Efficacy of supervised maintenance exercise in peer support groups to maintain gains following pulmonary rehabilitation: A quasi-experimental study

Title: Efficacy of supervised maintenance exercise in peer support groups to maintain gains following pulmonary rehabilitation: A quasi-experimental study
Author(s): B Murphy, A Holmes, B Fitzgibbon
Institution: University of Limerick, St. Luke's Hospital Kilkenny
Poster: Click to view poster
Category: Asthma and COPD
Abstract: Introduction:
Although the short-term benefits of pulmonary rehabilitation (PR) are well established in patients with chronic obstructive pulmonary disease (COPD) (Spruit et al. 2013), the long-term benefits are unclear as outcomes often return to baseline in the months following the programme. One factor attributed to this is non-adherence to regular exercise in the post-rehabilitation period (Donesky et al. 2015) Despite this, no standard approach to assist patients in maintaining exercise levels currently exists.

The aim of this study was to examine:
i) If supervised, community-based exercise in a peer support group was more likely to maintain exercise capacity and health status than usual care 12-18 months following PR.
ii)Perceived barriers and facilitators to participation in the SG.

Following completion of an 8-week PR programme, participants with COPD were encouraged to take part in a community-based peer support group (SG) involving weekly exercise and bimonthly healthcare education.
Those who elected not to join received usual primary care follow-up (UCG).
Outcome measurements at pre-PR, baseline (post-PR) and 12-months included the incremental shuttle walk test (ISWT), COPD assessment test (CAT) and secondary measures of anxiety, depression, lower limb functional capacity and gait speed. Programme adherence and the benefits and barriers to participation were assessed with a self-reported questionnaire.

All participants of PR with a primary diagnosis of COPD who fully completed the 8 week PR program between Oct and Dec 2018 were invited to participate and attend for review (n=36). Nineteen patients attended for 12-18 month follow-up. No adverse events were reported. Participants endorsed the benefits of the SG. Barriers to participation included accessibility, transport availability and timing of sessions.

Clinical Outcomes:
Mean changes at one-year showed significant and clinically relevant between-group differences in favour of the SG for exercise capacity, gait speed and anxiety (all p < 0.05). No significant differences were found for health status, depression or lower limb functional capacity (however low power was a limiting factor).

A community-based peer support group with an integrated exercise programme is endorsed by patients with COPD, however barriers such as programme accessibility and timing of sessions must be explored.
This model can offer a potentially innovative and efficient way of maintaining exercise capacity and health-related quality of life domains following PR.
A larger, multicentre, randomized controlled trial is warranted to further explore the promising results of this study