Abstract
Background: Although the benefits of comprehensive pulmonary rehabilitation have been demonstrated in patients with COPD, the effects of exercise sessions within self-management programs remain unclear. We hypothesized that 8 supervised exercise sessions incorporated in a 1-month self-management education program in COPD patients would be effective to improve health outcomes and to reduce direct medical costs after one year, compared to usual care. Methods: In this randomized controlled trial, 38 moderate-to-severe COPD patients were assigned either to an intervention group or to a usual care group. The hospital-based intervention program provided a combination of 8 sessions of supervised exercise with 8 self-management education sessions over a 1-month period. The primary end-point was the 6-min walking distance (6MWD), with secondary outcomes being health-related quality of life (HRQoL) e using the St. George’s Respiratory Questionnaire (SGRQ) and Nottingham Health Profile (NHP), maximal exercise capacity and healthcare utilization. Data were collected before and one year after the program.Results: After 12 months, we found statistically significant between-group differences in favor of the intervention group in 6MWD (þ50.5 m (95%CI, 2 to 99), in two domains of NHP (energy, 19.8 ( 38 to 1); emotional reaction, e10.4 ( 20 to 0)); in SGRQ-symptoms ( 14.0 ( 23 to 5)), and in cost of COPD medication ( 480.7 V (CI, 891 to 70) per patient per year).Conclusion: The present hospital-based intervention combining supervised exercise with self- management education provides significant improvements in patient’s exercise tolerance and HRQoL, and significant decrease of COPD medication costs, compared to usual care.