An examination of the effect of duration on pulmonary rehabilitation programs in people with chronic obstructive pulmonary disease

Abstract

Currently there is no consensus on the optimal duration of pulmonary rehabilitation (PR) programs in people with chronic obstructive pulmonary disease (COPD) with program durations varying greatly around the world from four weeks to 18 months.

Chapter 1 of the thesis is a literature review. Chapter 2 is the overarching protocol for the following studies in the thesis presented in Chapters 3, 4 and 5.

The aims of the studies in Chapters 3, 4 and 5 in the thesis were:

1) to determine the changes in exercise capacity and health-related quality of life (HRQoL) at four and eight weeks during a twice-weekly supervised PR program in people with COPD (Chapter 3);

2) to determine whether PR program of eight weeks and 12 weeks duration were equivalent at improving endurance exercise capacity (primary outcome) and HRQoL, functional exercise capacity, health status, anxiety, depression, physical activity (PA), and healthcare utilisation (secondary outcomes) in people with COPD (Chapter 4);

3) to compare the patterns of PA in: i) the week prior to commencement of a PR program (pre PR) and a week during a PR program (PR week), including PR days and non-PR days; ii) PR days and non-PR days in the PR week; and iii) the pre-PR week and the week following PR program completion (post PR) in people with COPD (Chapter 5).

The main findings were:

1) The greatest magnitude of improvements in exercise capacity and HRQoL occurred in the first four weeks of a PR program (Chapter 3).

2) Equivalence was shown between 8-and 12-week PR programs for endurance exercise capacity, but superiority could not be ruled out for the 12-wk Group (Chapter 4).

3) Daily step count and time spent in moderate to vigorous PA increased significantly during the PR week, solely due to increased PA on days participants attended PR (Chapter 5).

Chapter 6 presents a summary of the thesis findings with clinical implications, limitations, and directions for future research.