Comparing 8-Week vs 12-Week Pulmonary Rehabilitation in COPD

Photo Credit: Vittorio Gravino

Researchers conducted a randomized trial to compare 8-week versus 12-week pulmonary rehabilitation programs for chronic obstructive pulmonary disease.

An 8-week pulmonary rehabilitation (PR) program yielded equivalent improvements in endurance exercise capacity compared with a 12-week program for patients with chronic obstructive pulmonary disease (COPD), according to a randomized trial published in Respirology. However, the longer program showed superior results in maintaining HRQOL 6-12 months post-rehabilitation.

PR is a cornerstone treatment designed to alleviate symptoms such as breathlessness, fatigue, and reduced physical activity among patients with COPD and improve patient outcomes. PR programs typically include supervised exercise training, education, and psychological support, leading to improved exercise capacity and HRQOL and reduced hospital admissions following exacerbations.

While the benefits of PR are well established, the optimal duration of these programs remains unclear, according to study author Joshua A. Bishop and colleagues. Although previous studies have explored PR programs ranging from 4 weeks to 18 months, evidence on the ideal duration for maintaining improvements is inconclusive.

“If the outcomes of programs of differing durations are equivalent, the additional cost to healthcare systems and increased patient burden of longer programs could be avoided. Conversely, if longer programs result in the maintenance of benefits, such programs may be worthwhile,” the researchers wrote.

To better understand the impact of these programs, the researchers conducted a prospective, multisite, randomized, controlled equivalence trial, recruiting 66 patients with COPD from three sites in Sydney, Australia. The study authors randomized patients into two groups, each undergoing an 8-week or 12-week PR program. Both programs included supervised exercise sessions twice weekly, supplemented with self-directed walking exercises at home.

The primary outcome was endurance exercise capacity, measured by the endurance shuttle walk test (ESWT). Secondary outcomes included functional exercise capacity, HRQOL, anxiety, depression, physical activity, and healthcare utilization. The researchers collected data from both groups at week 12 and during follow-up care at 6-12 months.

The mean difference in ESWT between the 12-week and 8-week groups was 71 seconds (95% CI, -61 to 203) at program completion, favoring the 12-week program.

“However, the mean difference and lower end of the CI fell within the EL, indicating equivalence between groups,” Bishop and colleagues said, adding that “the upper end of the CI was above the upper bound of the EL, demonstrating that superiority of the 12-week group could not be ruled out.”

Secondary outcomes, such as functional exercise capacity (6-minute walk distance), also demonstrated equivalence between the groups at program completion. However, the 12-week group showed superiority at follow-up with a mean difference of 37 meters (95% CI, 12-62).

HRQOL, measured using the St. George’s Respiratory Questionnaire, showed greater improvement in the 12-week group, with superiority over the 8-week group both at program completion (-6 points; 95% CI, -10 to -2) and follow-up (-10 points; 95% CI, -15 to -6).

The researchers found no significant differences between groups for other secondary outcomes, such as the COPD Assessment Test score, Hospital Anxiety and Depression Scale scores, and daily step counts.

There were also no significant differences in healthcare utilization, including ED visits and hospital admissions, between the groups during the 12 months following program completion.

The researchers concluded that while the 8-week and 12-week PR programs generally were equivalent in improving endurance exercise capacity, the 12-week program showed some additional benefits in functional exercise capacity and HRQOL, particularly over the long term.

“The equivalence demonstrated in endurance exercise capacity at all time points between these groups is an important finding, as previous research had been unclear on the effect of PR durations on exercise capacity,” Bishop and colleagues concluded. “Longer PR programs mean an additional cost to the healthcare system; therefore, the decision to implement longer programs will depend on local waitlist times, healthcare budgets, and patient preference.”