ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Effectiveness of a Long-Term Home-Based Maintenance Exercise Training Program Using Minimal Equipment vs. Usual Care in COPD Patients: HOMEX-1 Randomized Controlled Trial
Session Title
C14 - C014 NEW INSIGHTS IN PULMONARY REHABILITATION
Abstract
A1154 - Effectiveness of a Long-Term Home-Based Maintenance Exercise Training Program Using Minimal Equipment vs. Usual Care in COPD Patients: HOMEX-1 Randomized Controlled Trial
Author Block: A. Frei1, T. Radtke1, K. Dalla Lana1, P. Brun2, T. Sigrist3, M. Spielmanns4, S. Beyer5, T. Riegler2, G. Buesching6, S. Schoendorf7, J. Braun1, T. Cerini1, R. Kunz1, M. Puhan1; 1Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland, 2Berner Reha Zentrum, Heiligenschwendi, Switzerland, 3Departement for Pulmonary Medicine, Klinik Barmelweid, Barmelweid, Switzerland, 4Pulmonary Medicine, Zürcher RehaZentren Wald, Zurich, Switzerland, 5Kantonsspital Winterthur, Zurich, Switzerland, 6Klinik Barmelweid, Barmelweid, Switzerland, 7Zürcher RehaZentren Wald, Zurich, Switzerland.
Rationale
Exercise training is an important component of pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD), but the great majority of patients with COPD never follows such programs or fails to maintain training after PR completion. Against this background, we developed the HOMEX exercise training program that requires minimal equipment and can be implemented long-term in the patient’s home-setting. The aim of the HOMEX-1 trial was to assess the effectiveness of the program in COPD patients after completing PR over the course of one year.
Methods
COPD patients recruited from four Swiss PR clinics were randomized into the intervention group (IG) or control group (usual care, CG). The HOMEX intervention consisted of minimal-equipment strength exercise training with progressive level of intensity, conducted by the participant on six days per week and instructed by a trained health care professional during three home visits and telephone calls during one year. Primary outcome was change in dyspnea (Chronic Respiratory Questionnaire; CRQ) from baseline to 12-months follow-up. Secondary outcomes were change in exercise capacity (1-minute-sit-to-stand-test, 6-minute-walk-test), health-related quality of life, health status, exacerbations and symptoms. To estimate effects we used linear regression models adjusted for stratification variables, sex and age. Data are given as numbers, mean (SD) or mean difference (95% CI).
Results
In total, 123 COPD patients (IG: 61, CG: 62) were randomized; 61 females, age 66.8 (8.1) years, FEV1% predicted 39.4 (15.4), number of comorbidities 4.2 (2.1). Hundred-and-four participants completed 12-months follow-up assessments (IG: 53, CG: 51). During the study year, 76 participants experienced at least one exacerbation [2.3 (1.6)] and 68 at least one serious adverse event (135 in total). Out of the 53 IG participants, 38 conducted the HOMEX training until study end and 43 for at least 10 months. We found no difference in change of CRQ dyspnea in one year (mean difference 0.28, 95% CI -0.23-0.80, p=0.27). There was a statistically significant difference in 1-minute-sit-to-stand test repetitions favoring the IG after one year (mean difference 2.6, 95% CI 0.02-5.03, p=0.033). In all other outcomes, no significant differences between the two groups were found.
Conclusion
The majority of this multimorbid and severely ill patient group succeeded in adhering to the HOMEX training in the long-term. Our results show that the HOMEX training provided benefit in functional exercise capacity assessed by the 1-minute-sit-to-stand test. This intervention is a promising approach to maintain the effects after PR long term.
Author Block: A. Frei1, T. Radtke1, K. Dalla Lana1, P. Brun2, T. Sigrist3, M. Spielmanns4, S. Beyer5, T. Riegler2, G. Buesching6, S. Schoendorf7, J. Braun1, T. Cerini1, R. Kunz1, M. Puhan1; 1Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland, 2Berner Reha Zentrum, Heiligenschwendi, Switzerland, 3Departement for Pulmonary Medicine, Klinik Barmelweid, Barmelweid, Switzerland, 4Pulmonary Medicine, Zürcher RehaZentren Wald, Zurich, Switzerland, 5Kantonsspital Winterthur, Zurich, Switzerland, 6Klinik Barmelweid, Barmelweid, Switzerland, 7Zürcher RehaZentren Wald, Zurich, Switzerland.
Rationale
Exercise training is an important component of pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD), but the great majority of patients with COPD never follows such programs or fails to maintain training after PR completion. Against this background, we developed the HOMEX exercise training program that requires minimal equipment and can be implemented long-term in the patient’s home-setting. The aim of the HOMEX-1 trial was to assess the effectiveness of the program in COPD patients after completing PR over the course of one year.
Methods
COPD patients recruited from four Swiss PR clinics were randomized into the intervention group (IG) or control group (usual care, CG). The HOMEX intervention consisted of minimal-equipment strength exercise training with progressive level of intensity, conducted by the participant on six days per week and instructed by a trained health care professional during three home visits and telephone calls during one year. Primary outcome was change in dyspnea (Chronic Respiratory Questionnaire; CRQ) from baseline to 12-months follow-up. Secondary outcomes were change in exercise capacity (1-minute-sit-to-stand-test, 6-minute-walk-test), health-related quality of life, health status, exacerbations and symptoms. To estimate effects we used linear regression models adjusted for stratification variables, sex and age. Data are given as numbers, mean (SD) or mean difference (95% CI).
Results
In total, 123 COPD patients (IG: 61, CG: 62) were randomized; 61 females, age 66.8 (8.1) years, FEV1% predicted 39.4 (15.4), number of comorbidities 4.2 (2.1). Hundred-and-four participants completed 12-months follow-up assessments (IG: 53, CG: 51). During the study year, 76 participants experienced at least one exacerbation [2.3 (1.6)] and 68 at least one serious adverse event (135 in total). Out of the 53 IG participants, 38 conducted the HOMEX training until study end and 43 for at least 10 months. We found no difference in change of CRQ dyspnea in one year (mean difference 0.28, 95% CI -0.23-0.80, p=0.27). There was a statistically significant difference in 1-minute-sit-to-stand test repetitions favoring the IG after one year (mean difference 2.6, 95% CI 0.02-5.03, p=0.033). In all other outcomes, no significant differences between the two groups were found.
Conclusion
The majority of this multimorbid and severely ill patient group succeeded in adhering to the HOMEX training in the long-term. Our results show that the HOMEX training provided benefit in functional exercise capacity assessed by the 1-minute-sit-to-stand test. This intervention is a promising approach to maintain the effects after PR long term.
