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Background and Objective: There is no strong evidence on the optimal duration of pulmonary rehabilitation (PR) programmes. The aim of the study was to determine whether an 8-week PR programme was equivalent to a 12-week PR programme in improving endurance exercise capacity in people with chronic obstructive pulmonary disease (COPD)., Methods: Participants with COPD were randomized to either an 8-week (8-wk Group) or 12-week (12-wk Group), twice weekly, supervised PR programme consisting of endurance and strength training and individualized self-management education. Between group comparisons were made at completion of each programme (i.e., week 8 or week 12), for both programmes at week 12, and at 6-12-month follow-up. The primary outcome was endurance exercise capacity measured by the endurance shuttle walk test (ESWT) with the minimally important difference of 186 s set as the equivalence limit., Results: Sixty-six participants [mean (SD); age 69 (7) years, FEV 1 48 (17) %predicted] were randomized (33 per group). Between-group comparisons demonstrated that the ESWT time was equivalent for the 12-wk Group compared to the 8-wk Group at programme completion [mean (95% CI)] [71 s (-61 to 203)], week 12 [70 s (-68 to 208)], and 6-12-month follow-up [93 s (-52 to 239)], though superiority of the 12-wk Group could not be ruled out at each time point., Conclusion: Equivalence was shown between 8-and 12-week PR programmes for endurance exercise capacity, but superiority could not be ruled out for the 12-wk Group. Decisions about programme duration may depend on local waitlist times, healthcare budgets and patient preference., (© 2024 The Author(s). Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.)

Pulmonary rehabilitation (PR) improves exercise capacity, health-related quality of life (HRQoL) and dyspnoea in patients with COPD and other lung conditions. Once PR is completed, the benefits gained begin to decline unless patients continue to exercise regularly. Due to limited evidence in other lung conditions, this review aims to examine the current evidence regarding maintenance exercise programmes for patients with COPD and to determine the types of programmes that are able to maintain the benefits gained from PR to 12 months and longer. A number of factors may affect the ability to maintain exercise capacity and HRQoL in the long term including: frequency of supervised maintenance exercise; strategies used to improve adherence to maintenance exercise; facilitators and barriers to long-term exercise training; and initial PR programme itself. The current evidence for maintenance exercise programmes that included supervised maintenance exercise was weak, and for those programmes that included unsupervised maintenance exercise (with and without support) were difficult to interpret and in many instances were no better than usual care. New research using technology has provided some promising results for the future and surveys have revealed important features that may help in the development of maintenance programmes from a participant perspective such as ongoing therapist support. How to best maintain the benefits gained from PR remains unclear. Therefore, it is likely that no one model of maintenance is ideal for all patients with COPD and that individually adapted maintenance exercise programmes need to be considered., (© 2019 Asian Pacific Society of Respirology.)

Background and Objective: The aim of the Pulmonary Rehabilitation Guidelines (Guidelines) is to provide evidence-based recommendations for the practice of pulmonary rehabilitation (PR) specific to Australian and New Zealand healthcare contexts., Methods: The Guideline methodology adhered to the Appraisal of Guidelines for Research and Evaluation (AGREE) II criteria. Nine key questions were constructed in accordance with the PICO (Population, Intervention, Comparator, Outcome) format and reviewed by a COPD consumer group for appropriateness. Systematic reviews were undertaken for each question and recommendations made with the strength of each recommendation based on the GRADE (Gradings of Recommendations, Assessment, Development and Evaluation) criteria. The Guidelines were externally reviewed by a panel of experts., Results: The Guideline panel recommended that patients with mild-to-severe COPD should undergo PR to improve quality of life and exercise capacity and to reduce hospital admissions; that PR could be offered in hospital gyms, community centres or at home and could be provided irrespective of the availability of a structured education programme; that PR should be offered to patients with bronchiectasis, interstitial lung disease and pulmonary hypertension, with the latter in specialized centres. The Guideline panel was unable to make recommendations relating to PR programme length beyond 8 weeks, the optimal model for maintenance after PR, or the use of supplemental oxygen during exercise training. The strength of each recommendation and the quality of the evidence are presented in the summary., Conclusion: The Australian and New Zealand Pulmonary Rehabilitation Guidelines present an evaluation of the evidence for nine PICO questions, with recommendations to provide guidance for clinicians and policymakers., (© 2017 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.)

