title: Adherence to a maintenance exercise program 1 year after pulmonary rehabilitation: what are the predictors of dropout?
abstract: OBJECTIVE
  To evaluate adherence to a maintenance exercise program in patients with chronic obstructive pulmonary disease (COPD) and explore predictors for adherence.
  
  
  METHODS
  Seventy patients with COPD were referred to a home-care maintenance exercise program after completing pulmonary rehabilitation (PR) in the rehabilitation center. Adherence (yes/no) to the maintenance program was assessed by a self-reported questionnaire, where adherence was defined as attending the maintenance program 1 year after PR. Early dropouts received a self-reported questionnaire after 6 months and the remaining patients after 12 months. Lung function, exercise capacity, exercise self-efficacy, illness perceptions, health-related quality of life, levels of anxiety and depression, duration of PR, and the number of exacerbations were studied as possible predictors of adherence.
  
  
  RESULTS
  Ten patients died or were lost to followup. Of the remaining 60 patients, 73.3% and 63.3% were adherent to the maintenance exercise program after 6 and 12 months, respectively. Forced expiratory volume in 1 second (FEV1) (P = .021), Hospital Anxiety and Depression Scale depression score (P = .025), and duration of PR (P = .018) were significant predictors of adherence to the maintenance program.
  
  
  CONCLUSIONS
  Adherence to the maintenance exercise program included a 36.7% drop-out rate during the first year after completing PR. Experiencing exacerbations was the most reported reason for dropout. Poorer lung function, shorter initial PR course measured by reviewing patient records, and higher level of depressive symptoms were predictive of drop-out to the maintenance program. Adherence to the maintenance program needs to be improved for patients with lower FEV1, with signs of depression, or with a shorter initial PR course.
authors.affiliation: Centre for Rehabilitation, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Ankie
authors.initials: A
authors.lastname: Heerema-Poelman
authors.forename: Ilse
authors.initials: I
authors.lastname: Stuive
authors.forename: Johan B
authors.initials: JB
authors.lastname: Wempe
mesh_terms: D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000503:physiopathology / Q000534:rehabilitation*; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome