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Exercise rehabilitation in COPD and heart failure: comparison of two national audits

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posted on 2023-03-24, 11:41 authored by Amy JonesAmy Jones, Rachael A Evans, Alexander S Harrison, Lauren SherarLauren Sherar, Michael C Steiner, Patrick Doherty, Sally J Singh

Background: Pulmonary (PR) and cardiac rehabilitation (CR) are recommended in the management of chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF); the impact of coexisting COPD and CHF on completion and outcomes of rehabilitation programmes is unknown. We examined enrolment, completion and clinical outcomes of CR and PR in adults with COPD, CHF and coexisting COPD and CHF.

Methods: The National Audit of CR and National COPD Audit Programme: clinical audits of PR were analysed (211 PR and 237 CR programmes); adults with a diagnosis of CHF, COPD or coexisting COPD and CHF were identified (COPD+CHF or CHF+COPD according to database). Propensity matching was conducted (age, sex, body mass index and functional status) between COPD+CHF and COPD, and CHF+COPD and CHF. Group by time interaction was examined using mixed 2×2 analysis of variance.

Results: Those with CHF+COPD had lower enrolment and completion of CR compared to those with CHF; there were no differences in PR enrolment or completion between the two groups. Adults with COPD made a significantly larger gain in the incremental shuttle walk test compared to adults with COPD+CHF following PR (59.3 m versus 37.4 m); the improvements following CR were similar (CHF 77.3 m versus CHF+COPD 58.3 m). Similar improvements were made in the 6-min walk test following CR (CHF 45.1 m versus CHF+COPD 38.8 m) and PR (COPD 48.2 m versus COPD+CHF 44.0 m). Comparable improvements in quality of life and mood state were made following CR and PR, regardless of diagnosis.

Conclusion: We have demonstrated that multi-morbid adults benefit from exercise-based rehabilitation, yet efforts are needed to promote completion. These findings support group-based, tailored, multi-morbid exercise rehabilitation.


National Institute for Health Research (NIHR) Leicester Biomedical Research Centre – Respiratory

NIHR clinician scientist fellowship CS-2016–16–020

National Centre of Sports and Exercise Medicine, Loughborough University

Centre for Exercise and Rehabilitation Sciences, University Hospitals of Leicester NHS Trust, Leicester



  • Sport, Exercise and Health Sciences

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ERJ Open Research






European Respiratory Society


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This is an Open Access Article. It is published by the European Respiratory Society under the Creative Commons Attribution 4.0 International Licence (CC BY). Full details of this licence are available at: https://creativecommons.org/licenses/by/4.0/

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Prof Lauren Sherar. Deposit date: 24 March 2023

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