title: Efficacy of a simple and inexpensive exercise training program for advanced chronic obstructive pulmonary disease patients in community hospitals.
abstract: BACKGROUND
  Exercise training is an important part of pulmonary rehabilitation; however it may not be appropriate for large-scale practice in community hospitals due to the complexity of the program and expensive training equipment, including cycle ergometry and treadmills. This study therefore aims to evaluate the efficacy of a more simplified exercise training program with inexpensive training equipment.
  
  
  METHODS
  A multicentre study of a mild to moderate intensity exercise training program was conducted based on incremental strength and endurance with two 35-40-minute sessions per week for 8 weeks. The program was performed by 30 outpatients from five community hospitals. Patients were monitored regularly for various parameters including strength of trained muscles, level of dyspnea, 6-minute walk distance, and quality of life (QoL) at baseline at 1, 2, 3, 6, 9 and 12 months. Unpaired t-tests were applied to determine the progress of trained muscle strength and minimal clinically important differences (MCIDs) were used to assess clinical outcomes.
  
  
  RESULTS
  Thirty patients (13 males, 17 females) were enrolled with a mean age of 69.1±8.9 years, body mass index 20.5±4.4 kg/m(2), and mean % of predicted forced expiratory volume in the first second (FEV1) 45.1±10.8. According to GOLD classification, eight (26.7%) cases were in stage II, 20 (66.7%) cases in stage III, and two (6.6%) cases in stage IV. Limb and chest wall muscle strength, dyspnea level, exercise capacity and QoL showed statistically significant improvements throughout the 12-month follow-up (P<0.01). There were clinically significant improvements in QoL throughout the 12-month follow-up, exercise capacity from months 2 to 12, and dyspnea levels at months 2, 3 and 9.
  
  
  CONCLUSIONS
  The implementation of a simplified and inexpensive exercise training program was shown to be effective for advanced chronic obstructive pulmonary disease patients in community hospitals.
authors.affiliation: Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
authors.forename: Chaicharn
authors.initials: C
authors.lastname: Pothirat
authors.affiliation: Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
authors.forename: Warawut
authors.initials: W
authors.lastname: Chaiwong
authors.affiliation: Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
authors.forename: Nittaya
authors.initials: N
authors.lastname: Phetsuk
keywords: Chronic obstructive lung disease; rehabilitation; strength training; walking