Benefits of Long-Term Pulmonary Rehabilitation Maintenance Program in Patients with Severe Chronic Obstructive Pulmonary Disease. Three-Year Follow-up.
In chronic obstructive pulmonary disease (COPD), the benefits of pulmonary rehabilitation (PR) tend to wane over time. Whether maintenance techniques may help sustain the benefits achieved after completion of the initial PR program remains controversial.



To determine whether a long-term (3-yr) maintenance program after PR preserves the short-term effects on outcomes in patients with COPD.



This was a multicenter prospective randomized trial including 143 patients with moderate-severe COPD, with 3 years of PR maintenance following an 8-week outpatient PR program. Patients were randomized to maintenance intervention group (IG) and standard monitoring program or control group (CG). The effects on BODE index, 6-minute-walk test distance (6MWD), and health-related quality of life were compared at 12, 24, and 36 months.



A total of 138 (96.5%) completed the 8-week program. At this time, all outcomes (BODE, 6MWD, and health-related quality of life) showed clinically and statistically significant improvements (P ≤ 0.001). During the follow-up period, the magnitude of change in 6MWD differed between IG and CG (P = 0.042), with a slight initial increase in the IG during the first year and smaller decline afterward. The BODE index changes differed between baseline and measurements at Month 24 (P = 0.043). At 3 years, the adherence rate of IG patients was 66% and 17% for the CG group (P < 0.001).



This study shows a 2-year beneficial effect of a program of rehabilitation maintenance on the BODE index and 6MWD when compared with a standard strategy. This effect vanishes after the second year of follow-up. Clinical trial registered with www.clinicaltrials.gov (NCT 01090999).
1 Hospital de la Santa Creu I Sant Pau, Barcelona, Spain.
Maria-Rosa
MR
Güell
2 Hospital Virgen Rocío, Sevilla, Spain.|3 Instituto de Biomedicina de Sevilla, Sevilla, Spain.
Pilar
P
Cejudo
2 Hospital Virgen Rocío, Sevilla, Spain.|3 Instituto de Biomedicina de Sevilla, Sevilla, Spain.
Francisco
F
Ortega
1 Hospital de la Santa Creu I Sant Pau, Barcelona, Spain.
M Carmen
MC
Puy
4 Hospital Clínico San Carlos, Madrid, Spain.
Gema
G
Rodríguez-Trigo
5 Hospital Universitario Cruces, Barakaldo-Biocruces Health Research Institute, Barakaldo, Spain.|6 CIBER de Epidemiología y Salud Pública, Madrid, Spain.|7 Spanish Clinical Research Network, Madrid, Spain.
José Ignacio
JI
Pijoan
5 Hospital Universitario Cruces, Barakaldo-Biocruces Health Research Institute, Barakaldo, Spain.
Lorea
L
Martinez-Indart
5 Hospital Universitario Cruces, Barakaldo-Biocruces Health Research Institute, Barakaldo, Spain.
Amaia
A
Gorostiza
8 Hospital La Madalena, Castellón, Spain.
Khaled
K
Bdeir
9 Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts; and.
Bartolome
B
Celli
5 Hospital Universitario Cruces, Barakaldo-Biocruces Health Research Institute, Barakaldo, Spain.|10 CibeRes, Madrid, Spain.
Juan B
JB
Galdiz
D005080:Exercise Test / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chronic obstructive pulmonary disease; long-term benefits; maintenance technique; pulmonary rehabilitation