a randomised controlled trial. Eur Respir J. 2010, 35: 571-577. 10.1183/09031936.00073609.PubMedCrossRef
24.
go back to reference Van Wetering CR, Hoogendoorn M, Mol SJM, Rutten-van Mölken MPMH, Schols AM: Short- and long-term efficacy of a community-based COPD management programme in less advanced COPD: a randomised controlled trial. Thorax. 2010, 65: 7-13. 10.1136/thx.2009.118620.PubMedCrossRef Van Wetering CR, Hoogendoorn M, Mol SJM, Rutten-van Mölken MPMH, Schols AM: Short- and long-term efficacy of a community-based COPD management programme in less advanced COPD: a randomised controlled trial. Thorax. 2010, 65: 7-13. 10.1136/thx.2009.118620.PubMedCrossRef
25.
go back to reference Effing T, Zielhuis G, Kerstjens H, van der Valk P, van der Palen J: Community based physiotherapeutic exercise in COPD self-management: a randomised controlled trial. Respir Med. 2011, 105: 418-426. 10.1016/j.rmed.2010.09.017.PubMedCrossRef Effing T, Zielhuis G, Kerstjens H, van der Valk P, van der Palen J: Community based physiotherapeutic exercise in COPD self-management: a randomised controlled trial. Respir Med. 2011, 105: 418-426. 10.1016/j.rmed.2010.09.017.PubMedCrossRef
26.
go back to reference Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg CR, Salem GJ, Skinner JS: American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc. 2009, 41: 1510-1530. 10.1249/MSS.0b013e3181a0c95c.PubMedCrossRef Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg CR, Salem GJ, Skinner JS: American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc. 2009, 41: 1510-1530. 10.1249/MSS.0b013e3181a0c95c.PubMedCrossRef
27.
go back to reference Puhan MA, Schünemann HJ, Buesching G, Vanoort E, Spaar A, Frey M: COPD patients’ ability to follow exercise influences short-term outcomes of rehabilitation. Eur Respir J. 2008, 31: 304-310. 10.1183/09031936.00078707.PubMedCrossRef Puhan MA, Schünemann HJ, Buesching G, Vanoort E, Spaar A, Frey M: COPD patients’ ability to follow exercise influences short-term outcomes of rehabilitation. Eur Respir J. 2008, 31: 304-310. 10.1183/09031936.00078707.PubMedCrossRef
28.
go back to reference Sabit R, Griffiths TL, Watkins AJ, Evans W, Bolton CE, Shale DJ, Lewis KE: Predictors of poor attendance at an outpatient pulmonary rehabilitation programme. Respir Med. 2008, 102: 819-824. 10.1016/j.rmed.2008.01.019.PubMedCrossRef Sabit R, Griffiths TL, Watkins AJ, Evans W, Bolton CE, Shale DJ, Lewis KE: Predictors of poor attendance at an outpatient pulmonary rehabilitation programme. Respir Med. 2008, 102: 819-824. 10.1016/j.rmed.2008.01.019.PubMedCrossRef
29.
go back to reference Soicher JE, Mayo NE, Gauvin L, Hanley JA, Bernard S, Maltais F, Bourbeau J: Trajectories of endurance activity following pulmonary rehabilitation in COPD patients. Eur Respir J. 2012, 39: 272-278. 10.1183/09031936.00026011.PubMedCrossRef Soicher JE, Mayo NE, Gauvin L, Hanley JA, Bernard S, Maltais F, Bourbeau J: Trajectories of endurance activity following pulmonary rehabilitation in COPD patients. Eur Respir J. 2012, 39: 272-278. 10.1183/09031936.00026011.PubMedCrossRef
30.
go back to reference Zuwallack R: The nonpharmacologic treatment of chronic obstructive pulmonary disease: advances in our understanding of pulmonary rehabilitation. Proc Am Thorac Soc. 2007, 4: 549-553. 10.1513/pats.200701-015FM.PubMedCrossRef Zuwallack R: The nonpharmacologic treatment of chronic obstructive pulmonary disease: advances in our understanding of pulmonary rehabilitation. Proc Am Thorac Soc. 2007, 4: 549-553. 10.1513/pats.200701-015FM.PubMedCrossRef
31.
go back to reference Horowitz MB, Littenberg B, Mahler DA: Dyspnea ratings for prescribing exercise intensity in patients with COPD. Chest. 1996, 109: 1169-1175. 10.1378/chest.109.5.1169.PubMedCrossRef Horowitz MB, Littenberg B, Mahler DA: Dyspnea ratings for prescribing exercise intensity in patients with COPD. Chest. 1996, 109: 1169-1175. 10.1378/chest.109.5.1169.PubMedCrossRef
32.
go back to reference Baumann HJ, Kluge S, Klose H, Hellweger A, Braumann KM, Meyer A: Heart rate measurement for determination of training intensity in outpatient pulmonary sport groups. Pneumologie. 2009, 63: 72-77. 10.1055/s-2008-1038288.PubMedCrossRef Baumann HJ, Kluge S, Klose H, Hellweger A, Braumann KM, Meyer A: Heart rate measurement for determination of training intensity in outpatient pulmonary sport groups. Pneumologie. 2009, 63: 72-77. 10.1055/s-2008-1038288.PubMedCrossRef
Metadata
Title
Low intensity, long-term outpatient rehabilitation in COPD: a randomised controlled trial
Authors
Hans Jörg Baumann
Stefan Kluge
Katrin Rummel
Hans Klose
Jan K Hennigs
Tibor Schmoller
Andreas Meyer
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Respiratory Research / Issue 1/2012
Electronic ISSN: 1465-993X
DOI
https://doi.org/10.1186/1465-9921-13-86

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