Home-based Pulmonary Rehabilitation: Benefits Similar to a Standard Program

Home-based Pulmonary Rehabilitation: An Alternative Approach

Background: Unfortunately, overall participation in standard pulmonary rehabilitation programs is low. The many reasons include no interest, “I am too busy,” travel time, inconvenience, and cost, depending on the individual’s medical insurance. Although home-based pulmonary rehabilitation offers an alternative, there is little information about its benefits. Does it work as well as a person going to the hospital or facility with an experienced nurse, respiratory therapist, and/or an exercise specialist?
Dr. Elizabeth Horton

Dr. Elizabeth Horton is Senior Lecturer in Exercise and Health at Coventry University

Study: Dr. Elizabeth Horton and colleagues from the Faculty of Health and Life Sciences, Coventry University, and the Centre for Exercise and Rehabilitation Science, University Hospitals Leicester NHS Trust, in the United Kingdom performed the study. 187 patients with COPD referred to their hospitals for pulmonary rehabilitation were assigned to either a standard program supervised by trained professionals OR to a structured unsupervised home-based pulmonary rehabilitation program. Shortness of breath with activities was selected as the main outcome to compare whether the home-based program was “as good as” the hospital-based program. The home-based pulmonary rehabilitation program included one hospital visit with a health care professional trained in motivational interviewing, a self-management manual, instructions on exercise, and two telephone calls over the 7 weeks.
Different exercises as part of a home-based pulmonary rehabilitation program

Different types of exercises can be performed as part of a home-based pulmonary rehabilitation program

The study was published on-line on July 29, 2017, in the journal Thorax (doi: 10.1136/thoraxjnl-2016-208506). Results: Both groups of patients had significant, but similar, gains in shortness of breath measured on the Chronic Respiratory Questionnaire Self-Report after 7 weeks. The authors did not report on changes in other outcomes such as exercise ability or albuterol rescue use. Conclusions: The authors concluded that a structured home-based pulmonary rehabilitation program was “as good as” the standard hospital-based program for improving daily shortness of  breath. My Comments: Not everyone with COPD is interested or able to perform physical activities for a variety of reasons. For almost all patients with COPD whom I see in my practice, I recommend participation in a standard pulmonary rehabilitation program . Major benefits include: better breathing; better quality of life; less frequent flare-ups (exacerbations); and the ability to do more physical activities.
Water exercise may be part of a home-based pulmonary rehabilitation program

Water Aerobics may be part of a home-based pulmonary rehabilitation program

If this is not possible, then I encourage the person to “do more” on their own. This may using a treadmill or exercise bike in their apartment or home, going to a community fitness center, and/or using an available swimming pool. I ask the person to write down these activities on paper or on the computer and bring this information at their next appointment.

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.