OBJECTIVE: Pulmonary rehabilitation in patients with COPD has been shown to be beneficial but the optimal setting is not known. In the present study, the efficacy of a short-term community-based exercise programme was compared with a standard hospital outpatient programme. Additionally, the usefulness of community or home programmes in maintaining improvements in the longer term was studied. METHODOLOGY: Forty-three patients with moderate to severe COPD were randomized to one of the following three groups: a 3-month hospital programme then a 9 month home programme (Hospital/Home); a 3-month hospital programme then a 9-month community programme (Hospital/Community); or a 12-month community programme (Community/Community). The initial 3-month programme was analysed by comparing the Hospital group (Hospital/Home plus Hospital/Community) with the Community group (Community/Community). Six-minute walking distance (6MWD), quality of life (Guyatt chronic respiratory disease questionnaire, CRQ) and lung function were measured at 0, 3, 6 and 12 months and results were analysed using the Wilcoxon rank sum test. RESULTS: At 3 months, there was a significant improvement from baseline in 6MWD in the Hospital group (81.3 +/- 18.3 m, P < 0.05, anova) but not the Community group (14.4 +/- 28.5 m, not significant). The difference between the groups was not significant (P = 0.058). At 3 months, there was a significant improvement in quality of life in the Hospital group (CRQ +16.3 +/- 3.1, P < 0.01, anova) and in the Community group (CRQ +10.2 +/- 4.9, P < 0.05, anova) but the difference between the groups was not significant. Following the initial 3-month programme, the dropout rate was high overall (73% by 12 months), and therefore data from the maintenance programme could not be analysed. CONCLUSIONS: A 3-month community-based exercise programme for patients with COPD did not improve 6MWD. The long-term retention rates in the programmes were poor.

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PubMedDate not supplied

A new unsupported upper limb exercise test for patients with chronic obstructive pulmonary disease.

UNLABELLED: PURPOSE This study aimed to develop a new unsupported upper limb exercise test (UULEX) for patients with chronic obstructive pulmonary disease (COPD). METHODS: The reproducibility of the UULEX was assessed in nine patients with COPD who performed the test on three occasions. A comparison of the UULEX and a supported incremental upper limb exercise test (SULEX) using an arm ergometer also was performed with 18 patients who had COPD. RESULTS: There were no significant differences in the maximum values for each cardiorespiratory variable and sensation of dyspnea between the three repetitions of the UULEX, and all the variables showed high reproducibility. During the supported test, maximum values for the cardiorespiratory variables were significantly higher, but the ratio of minute ventilation to carbon dioxide output was lower than during the unsupported exercise test. There were significant correlations for cardiorespiratory responses, arm muscle fatigue, and sensation of dyspnea between the two tests. CONCLUSIONS: The findings suggest that the new UULEX test is a reproducible and acceptable exercise test for patients with COPD that can be used as a simple method to evaluate upper limb function in these patients. Further studies are required to determine the external validity of the test and its sensitivity to interventions such as pulmonary rehabilitation.

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