title: Comprehensive pulmonary rehabilitation for anxiety and depression in adults with chronic obstructive pulmonary disease: Systematic review and meta-analysis.
abstract: OBJECTIVE
  To estimate the clinical effect of pulmonary rehabilitation (with or without education) on anxiety and depression in patients with chronic obstructive pulmonary disease (COPD). Secondary outcomes were generic and disease-specific health-related quality of life (HRQOL).
  
  
  METHODS
  Systematic review and meta-analysis of primary outcomes to calculate mean change effect sizes [standardized mean difference (SMD)] and associated 95% CIs.
  
  
  RESULTS
  Six randomized controlled trials (RCTs) that compared pulmonary rehabilitation with standard care (with or without education) were included in the review. Three studies (n=269) showed that comprehensive pulmonary rehabilitation was significantly more effective than standard care in reducing short-term anxiety (SMD=-0.33, 95% CI: -0.57 to -0.09, P=.008) and depression (SMD=-0.58, 95% CI: -0.93 to -0.23, P=.001). Education alone and exercise training alone were not associated with significant reductions in either anxiety or depression. When compared with standard care, comprehensive pulmonary rehabilitation was also associated with short-term significant gains in both disease-specific and generic HRQOL. Studies that included long-term follow-up data showed that gains in both psychological health status and HRQOL were not sustained at 12 months.
  
  
  CONCLUSIONS
  Rehabilitation programmes that include up to three sessions per week of incremental and supervised exercise, along with education and psychosocial support, significantly reduce anxiety and depression more than standard care in patients with COPD. Further research should focus on exploring effective and acceptable maintenance strategies along with evaluations of stepped care approaches for the management of psychological co-morbidity, especially among those with severe anxiety and depression.
authors.affiliation: School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, United Kingdom. peter.a.coventry@manchester.ac.uk
authors.forename: Peter A
authors.initials: PA
authors.lastname: Coventry
authors.forename: Daniel
authors.initials: D
authors.lastname: Hind
mesh_terms: D001008:Anxiety Disorders / Q000453:epidemiology* / Q000523:psychology*; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology*; D015444:Exercise; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation; D011788:Quality of Life / Q000523:psychology; D016032:Randomized Controlled Trials as Topic