Effectiveness of repeated pulmonary rehabilitation in patients with chronic obstructive pulmonary disease
Jibril Mohammed, Sarah Houben-Wilke, Miriam T.J. Groenen, Frits M.E. Franssen, Rein Posthuma, Daisy J.A. Janssen, Martijn A. Spruit, Anouk W. VaesIntroduction
Pulmonary rehabilitation (PR) improves exercise capacity, functional status, and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). However, these benefits often decline over time, necessitating repeated PR. Evidence regarding the effectiveness of repeated PR on clinical outcomes remains limited. This study evaluated the effects of a second PR program on functional, physical, and patient-reported outcomes in patients with COPD.
Methods
Data from patients with COPD who completed two PR programs (PR1 and PR2) at Ciro, Horn, the Netherlands, between January 2005 and September 2022 were retrospectively analyzed. Outcomes included exercise capacity (constant work rate test [CWRT]), quadriceps muscle strength (isokinetic quadriceps strength [IQS]), functional capacity (6-minute walk distance [6MWD]), and patient-reported outcomes using the COPD Assessment Test (CAT), St. George’s Respiratory Questionnaire (SGRQ), Hospital Anxiety and Depression Scale (HADS), and Canadian Occupational Performance Measure (COPM).
Results
Of 7,984 PR records, 429 patients (858 PR records) met the inclusion criteria (54% men; mean age 62.5±8.1 years; FEV₁ 43.5% predicted). Significant improvements were observed following both PR programs, including 6MWD (PR1: Mean Difference [MD] 37.0 m, 95% Confidence Interval [CI] 29.2–44.8; PR2: MD 27.0 m, 95% CI 19.2–34.8) and IQS (PR1: MD 10.4 Nm, 95% CI 8.4–12.4; PR2: MD 8.6 Nm, 95% CI 6.6–10.6), as well as for CWRT, CAT, SGRQ, HADS, and COPM (all p < 0.05). Improvements in 6MWD and IQS were significantly greater after PR1 than PR2 ( p < 0.05). All outcomes declined significantly between completion of PR1 and initiation of PR2 ( p < 0.05).
Discussion
Although improvements following repeated PR were smaller than those after the initial program, clinically meaningful gains were achieved across multiple outcomes, supporting the value of repeated PR in patients whose health status deteriorates over time.
Conclusion
Repeated PR effectively improves functional capacity, muscle strength, exercise performance, and patient-reported outcomes in patients with COPD. Strategies to sustain PR benefits after program completion should be prioritized.