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Fig. 12.4 Mean values (SEM) for maximal workload (Wmax) reached during incremental symptom-limited cycle testing at visits 1-5. *, P <0.05; **, P <0.005 compared with baseline; #, P <0.05 compared with the control group [32].

Controls

Fig. 12.4 Mean values (SEM) for maximal workload (Wmax) reached during incremental symptom-limited cycle testing at visits 1-5. *, P <0.05; **, P <0.005 compared with baseline; #, P <0.05 compared with the control group [32].

for 8-10weeks, including exercise training, upper and lower limb exercises, education and a nutritional programme. After 10weeks, exercise tolerance and quality of life improved significantly in the COPD patients. However, only the improvements in quality of life were still present after 1 year. In contrast, Strijbos et al. did show more positive effects after home-based rehabilitation after 18months [32]. This controlled trial compared home-based rehabilitation and outpatient rehabilitation with a control group. Patients received a programme of 12 weeks consisting of visiting the physiotherapist twice weekly either at the outpatient clinic (outpatient group) or in their own environment (home group). In addition, a nurse and a physician supervised the patients once a month. After this period of 12weeks, no supervision was given. After 18 months, the home-based rehabilitation group showed a significantly improved maximal workload compared to the control group (Fig. 12.4), and a significantly improved walking distance compared to baseline. Both groups showed a significant improvement in well-being after 18 months. Another Dutch study that investigated the long-term effects of rehabilitation at home showed that health status improved, but exercise tolerance remained the same (Fig. 12.5) [39,40]. In contrast, exercise tolerance in the control group decreased significantly, whereas the health status remained unchanged.

Recently, a very interesting study was published by Griffiths et al. Two hundred patients with COPD, with a mean FEVj of 0.9 ± 0.4L, were randomly assigned to a 6-week multidisciplinary outpatient rehabilitation programme (18 visits) or standard medical management [41]. After 1year, there

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