Effectiveness of an exercise training programme COPD in primary care: A randomized controlled trial

• Published in: Respiratory medicine 2020-04, Vol.165, p.105943-105943, Article 105943
• Main Authors: Fastenau, Annemieke, van Schayck, Onno CP, Winkens, Bjorn, Aretz, Karin, Gosselink, Rik, Muris, Jean WM
• Format: Article
• Language: English
• Subjects: Aged; Caregivers; Chronic obstructive pulmonary disease; Clinical trials; COPD; Dyspnea; Efficiency, Organizational; Exercise; Exercise - physiology; Exercise Tolerance - physiology; Exercise training; Female; Fitness training programs; Follow-Up Studies; Health care; Humans; Male; Middle Aged; Muscle Strength; Patients; Performance evaluation; Physical activity; Physical fitness; Physical Fitness - physiology; Physical training; Primary care; Primary Health Care; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Disease, Chronic Obstructive - rehabilitation; Quality of Life; Questionnaires; Randomized controlled trial; Rehabilitation; Respiration; School dropout programs; School dropouts; Severity of Illness Index; Time Factors; Training; Walking
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2020.105943

Pulmonary rehabilitation is very effective in improving exercise capacity, dyspnea and quality of life in the small group of patients with moderate to severe COPD. Given that little is known about exercise training in the large group of patients with mild to moderate COPD, we assessed the effectiveness of an exercise training programme in primary care. In this RCT, 90 patients with mild to moderate COPD (FEV1 74.2 ± 13.5%pred) participated in a 4-month exercise training programme or control treatment. Primary outcome was improvement in functional exercise capacity, assessed by the 6-min walking distance (6MWD). Secondary outcomes were breathlessness (MRC dyspnoea score), disease-specific quality of life (CCQ, CRQ), muscle strength and objective daily physical activity. There was a follow-up measurement at 6 months. At 4 months, we found a statistically and clinically relevant between-group difference in 6MWD of +26.6 m (95% CI: 4,3–49.0, p = 0.020). Shoulder strength significantly improved with a between-group difference of 23.9 Nm (p = 0.0350). At 6 months, there was a significant improvement in handgrip force and CRQ sub score mastery of respectively 1.9 KgF (p = 0.028) and 0.5 (p = 0.035). There were no significant between-group differences in breathlessness, quality of life, knee strength and daily physical activity. The results indicate that exercise training in primary care is particularly effective in improving physical fitness (exercise capacity and strength), but not in breathlessness, health-related quality of life and daily physical activity. A broader assessment for COPD patients in primary care might be a necessary condition to offer the most effective intervention. •Many patients with mild to moderate COPD in primary care are physically inactive.•An exercise training programme is effective in improving exercise capacity.•Increased exercise capacity is not a guarantee for enhanced physical activity.