Endurance or resistance training in primary care after in-patient rehabilitation for COPD?

Summary 

Resistance (RT) and endurance training (ET) prescribed by a rehabilitation centre and carried out under the supervision of primary care physiotherapists after the completion of 4 weeks of multidisciplinary in-patient pulmonary rehabilitation (IPR) were compared regarding capacity to induce further health effects.

After IPR, 40 chronic obstructive pulmonary disease (COPD) patients were allocated to RT or ET twice weekly for 12 weeks. Primary outcome variables were walking capacity (treadmill endurance time, TET; 6-min walking distance, 6MWD), functional status (Glittre ADL-test; Hyrim Physical Activity Questionnaire) and health-related quality of life (HRQOL) (St. George's Respiratory Questionnaire, SGRQ). Body functions variables were included as secondary outcome measures. HRQOL and physical activity were reinvestigated after 1 year.

Median attendance rates were not different between RT (21, interquartile range [17;23]) and ET (22 [18;24]). Both groups improved in TET (RT 7.7min 95% CI {3.6;12}, ET 5.7min {1.7;9.8}). 6MWD increased significantly after ET (46m {20;72}). Functional status was unchanged. SGRQ tended to further improve after RT (−3.2{−7.4;1.2}), while ET maintained the improvement gained during IPR. Body functions measures changed according to training modality. After 1 year, a majority of patients in both groups were exercising regularly, but SGRQ was significantly better than pre-IPR only in the RT group (−7.9{−14.3;−1.5}).

We conclude that supervised RT or ET twice weekly sustains and improves the effects of IPR. With no large differences detected between the two training modalities, the choice of training may be guided by individual needs, patient preferences and the availability of equipment.

Keywords: Chronic obstructive pulmonary disease, Physical training in COPD, Health-related quality of life, Primary care, Pulmonary rehabilitation