title: The effects of maintenance schedules following pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomised controlled trial.
abstract: OBJECTIVE
  Pulmonary rehabilitation (PR) provides benefit for patients with chronic obstructive pulmonary disease (COPD) in terms of quality of life (QoL) and exercise capacity; however, the effects diminish over time. Our aim was to evaluate a maintenance programme for patients who had completed PR.
  
  
  METHODS
  Primary and secondary care PR programmes in Norfolk.
  
  
  METHODS
  148 patients with COPD who had completed at least 60% of a standard PR programme were randomised and data are available for 110 patients. Patients had greater than 20 pack year smoking history and less than 80% predicted forced expiratory volume in 1 s but no other significant disease or recent respiratory tract infection.
  
  
  METHODS
  Patients were randomised to receive a maintenance programme or standard care. The maintenance programme consisted of 2 h (1 h individually tailored exercise training and 1 h education programme) every 3 months for 1 year.
  
  
  METHODS
  The Chronic Respiratory Questionnaire (CRQ) (primary outcome), endurance shuttle walk test (ESWT), EuroQol (EQ5D), hospital anxiety and depression score (HADS), body mass index (BMI), body fat, activity levels (overall score and activity diary) and exacerbations were assessed before and after 12 months.
  
  
  RESULTS
  There was no statistically significant difference between the groups for the change in CRQ dyspnoea score (primary end point) at 12 months which amounted to 0.19 (-0.26 to 0.64) units or other domains of the CRQ. There was no difference in the ESWT duration (-10.06 (-191.16 to 171.03) seconds), BMI, body fat, EQ5D, MET-minutes, activity rating, HADS, exacerbations or admissions.
  
  
  CONCLUSIONS
  A maintenance programme of three monthly 2 h sessions does not improve outcomes in patients with COPD after 12 months. We do not recommend that our maintenance programme is adopted. Other methods of sustaining the benefits of PR are required.
  
  
  BACKGROUND
  NCT00925171.
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, UK Department of Respiratory Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Wilson
authors.affiliation: Department of Respiratory Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
authors.forename: Paula
authors.initials: P
authors.lastname: Browne
authors.affiliation: Department of Respiratory Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
authors.forename: Sandra
authors.initials: S
authors.lastname: Olive
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: Allan
authors.initials: A
authors.lastname: Clark
authors.affiliation: Department of Respiratory Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
authors.forename: Penny
authors.initials: P
authors.lastname: Galey
authors.affiliation: Department of Respiratory Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Dix
authors.affiliation: Department of Respiratory Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
authors.forename: Helene
authors.initials: H
authors.lastname: Woodhouse
authors.affiliation: Department of Respiratory Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Robinson
authors.affiliation: Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK.
authors.forename: Edward C F
authors.initials: EC
authors.lastname: Wilson
authors.affiliation: Norfolk Community Health and Care NHS Trust, Norwich, UK.
authors.forename: Lindi
authors.initials: L
authors.lastname: Staunton
mesh_terms: D000203:Activities of Daily Living; D000273:Adipose Tissue; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology; D001071:Appointments and Schedules; D015992:Body Mass Index; D003863:Depression / Q000209:etiology; D004417:Dyspnea / Q000209:etiology / Q000517:prevention & control*; D005080:Exercise Test; D005081:Exercise Therapy; D005260:Female; D005541:Forced Expiratory Volume; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010809:Physical Fitness; D015397:Program Evaluation; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000534:rehabilitation / Q000628:therapy*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016138:Walking