title: Systematic review of supervised exercise programs after pulmonary rehabilitation in individuals with COPD.
abstract: 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.
authors: Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA.
authors: Marla K
authors: MK
authors: Beauchamp
authors: Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, England.
authors: Rachael
authors: R
authors: Evans
authors: Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada; St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors: Tania
authors: T
authors: Janaudis-Ferreira
authors: Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors: Roger S
authors: RS
authors: Goldstein
authors: Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada. Electronic address: dina.brooks@utoronto.ca.
authors: Dina
authors: D
authors: Brooks
mesh_terms: D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation*