title: A community-based exercise programme in COPD self-management: two years follow-up of the COPE-II study.
abstract: BACKGROUND
  It is still unknown how best to maintain effects of exercise programmes in COPD in the long-term. We present the long-term effects of a community-based exercise programme incorporated in a self-management programme, compared to a self-management programme only in patients with COPD.
  
  
  METHODS
  All included patients participated in four self-management sessions. Additionally, patients in the intervention group participated in an 11-month community-based exercise programme led by physiotherapists. Patients trained three times/week for six months and two times/week during the subsequent five months. To encourage a behavioural change towards exercise, one of these weekly training sessions was home-based (unsupervised). No formal exercise training was offered to intervention patients in the second year.
  
  
  RESULTS
  The intervention was assigned to 80 patients, and the control condition to 79 patients. 82.5% and 78.5% of the intervention and control group, respectively, completed 24 months follow-up. Modified intention-to-treat analyses were performed. Although statistically significant after 12 months (35.1 m (95%CI: 8.4-61.8)), the between-group difference on maximal exercise capacity was not statistically significant after 24 months (12.2 m (95%CI: -16.6 to 41.0). Nevertheless, the between-group difference in daily physical activity was maintained after 24 months (1193 steps/day (95%CI: 203-2182)). A beneficial effect was also found on CRQ dyspnoea score but not on other CRQ domains, CCQ and HADS.
  
  
  CONCLUSIONS
  Our intervention was effective in achieving a behavioural change reflected by a sustained increase in daily physical activity, not accompanied by a sustained increase in maximal exercise capacity after two years of follow-up (ISRCTN81447311).
authors.affiliation: Medisch Spectrum Twente, Department of Pulmonary Medicine, The Netherlands. Electronic address: m.zwerink@mst.nl.
authors.forename: Marlies
authors.initials: M
authors.lastname: Zwerink
authors.affiliation: Medisch Spectrum Twente, Department of Pulmonary Medicine, The Netherlands; University Twente, Department of Research Methodology, Measurement and Data Analysis, Enschede, The Netherlands.
authors.forename: Job
authors.initials: J
authors.lastname: van der Palen
authors.affiliation: University of Groningen, and University Medical Center Groningen, Department of Pulmonology, Groningen, The Netherlands.
authors.forename: Huib A M
authors.initials: HA
authors.lastname: Kerstjens
authors.affiliation: Medisch Spectrum Twente, Department of Pulmonary Medicine, The Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: van der Valk
authors.affiliation: Medisch Spectrum Twente, Department of Pulmonary Medicine, The Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Brusse-Keizer
authors.affiliation: Radboud University Medical Center, Department for Health Evidence, Nijmegen, The Netherlands.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Zielhuis
authors.affiliation: Southern Adelaide Local Health Network, Repatriation General Hospital, Respiratory Research Unit, Daw Park, South Australia, Australia; Flinders University, School of Medicine, Adelaide, South Australia, Australia.
authors.forename: Tanja
authors.initials: T
authors.lastname: Effing
mesh_terms: D000368:Aged; D003153:Community Health Services / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000534:rehabilitation*; D012648:Self Care / Q000379:methods*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014797:Vital Capacity / Q000502:physiology
keywords: COPD; Community-based; Exercise; Physical activity; Self-management