How long should outpatient pulmonary rehabilitation be? A randomised controlled trial of four-weeks versus seven-weeks

Louise Sewell ¹, Sally J Singh ^1*, Johanna E A Williams ¹, Rachael Collier ¹ and Mike Morgan ¹

¹ Glenfield Hospital, University Hospitals of Leicester NHS Trust, United Kingdom

^* To whom correspondence should be addressed. E-mail: sally.singh{at}uhl-tr.nhs.uk.

Accepted 14 January 2006

Abstract

Background: The evidence of benefit for pulmonary rehabilitation (PR) programmes is established. However the optimal duration of a PR programme is not known. We completed a randomised controlled trial with patients with COPD to assess whether a four-week PR programme was equivalent to our conventional seven-week PR programme at equivalent time points of seven-weeks and six months.

Methods: 100 patients (56 men) with stable COPD of mean (SD) age 70 (8) years, forced expiratory volume in one second (FEV1) 1.13 (0.50) litres were randomised to either a seven-week (n=50) or four-week (n=50) supervised PR programme. Patients were assessed at baseline, completion of the supervised PR programme and six months later. Patients randomised to the four-week group were also assessed at the seven-week time point. Outcome measures were: Incremental Shuttle Walking Test, Endurance Shuttle Walk Test (ESWT) Chronic Respiratory Questionnaire - Self Reported and the Breathing Problems Questionnaire.

Results: 41 patients in each group completed the PR programme. Patients in the four-week group attained higher ESWT times (mean difference (95% CI) 124 seconds (17.00 to 232.16), p=0.024) at the seven-week time point. There were no other statistically significant between group differences for any other measure at the seven-week or six month time points. Patients in both groups made statistically significant improvements in all outcome measures at seven-weeks.

Conclusions: A shortened four-week supervised pulmonary rehabilitation programme is equivalent to a seven-week supervised pulmonary rehabilitation programme at the comparable time points of seven-weeks and six months.

Keywords: COPD, exercise, pulmonary rehabilitation

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