Background Pulmonary rehabilitation (PR) improves exercise capacity, health-related quality of life (HRQoL) and dyspnea in chronic obstructive pulmonary disease (COPD) patients. Maintenance programs can sustain the benefits for 12 to 24 months. Yet, the long-term effects (> 12 months) of pragmatic maintenance programs in real-life settings remain unknown. This prospective cohort study assessed the yearly evolution in the outcomes [6-min walking distance (6MWD), HRQoL, dyspnea] of a supervised self-help PR maintenance program for COPD patients followed for 5 years. The aim was to assess the change in the outcomes and survival probability for 1 to 5 years after PR program discharge in COPD patients following a PR maintenance program supported by supervised self-help associations. Methods Data were prospectively collected from 144 COPD patients who followed a pragmatic multidisciplinary PR maintenance program for 1 to 5 years. They were assessed yearly for 6MWD, HRQol (VQ11) and dyspnea (MRC). The 5-year survival probability was compared to that of a control PR group without a maintenance program. A trajectory-based cluster analysis identified the determinants of long-term response. Results Maintenance program patients showed significant PR benefits at 4 years for 6MWD and VQ11 and 5 years for MRC. The 5-year survival probability was higher than for PR patients without PR maintenance. Two clusters of response to long-term PR were identified, with responders being the less severe COPD patients. Conclusions This study provides evidence of the efficacy of a pragmatic PR maintenance program in a real-life setting for more than 3 years. In contrast to short-term PR, long-term PR maintenance appeared more beneficial in less severe COPD patients.

Pulmonary rehabilitation (PR) is a core component for the management of obstructive lung disease (OLD), but the benefits decline within 6 to 12 months without maintenance strategies (Spruit et al, 2013 AJRCCM). Pragmatic and effective long-term PR maintenance programs are therefore crucial. This study evaluated the effectiveness of a PR maintenance program to stabilize the benefits of PR over 7 years in patients with OLD. Data were prospectively collected from 289 OLD patients (age: 66.5±8.7 years, FEV1: 64.0±24.8%predic.) who followed a PR maintenance program lasting from 1 to 7 years. The program was carried out in self-help associations within a healthcare network and consisted in 1 session/week of supervised exercise training and 8 sessions/year of therapeutic education. Changes in 6-minute walk distance (6MWD), quality of life score (VQ11), dyspnea (MRC) and lung function (FEV1) were assessed using mixed effect linear models. Over the 7 years of follow-up, no significant deterioration in the VQ11 score (time effect: β=0.61, p=0.52), dyspnea (time effect: β=0.28, p=0.10) or FEV1 (%predic.; time effect: β=0.35, p=0.16) was observed. Conversely, 6MWD declined (%predic.; time effect: p<0.01) but this decline was statistically significant only from the 60th month (p<0.05). This study demonstrated that PR gains in exercise tolerance were maintained for 5 years and that the PR effect on dyspnea and quality of life remained stabilized for 7 years. These findings suggest that pragmatic PR maintenance programs can conserve a long term efficiency.