Background and Objective: Telerehabilitation has the potential to increase access to pulmonary rehabilitation (PR) for patients with COPD who have difficulty accessing centre-based PR due to poor mobility, lack of transport and cost of travel. We aimed to determine the effect of supervised, home-based, real-time videoconferencing telerehabilitation on exercise capacity, self-efficacy, health-related quality of life (HRQoL) and physical activity in patients with COPD compared with usual care without exercise training., Methods: Patients with COPD were randomized to either a supervised home-based telerehabilitation group (TG) that received exercise training three times a week for 8 weeks or a control group (CG) that received usual care without exercise training. Outcomes were measured at baseline and following the intervention., Results: Thirty-six out of 37 participants (mean ± SD age = 74 ± 8 years, forced expiratory volume in 1 s (FEV 1 ) = 64 ± 21% predicted) completed the study. Compared with the CG, the TG showed a statistically significant increase in endurance shuttle walk test time (mean difference = 340 s (95% CI: 153-526, P < 0.001)), an increase in self-efficacy (mean difference = 8 points (95% CI: 2-14, P < 0.007)), a trend towards a statistically significant increase in the Chronic Respiratory Disease Questionnaire total score (mean difference = 8 points (95% CI: -1 to 16, P = 0.07)) and no difference in physical activity (mean difference = 475 steps per day (95% CI: -200 to 1151, P = 0.16))., Conclusion: This study showed that telerehabilitation improved endurance exercise capacity and self-efficacy in patients with COPD when compared with usual care., (© 2016 Asian Pacific Society of Respirology.)

Background and Objective: The prevalence of physical comorbidities such as obesity, musculoskeletal or neurological conditions in people with chronic obstructive pulmonary disease (COPD) is high, yet little is known about the impact of these physical comorbidities on physical activity. The primary aim of the study was to compare the physical activity levels of people with COPD with physical comorbidities (COPD + PC) to people with COPD without physical comorbidities (COPD) and healthy age-matched volunteers (control group)., Methods: Twenty-five people with COPD + PC (mean (standard deviation (SD)) age 73 (11) years, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage II-IV), 25 people with COPD (70 (8) years, GOLD stage II-IV) and 25 controls (70 (7) years) wore the SenseWear Pro3 Armband for 7 days., Results: Engagement in light intensity physical activity (1.5-3.0 metabolic equivalents (MET)) (140 (76) minutes per day (min/day)) and moderate intensity physical activity (3.0-6.0 MET) (25 (35) min/day) in the COPD + PC group was significantly reduced compared with the COPD (231 (76) and 104 (106), respectively) and control group (259 (75) and 114 (57), respectively). In the 16 daytime hours between 6 am and 10 pm, people with COPD + PC spent a mean (SD) of 771 (98) min/day engaged in sedentary behaviour (<1.5 MET). This was significantly greater than the group with COPD (603 (148) min/day) and the control group (567 (76) min/day) (P < 0.001)., Conclusions: People with COPD + PC had significantly lower daily physical activity levels compared with people with COPD without physical comorbidities and healthy people., (© 2014 Asian Pacific Society of Respirology.)

This study evaluates the physiological responses to giant bullectomy. A 42-year-old female with bilateral giant bullae presented with dyspnoea and exercise limitation. At baseline and 3 months after bullectomy she had tests of lung function; exercise capacity via a symptom-limited cycle test and a 6-min walk test (6MWT). Quality of life (QoL) and gas exchange using the multiple inert gas elimination technique (MIGET) were also assessed. There were significant improvements in pulmonary function following surgery with the FEF(25-75%) predicted increasing from 16 to 96. The 6MWT increased by 10% and the peak leg work capacity by 48%. A MIGET measure of the distribution of perfusion (Log SDQ) fell from 0.52 to 0.36. There was also radiological improvement in hyperinflation and diaphragmatic configuration. The QoL total score decreased from 56 to 25. This patient demonstrated significant improvements in exercise tolerance, gas exchange and QoL following bullectomy.