New Danish Study Reaffirms Benefit of Long-Term Pulmonary Rehab

In the January/February 2010 issue of the Journal of Cardiopulmonary Rehabilitation and Prevention, Danish researchers led by Thomas Ringbaek reported that COPD patients who continued a maintenance pulmonary rehabilitation for 1 year after graduating a traditional 7 week rehab program enjoyed higher, sustained physical capacity and conditioning (Ringbaek T, et al. Long-term Effects of 1-Year Maintenance Training on Physical Functioning and Health Status in Patients With COPD. J Cardiopulm Rehabil Prev. 2010 Jan-Feb;30(1):47-52). Normally, we'd provide you a link to the free, full-text of the study so you can read it for yourself but alas this one you have to pay the journal publisher to read L

This is not the first study to show such results but it is a helpful reminder of the value of beginning and continuing a physical exercise program if you suffer from chronic shortness of breath or have a lung condition such as COPD. As the researchers noted, "Our data support the notion that poor adherence to exercise at home (and supervised training if offered) is the most important reason for the declining effect of pulmonary rehabilitation. Adherence to home exercise after rehabilitation is rarely reported."

In other words, far too often patients who've achieved notable physical conditioning improvements during a pulmonary rehab programs see those benefits diminish or disappear over time because they don't stick with it. It's a frustrating situation for practitioners who invest a lot of time and effort over the course of a 6-8 week pulmonary rehab program to instill in patients the things they can and should do to improve how they feel and live. But alas, many (no strike that, most) patients don't continue on.

The research team here sought to provide a solution to this problem by offering once a week maintenance exercise sessions for the first six months after the formal 7 week rehab program and then once a month sessions for the six months after that. The group that completed the initial 7 week program and continued with the research-team designed maintenance program (deigned the Maintenance group by the researchers) saw significantly higher levels of conditioning compared to those who completed the initial 7 week program and were sent on their way to fend for themselves with the advice to keep up the good work (denoted as the Control group in the study).

Both groups experienced huge jumps in a test called the Endurance Shuttle Walk Test (ESWT) as a result of the 7 week rehab program. In this test, patients are asked to walk at a constant speed at 85% of their physical capacity (85% of their VO2 predicted maximum). From the researchers published graphs, it appears both groups saw their physical capacity rise approximately 70%-80% from their pre-rehab test to their post-rehab ESWT. The power of pulmonary rehab in action.

The Maintenance group saw further, but modest, improvement in ESWT over the next year after the formal rehab program but the Control group saw their rehab program gains erode significantly in the same time span. The researchers conclude, "We conclude that MT (maintenance training) for 1 year following a 7-week pulmonary rehabilitation program improved physical capacity…". It should be noted that the researchers also evaluated improvements in quality of life survey results and future hospitalizations in the study and in both cases did not find significant differences between the two groups.

The researchers wrap up their paper by encouraging further research into why the majority of COPD patients do not maintain exercise after a rehab program. They cite lack of motivation/supervision as one likely answer and breathing exacerbation events as another (an exacerbation is essentially a shortness of breath attack that often lands a patient back in the hospital).

They are probably right on both counts – but we think the real lesson is clear. The more people are given access to the principles and practices of pulmonary rehab and the more places these people can receive guidance and support for beginning and maintaining a better breathing rehab program (whether inside the medical community or by enterprising, qualified trainers/therapists outside the medical community) the likelihood of exercise adherence will increase and the conditioning gains achieved during such programs will be sustained.