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ABSTRACT 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. [ABSTRACT FROM AUTHOR]

ABSTRACT 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 ( FEV1 ) = 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. [ABSTRACT FROM AUTHOR]

This study aimed to determine the physical activity level of people admitted to hospital with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and whether physical activity changed immediately after discharge and 6 weeks post hospital admission. In this prospective observational study, people admitted to hospital with an AECOPD had physical activity levels monitored using the SenseWear® Armband (model MF-SW) for 3 days in hospital (T1), during the first week at home following discharge (T2), and at home during the sixth week after admission (T3). Fifty participants (mean age (SD) 71 (10) years) completed the study. There was a linear increase in average steps per day over the three time periods (T1, mean (SD) 1385 (1972) steps/day; T2, 2040 (2680); T3, 2328 (2745); analysis of variance (ANOVA) p = 0.001) and time spent in moderate activity (3.0–6.0 metabolic equivalents; minutes/day) (T1, mean (SD) 16 (27) minutes/day; T2, 32 (46) minutes/day; T3, 35 (58) minutes/day; ANOVA p = 0.008). For both outcomes, post hoc t-tests showed significant improvements from T1 to T2 and from T1 to T3, but not between T2 and T3. Physical activity was low in hospital and significantly improved in the week after discharge but showed no further significant improvement at 6 weeks following a hospitalized AECOPD. [ABSTRACT FROM AUTHOR]

Background and Objective Methods Results Conclusion 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).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.Sixty‐six participants [mean (SD); age 69 (7) years, FEV1 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.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. [ABSTRACT FROM AUTHOR]

Pulmonary rehabilitation is an essential component of chronic obstructive pulmonary disease (COPD) management with strong evidence supporting the efficacy of pulmonary rehabilitation to improve exercise capacity and quality of life, as well as reduce hospital admissions. However, it is estimated that only 2-5% of people with COPD who could benefit from pulmonary rehabilitation have access to programs. Most research on the benefits of pulmonary rehabilitation has used equipment such as cycle ergometers and treadmills for endurance training and weight machines for resistance training. To enable greater availability of pulmonary rehabilitation, the efficacy of exercise training using minimal equipment needs to be evaluated. Randomised controlled trials that used minimal, low cost equipment for endurance (eight trials) and strength training (three trials) compared to no training in people with COPD were evaluated. Statistically and clinically significant differences in functional exercise capacity and quality of life, as well as improvements in strength were demonstrated when exercise training with minimal equipment was compared to no training [six-minute walk test: mean difference 40 (95% CI: 13 to 67) metres; St George's Respiratory Questionnaire: mean difference -7 (95% CI: -12 to -3) points]. While the number of studies is relatively small and of variable quality, there is growing evidence that exercise training using minimal, low cost equipment may be an alternative to equipment-intensive pulmonary rehabilitation programs.

Land-based exercise is often difficult for people with chronic obstructive pulmonary disease (COPD) who have coexisting obesity or musculoskeletal or neurological conditions. This randomised controlled trial aimed to determine the effectiveness of water-based exercise training in improving exercise capacity and quality of life compared to land-based exercise training and control (no exercise) in people with COPD and physical comorbidities. Participants referred to pulmonary rehabilitation were randomly allocated to a water-based exercise, land-based exercise or the control group. The two exercise groups trained for 8 weeks, completing three sessions per week. 45 out of 53 participants (mean ± SD age 72 ± 9 years; forced expiratory volume in 1 s 59 ± 15% predicted) completed the study. Compared to controls, water-based exercise training significantly increased 6-min walking distance, incremental and endurance shuttle walk distances, and improved Chronic Respiratory Disease Questionnaire (CRDQ) dyspnoea and fatigue. Compared to land-based exercise training, water-based exercise training significantly increased incremental shuttle walk distance (mean difference 39 m, 95% CI 5-72 m), endurance shuttle walk distance (mean difference 228 m, 95% CI 19-438 m) and improved CRDQ fatigue. Water-based exercise training was significantly more effective than land-based exercise training and control in increasing peak and endurance exercise capacity and improving aspects of quality of life in people with COPD and physical comorbidities.

The aims of the study were to determine the effect of short-form Sun-style t'ai chi (SSTC) (part A) and investigate exercise intensity of SSTC (part B) in people with chronic obstructive pulmonary disease (COPD). Part A: after confirmation of eligibility, participants were randomly allocated to either the t'ai chi group or control group (usual medical care). Participants in the t'ai chi group trained twice weekly for 12 weeks. Part B: participants who had completed training in the t'ai chi group performed a peak exercise test (incremental shuttle walk test) and SSTC while oxygen consumption (VO₂) was measured. Exercise intensity of SSTC was determined by the per cent of VO₂ reserve. Of 42 participants (mean ± sd forced expiratory volume in 1 s 59 ± 16% predicted), 38 completed part A and 15 completed part B. Compared to control, SSTC significantly increased endurance shuttle walk time (mean difference 384 s, 95% CI 186-510); reduced medial-lateral body sway in semi-tandem stand (mean difference -12.4 mm, 95% CI -21- -3); and increased total score on the chronic respiratory disease questionnaire (mean difference 11 points, 95% CI 4-18). The exercise intensity of SSTC was 53 ± 18% of VO2 reserve. SSTC was an effective training modality in people with COPD achieving a moderate exercise intensity which meets the training recommendations.