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Bruna Wageck,1 Narelle S Cox,1– 3 Christine F McDonald,3– 5 Angela T Burge,1– 3,6 Ajay Mahal,7 Catherine J Hill,3,8 Annemarie L Lee,2,3,6 Rosemary Moore,3,8 Caroline Nicolson,9,10 Paul O’Halloran,11 Aroub Lahham,1– 3 Rebecca Gillies,1,8 Anne E Holland1– 3,6 1La Trobe University, Melbourne, Australia; 2Monash University, Melbourne, Australia; 3Institute for Breathing and Sleep, Melbourne, Australia; 4Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia; 5Department of Medicine, The University of Melbourne, Melbourne, Australia; 6Department of Physiotherapy, Alfred Health, Melbourne, Australia; 7The Nossal Institute of Global Health, The University of Melbourne, Melbourne, Australia; 8Department of Physiotherapy, Austin Health, Melbourne, Australia; 9Department of Pulmonary Hypertension, Alfred Health, Melbourne, Australia; 10Physiotherapy Department, Monash University, Melbourne, Australia; 11Department of Public Health, La Trobe University, Melbourne, AustraliaCorrespondence: Anne E HollandMonash University, Central Clinical School, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, AustraliaTel +61 3 99030214Email a.holland@alfred.org.auBackground: Pulmonary rehabilitation is an effective treatment for people with chronic obstructive pulmonary disease (COPD), but its benefits are poorly maintained. The aim of this study was to evaluate the impact of COPD exacerbations in the year following pulmonary rehabilitation on outcomes at 12 months.Methods: This was a secondary analysis from a trial of home versus hospital-based rehabilitation in COPD, with 12 months of follow-up. Moderate and severe exacerbations were identified using administrative data (prescriptions) and hospital records (admissions) respectively. The impact of exacerbations at 12 months following pulmonary rehabilitation was evaluated for quality of life (Chronic Respiratory Questionnaire, CRQ), dyspne

Aroub Lahham,1,2 Christine F McDonald,2–4 Anne E Holland1,2,5 1Discipline of Physiotherapy, La Trobe University, 2Institute for Breathing and Sleep, 3Department of Respiratory and Sleep Medicine, Austin Health, 4Department of Medicine, The University of Melbourne, 5Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia Background: Physical inactivity is associated with poor outcomes in COPD, and as a result, interventions to improve physical activity (PA) are a current research focus. However, many trials have been small and inconclusive.Objective: The aim of this systematic review and meta-analysis was to study the effects of randomized controlled trials (RCTs) targeting PA in COPD.Methods: Databases (Physiotherapy Evidence Database [PEDro], Embase, MEDLINE, CINAHL and the Cochrane Central Register for Controlled Trials) were searched using the following keywords: “COPD”, “intervention” and “physical activity” from inception to May 20, 2016; published RCTs that aimed to increase PA in individuals with COPD were included. The PEDro scale was used to rate study quality. Standardized mean differences (effect sizes, ESs) with 95% confidence intervals (CIs) were determined. Effects of included interventions were also measured according to the minimal important difference (MID) in daily steps for COPD (599 daily steps).Results: A total of 37 RCTs with 4,314 participants (mean forced expiratory volume in one second (FEV1) % predicted 50.5 [SD=10.4]) were identified. Interventions including exercise training (ET; n=3 studies, 103 participants) significantly increased PA levels in COPD compared to standard care (ES [95% CI]; 0.84 [0.44–1.25]). The addition of activity counseling to pulmonary rehabilitation (PR; n=4 studies, 140 participants) showed important effects on PA levels compared to PR alone (0.47 [0.02–0.92]), achieving significant increases that exceeded the MI