Within pulmonary medicine circles, there is an ongoing debate regarding the effectiveness and safety of home-based pulmonary rehabilitation programs for COPD patients. A home-based pulmonary rehab program is one in which practitioners provide initial exercise sessions in a clinical environment or at the patient’s home, and then periodically check-in with patients to see how they are doing with the at-home program and to encourage them to continue (typically the check-ins are conducted once or twice a month).
On one hand there are practitioners and researchers who contend that to really get measurable benefit out of home based exercise programs, COPD patients need to increase intensity of exercise as they progress through their program. In their opinion, to do so at home without medical professional observation is risky (i.e. what if the patient has an exacerbation event, meaning a shortness of breath attack, with no medical professionals available to assist them respond to the exacerbation).
On the other hand, the practical reality is that very few COPD patients are admitted to hospital outpatient pulmonary rehabilitation programs for a variety of reasons. And for those who are admitted, the programs only last 6-8 weeks before patients graduate and are expected to indefinitely continue a self-managed program on their own thereafter. For these folks, there is no choice. It’s either a self managed home-based or fitness center-based pulmonary rehab program or nothing.
So, another group of practitioners and researchers have been studying the effectiveness and safety of home-based pulmonary rehab programs to determine how closely they resemble outpatient programs in terms of improved physical conditioning, self-reported quality of life, and incidence of dyspnea (shortness of breath attacks/episodes).
To that end, a recent review of 12 average-quality home-based pulmonary rehabilitation studies concludes that in general home-based pulmonary rehab programs for COPD patients produce outcomes equivalent to hospital outpatient programs and that the incidence of dyspnea events is not significantly different between the two – even in studies where patients were asked to notably increase the intensity of their exercise over the course of their program (Vieria D, Maltais F, Borbeau J. Home-based pulmonary rehabilitation in chronic obstructive pulmonary disease patients. Curr Opin Pulm Med. 2010 Mar; 16(2):134-43). If you are interested, the full text of this article can be purchased by clicking here. The cost of the article is $35.00.
The tricky part for the review article authors is that none of the 12 studies are exactly the same. Some focused on the efficacy of home-based pulmonary rehab programs versus post-outpatient rehab standard care (standard care meaning sending folks home with modest advice/education/instruction to begin an unsupervised program at home with no further intervention). Other studies focused on comparing home based versus outpatient pulmonary rehab programs. Further, the program durations were different across the studies as well as the measurements of improvement utilized in the clinical trials and how the study researchers presented their measurement results.
But even with these disparities looking across the spectrum of the studies, it was clear to see that home-based rehab programs are effective. In the studies where the comparison was against standard care (i.e. self manage with minimal instruction and no subsequent check-ins), home-based rehab programs showed significantly higher levels of physical conditioning, self-reported quality of life and incidence of dyspnea. In comparison to hospital based programs, home-based programs were generally as effective as outpatient programs on these same basic evaluation criteria. And as mentioned at the outset of this article, home-based programs that involved increasing intensity of exercise during the program showed no measurable differences in reported exacerbation events compared to outpatient programs.
So what’s the takeaway here?
Exercise programs for COPD patients (or anyone who experiences chronic shortness of breath) have been shown to be very helpful in improving physical conditioning, reducing shortness of breath, and improving patient quality of life – whether in a home-based program or in a clinical setting. If you can gain access to an outpatient rehab program, by all means give it a try. If you can’t or don’t want to, ask your physician to recommend a program you can do at home or at a fitness center. If your doctor doesn’t have an exercise program to recommend, take your doctor the program we outline in our Breathe Better for Life guide as an option to consider (available at www.breathebetterforlife.com for $29.99). If you use a fitness center, consider enlisting the services of a personal trainer who is certified in chronic disease management training (many trainers these days carry such certifications) to structure a program for you and provide observation during your training program (personal trainers charge by the hour but many will provide an initial consultation for free).
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