S136 Implementation of the BTS clinical statement on pulmonary rehabilitation 2023: evidence from a community COPD service

Résumé fourni par la source

Pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) is associated with improved symptoms, exercise capacity, health- related quality of life and a reduction in exacerbation frequency. The British Thoracic Society (BTS) clinical statement (2023) recommends both aerobic and resistance exercise training as part of PR programmes, which underpins standards to achieve accreditation from the PR Service Accreditation Scheme (PRSAS). We aimed to evaluate the impact of a new PR programme (PRnew), adapted to meet PRSAS standards, on outcomes in patients from a COPD community service (CCS), compared to the former PR programme (PRold). PR programmes were community-based, comprising of 90-minute supervised sessions performed twice weekly; PRold consisted of aerobic components only, whilst PRnew included the addition of resistance training, in lieu of 3 aerobic components. Clinical outcomes following the completion of the programmes were compared between programmes, including: COPD assessment test (CAT) score, hand grip strength (HGS) and incremental shuttle walk test (ISWT), in a retrospective analysis of patients under the care of a CCS, Manchester University NHS Foundation Trust, between 2023–2025. COPD patients (n=89) were aged 67.6 (8.7) years, well balanced for biological sex (53.9% female) and 28.1% were current smokers, with a pack year history of 39.0 (21.9). Mean FEV1 was 69.0% (19.4%). PRnew and PRold comprised n=43 vs n=46 COPD patients; there were no differences in baseline characteristics between groups (table 1). Significant improvements in CAT, HGS and ISWT were observed following completion of PRnew (CAT: 20.1 vs 15.9, p<0.01; ISWT: 234.7 vs 327.0m, p <0.01; HGS: 26.4 vs 29.4 kg, p= 0.01) and PRold (CAT: 22.6 vs 16.8, p<0.01; ISWT: 215.9 vs 295.0m, p<0.01; HGS: 30.6 vs 32.1 kg, p=0.02). No differences in the magnitude of improvement were observed between programmes for any clinical outcome when assessed as a continuous variable or as the proportion of patients meeting the MCID (table 1). Improvements in outcome measures were observed for all patients undertaking PR, regardless of PR programme structure. Despite the addition of resistance training, we observed no difference in outcomes between the programmes, including HGS, a surrogate marker of muscle strength.

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