Early comprehensive pulmonary rehabilitation for hospitalized patients with acute ex-acerbation of chronic obstructive pulmonary disease: a randomized controlled trial.

The assessors could not be fully blinded to group allocation. The trial combined strength training, inspiratory muscle training, endurance exercise and education, so the contribution of any single component cannot be separated. The primary discharge walking distance was not significantly different between groups; the positive result was the change from baseline. The in-hospital programme lasted only during admission, while guidelines recommend pulmonary rehabilitation for more than 8 weeks. Seven usual-care patients were excluded from analysis because they refused discharge reassessment, and they were overweight and had a shorter walking distance. At 1 year, 46 patients were lost to follow-up, so long-term exacerbation results are uncertain. Patients had to be able to complete a walking test and consent to exercise, so the results may not apply to patients too unwell or impaired to walk. Usual care included substantial education and a home rehabilitation proposal, so the comparison was not with no treatment.

The authors declared no conflicts of interest. The study was funded by the National Key Clinical Specialty Construction Projects of China and the Hunan Provincial Natural Science Foundation. The funders played no role in the design, conduct, or reporting of the study.

Do not conclude that early rehabilitation gives patients a longer walk than usual care at discharge. The discharge walking distance was not significantly different; the positive result was the larger improvement from baseline. Do not infer long-term benefit, because 1-year exacerbation outcomes were also not significant.