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Abstract
Background: Pulmonary rehabilitation has become an integral component in the management of chronic obstructive pulmonary disease (COPD). However, the improvements in exercise capacity and quality of life (QOL) gained following pulmonary rehabilitation have been shown to decline when the exercise training was ceased. Recent interest has arisen in the use of maintenance programs to prolong the benefits gained from pulmonary rehabilitation.
Objective: This review was undertaken to examine the literature on the effects of maintenance programs on exercise capacity and QOL in people with COPD.
Major findings: An electronic database search found eight randomized controlled trials evaluating exercise capacity and QOL. A meta-analysis of the available post-intervention data indicated a moderate effect on exercise capacity [weighted mean difference (WMD) = 23·20 m; 95% CI: 3·82–42·59] and a small effect on QOL [standard mean difference (SMD) = 0·13; 95% CI: −0·06–0·31] with the maintenance programs. Consequently, maintenance programs in these trials were found to be effective in sustaining the improvements gained from the initial pulmonary rehabilitation. However, the maintenance programs needed to be well designed and preceded by well-designed pulmonary rehabilitation programs. Supervised and unsupervised maintenance programs were both shown to be effective, although feedback strategies were necessary to enhance compliance to exercise when supervision was limited.
Conclusion: This review suggests that maintenance programs are likely to sustain the improvements in exercise capacity and QOL achieved from the initial pulmonary rehabilitation. However, further research is necessary to identify the optimal methods of maintenance training.
The authors wish to thank Associate Professor Louise Ada for her help with the statistical analysis.