In chronic obstructive pulmonary disease (COPD), the benefits of pulmonary rehabilitation (PR), which are: an improvement of exercise capacity, symptoms, and health-related quality of life tend to wane over time.  The objective of this study was to determine whether a long-term (3 years) supervised maintenance program after PR preserves the short-term effects on the outcomes in patients with moderate to severe COPD compared to minimal standard monitoring programs. Some other studies have shown that the benefits of PR programs last no more than 1 year with a maintenance technique, whereas other studies have shown that these techniques manage to extend the benefits of PR for longer periods.

This study was performed in multiple Health Care Centers in Spain. It was a prospective study (investigators recruit patients, and collect baseline exposure data on all them before any of the patients have developed any of the outcomes of interest, and finally followed into the future in order to record the appearance of any of the outcomes of interest). It was also a randomized study (people participating in the trial are randomly allocated to either the group receiving the treatment under investigation or to a group receiving standard treatment or placebo as the control).

This clinical trial included 143 patients with moderate–severe COPD, with 3 years of PR maintenance following an 8-week outpatient PR program, which included a 2 hour, 2-3 times weekly of educational sessions and chest physiotherapy. After completion of the 8-week PR program, patients were randomized to maintenance intervention group (IG) and standard monitoring program or control group (CG). In the IG maintenance program, patients were asked to continue at home a similar session to the initial PR program; during the 3 year period, these patients were called by the physiotherapist every 2 weeks. Also, they were asked to attend a similar program in the Hospital. Patients in the CG group were advised to maintain the exercise at home without any supervision.

The main outcomes measures were BODE index (scoring and capacity index used to test patients who have been diagnosed with COPD to predict long-term outcomes), 6-minte walk test (6MWT: exercise capacity test) and respiratory questionnaires as the health-related quality of life (HRQoL). The effects on these measurements were compared at 12, 24, and 36 months. A total of 138 (96.5%) completed the 8-week program. At this time, all outcomes (BODE, 6MWD, and HRQoL) showed clinically and mathematical significant improvements. During the follow-up period, the magnitude of change in the exercise capacity test differed between IG and CG, with a slight initial increase in the IG during the first year and smaller decline afterward. The BODE index (COPD outcome predictor) changes differed between baseline and measurements at 2 years. The drop out rate in the IG group was low (less than 4%), possibly related to impediments of people’s attendance to PR programs like travel, transport barriers, lack of perceived benefits, depression or COPD exacerbations.

This study shows a 2-year beneficial effect of a program of rehabilitation maintenance on the BODE index and 6MWD when compared with a standard strategy. This effect vanishes after the second year of follow-up. One of the main pitfalls of this study was that it involved mainly men patients, so these conclusions may not be extrapolated to women. Also, the analysis at-home compliance was difficult to asses. More studies are needed, especially for women with COPD, to generalize recommendations on long-term benefits of PR Programs, however, there are suggestions that these programs are beneficial.