Effect of pulmonary rehabilitation duration on exercise capacity and health-related quality of life in people with chronic obstructive pulmonary disease (PuRe Duration Trial): A randomized controlled equivalence trial

Background and objective: There is no strong evidence on the optimal duration of pulmonary rehabilitation (PR) programmes. The aim of the study was to determine whether an 8-week PR programme was equivalent to a 12-week PR programme in improving endurance exercise capacity in people with chronic obstructive pulmonary disease (COPD).

Methods: Participants with COPD were randomized to either an 8-week (8-wk Group) or 12-week (12-wk Group), twice weekly, supervised PR programme consisting of endurance and strength training and individualized self-management education. Between group comparisons were made at completion of each programme (i.e., week 8 or week 12), for both programmes at week 12, and at 6-12-month follow-up. The primary outcome was endurance exercise capacity measured by the endurance shuttle walk test (ESWT) with the minimally important difference of 186 s set as the equivalence limit.

Results: Sixty-six participants [mean (SD); age 69 (7) years, FEV₁ 48 (17) %predicted] were randomized (33 per group). Between-group comparisons demonstrated that the ESWT time was equivalent for the 12-wk Group compared to the 8-wk Group at programme completion [mean (95% CI)] [71 s (-61 to 203)], week 12 [70 s (-68 to 208)], and 6-12-month follow-up [93 s (-52 to 239)], though superiority of the 12-wk Group could not be ruled out at each time point.

Conclusion: Equivalence was shown between 8-and 12-week PR programmes for endurance exercise capacity, but superiority could not be ruled out for the 12-wk Group. Decisions about programme duration may depend on local waitlist times, healthcare budgets and patient preference.