title: Effectiveness of Repeated Courses of Pulmonary Rehabilitation on Functional Exercise Capacity in Patients With COPD.
abstract: OBJECTIVE
  To determine whether an as-needed repeated pulmonary rehabilitation (PR) intervention produces a clinically important improvement in exercise capacity.
  
  
  METHODS
  The study included a retrospective analysis of characteristics and 6-minute walk distance (6MWD) of patients with chronic obstructive pulmonary disease (COPD) who completed PR at 2 centers. Data were abstracted from all patients with COPD completing 2 courses of rehabilitation and those of randomly sampled patients completing only 1 course of PR.
  
  
  RESULTS
  We identified 37 repeaters and selected 69 nonrepeaters for analysis. No significant differences between the 2 groups with regard to age, FEV1 percent predicted, gender, initial 6MWD, improvement in 6MWD, and the percentage of patients achieving the minimal important difference (MID) of ≥ 35 m were observed with the completion of the first rehabilitation. The time between the first and second PR interventions was a mean of 45 ± 24 months. Repeating patients had a decrease of 90 ± 76 m in 6MWD at the beginning of the second rehabilitation course compared with the end of the first intervention (P = .001). Twenty-four (65%) of repeating patients achieved the MID in 6MWD at the end of the second course of PR. Those who achieved the MID in 6MWD during the second course of rehabilitation also tended to have attained greater improvement in this outcome during the first course (P = .07).
  
  
  CONCLUSIONS
  Two-thirds of patients with COPD undergoing repeat PR experienced significant improvement in exercise capacity. Offering PR to patients with COPD on an as-needed basis appears to be beneficial even after a prolonged period of time between the interventions.
authors: Pulmonary, Critical Care, and Sleep Medicine, Norwalk Hospital, Norwalk, Connecticut (Drs Atabaki and Fine, Ms Haggerty, and Mr Yu); Pulmonary, Critical Care, and Sleep Medicine, St. Francis Hospital and Medical Center, Hartford, Connecticut (Ms Marolda and Dr ZuWallack); and Center for Public Health and Health Policy, University of Connecticut Health Center, Farmington (Ms Wakefield).
authors: Ali
authors: A
authors: Atabaki
authors: Jonathan
authors: J
authors: Fine
authors: Margaret
authors: M
authors: Haggerty
authors: Corliss
authors: C
authors: Marolda
authors: Dorothy
authors: D
authors: Wakefield
authors: Andrew
authors: A
authors: Yu
authors: Richard
authors: R
authors: ZuWallack
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation*; D012189:Retrospective Studies; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology