A home-based exercise program had no effect on dyspnea in patients with chronic obstructive pulmonary disease (COPD) who had already completed pulmonary rehabilitation (PR); however, the program did improve exercise capacity and was beneficial based on patient reports. These were among study findings published in CHEST.
Most patients with COPD do not maintain gains made in exercise training during pulmonary rehabilitation. Researchers therefore conducted a clinical trial (HOMEX-1; ClinicalTrials.gov Identifier: NCT03461887) to develop and assess HOMEX, a structured, home-based strength training program for patients with COPD that patients can do following PR to maintain training effects of rehabilitation or on a stand-alone basis.
The randomized, parallel group, controlled trial enrolled 123 patients with COPD who had undergone PR at 1 of 4 Swiss PR clinics from January 2018 to March 2020. Participants were randomly assigned to either an intervention group (IG; n=61) receiving home-based exercise training or to a control group (CG; n=62) receiving no intervention/usual care. The average age was 66.8 (SD 8.1) years, 50% were female, and 75% had severe or very severe COPD.
Participants in the IG were instructed to perform the training 6 days per week for about 20 minutes per day for 12 months. The primary outcome was change in dyspnea after 12 months as measured with the self-administered version of the Chronic Respiratory Questionnaire (CRQ) dyspnea domain; other outcomes included functional exercise capacity, patient-reported improvements and satisfaction, and cost-effectiveness. Of the cohort, 104 participants completed the 12-month follow-up assessments (53 IG, 51 CG).
For the IG group, CRQ dyspnea decreased from 4.65 (SD±1.33) at baseline to 4.42 (SD±1.49) at 12 months, and for the CG group CRQ dyspnea decreased from 4.61 (SD±1.27) to 4.06 (SD±1.45). No evidence was found for a between-group difference in change of CRQ dyspnea after 12 months in the intention-to-treat analysis (0.28; 95% CI, -0.23 to 0.80; P =.27).
No difference in the 6-minute walk test distance after 12 months was observed in the 2 groups (1.37; 95% CI, -35.06 to 37.79, P =.94). However, researchers found moderate evidence of improvement in the 1-minute-sit-to-stand-test in the IG group (2.6; 95% CI, 0.22-5.03; P =.033). For all other outcomes, no evidence of differences was observed between the 2 groups.
A total of 37 participants (70%) performed the training exercise until the study’s end and 42 (79%) for at least 10 months. In addition, 16 participants discontinued the training on average after 28 weeks (SD±14.6, range 1-46), 11 owing to health reasons and 5 for other reasons.
Regarding findings from the satisfaction survey, 81% of IG group participants reported that they much or very much liked participating in the program. Also, 41 participants (79%) reported seeing positive effects from the training. Analysis of cost-effectiveness found that the intervention was 44% likely to be cost-effective.
Among several study limitations was that some participants did not travel to the rehabilitation clinics for the follow-up assessment, thus requiring assessors to conduct home visits. In addition, the assessors were not blinded and changes in muscle strength were not objectively measured to quantify self-reported improvement in strength.
“Although we were not able to demonstrate statistical evidence for an effect of the HOMEX program on most objectively assessed outcomes, a vast majority of the IG participants reported that they experienced positive changes in daily life which they attributed to the training,” the study authors commented.
Frei A, Radtke T, Lana KD, et al. Effectiveness of a long-term home-based exercise training program in patients with COPD following pulmonary rehabilitation: a multi-center randomized controlled trial. Chest. Published online August 8, 2022. doi:10.1016/j.chest.2022.07.026