慢性阻塞性肺疾病患者的社区运动康复

目的探讨社区开展慢性阻塞性肺疾病(COPD)运动康复对缓解期患者日常生活活动能力和生活质量的影响。方法对社区病情稳定的COPD患者20例进行为期10周的传统康复运动处方锻炼。康复前后进行肺功能、改良Borg呼吸困难评分、6分钟步行试验(6MWD)、圣乔治呼吸问卷(SGRQ)评定。结果康复后,患者Borg计分从(4.45±2.04)降至(3.15±2.13)(P0.05),6MWD从(370.32±74.48)m增加至(403.75±76.15)m(P0.05);SGRQ评定结果中症状分从(48.10±27.94)降至(38.20±25.52)、活动分从(46.30±19.28)降至(40.60±16.93)、影响分从(37.4±24.28)降至(28.55±21.6)、总分从(42.00±20.84)降至(33.65±18.46)(均P0.05)。结论运动康复可以提高社区缓解期COPD患者的运动能力,减轻呼吸困难,提高生活质量。     

经支气管镜大容量肺灌洗治疗尘肺病合并慢性阻塞性肺疾病的疗效分析*

目的评价经支气管镜大容量肺灌洗对尘肺病合并慢性阻塞性肺疾病(COPD)患者的临床症状及肺功能的改善作用。方法 103例尘肺病合并COPD患者随机分为治疗组54例,给予经支气管镜大容量肺灌洗治疗,对照组49例。观察患者治疗前、治疗后12、24和48周运动耐量、呼吸困难评分、6 min步行试验距离(6MWD)、圣乔治问卷评分(SGRQ)以及肺功能变化。并记录灌洗时的不良反应。结果两组患者第12、24和48周医学研究委员会(MRC)呼吸困难评分均较治疗前下降(P 0.05),但治疗组较对照组下降更明显(P 0.05);治疗组各时点6MWD值较前明显增加,SGRQ较治疗前下降,差异均有统计学意义(P 0.05),而对照组有所改善,但与治疗前比较差异无统计学意义(P0.05);治疗组中各项指标较对照组改善(P 0.05)。治疗组12、24和48周用力肺活量(FVC)、第1秒用力肺活量(FEV1)均较治疗前明显增加(P 0.05);对照组与治疗前比较无差异,治疗组肺功能改善优于对照组(P 0.05)。结论经支气管镜大容量肺灌洗治疗尘肺病合并COPD安全、有效,值得临床推广。     

慢性阻塞性肺疾病肺康复护理的探讨

目的 探讨肺康复护理对慢性阻塞性肺疾病（COPD）患者康复的影响.方法 将88例COPD患者分为康复组48例和对照组40例.对照组采用常规护理,康复组在对照组基础上给予肺康复护理训练指导.在康复训练前和康复训练6个月后收集患者的肺功能、6min步行距离（6MWD）及呼吸资料.呼吸测定采用圣·乔治医院呼吸问卷（SGRQ）.将康复组和对照组患者康复训练6个月后相关指标与康复训练前进行对比.结果 康复训练6个月后,康复组患者的SGRQ总分、症状评分、活动评分和影响评分均降低.康复组患者经过6个月肺康复训练,6MWD提高了50.1m.对照组患者6个月后各项目与康复训练前比较均无统计学意义.康复训练6个月后康复组患者的SGRQ各项分值和6MWD好于对照组.结论 合理的肺康复护理不但可以提高康复训练效果,而且肺康复训练还可以改善COPD患者的呼吸困难症状,提高运动耐力和改善与健康相关的生活质量.     

连续护理干预对COPD病人生活质量的影响

[目的]探讨连续护理干预对慢性阻塞性肺疾病(COPD)病人生活质量的影响。[方法]将86例COPD病人采用随机数字表法分为对照组和观察组各43例,对照组采用常规护理模式,观察组出院后给予连续护理干预6个月,对照分析两组的肺功能(FEV1、FVC)、呼吸困难程度(MMRC评分)、6 min连续步行距离(6MWD)及生活质量(SGRQ 问卷评分)。[结果]观察组护理干预后的FEV1、FVC、SGRQ、MMRC评分及6MWD均显著优于对照组(P<0.05)。[结论]连续护理干预可明显改善 COPD病人呼吸困难程度,延缓肺功能下降,提高生活质量。     

行为认知疗法对农村COPD老年患者院外康复治疗依从性的影响

目的:探讨行为认知疗法对农村慢性阻塞性肺疾病(COPD)老年患者院外康复治疗依从性的影响。方法:选取老年急性加重期COPD患者120例作为研究对象,随机分为研究组和对照组各60例,两组均常规进行急性加重期COPD治疗,并于出院后每月2次通过电话随访进行院外用药指导、康复锻炼、健康教育等康复治疗;研究组在对照组的基础上采用行为认知疗法。比较两组随访期间的依从性和出院12周时的患者满意度,比较两组出院当天、出院6周和出院12周时肺功能指标、6min步行距离(6MWD)和生存质量(SGRQ)评分。结果:研究组依从性和患者满意度明显高于对照组(P0.05);与出院时比较,两组出院后的一秒用力呼出量(FEV_1)、用力肺活量(FVC)等肺功能指标和6MWD均升高,同期SGRQ得分则均降低(P0.05);与对照组比较,研究组出院后的FEV_1、FVC和6MWD均升高,同期SGRQ得分均降低(P0.05)。结论:行为认知疗法可有效改善农村COPD老年患者院外康复治疗效果和依从性,提高患者满意度及其生存质量,值得临床推广应用。     

肺康复锻炼联合呼吸操干预对慢性阻塞性肺疾病患者康复的影响

目的探讨肺康复锻炼联合呼吸操对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者康复的影响。方法按随机数字表法将100例患者分为对照组和观察组各50例。对照组按照COPD护理常规进行护理,观察组在对照组基础上给予肺康复锻炼联合呼吸操干预,观察比较两组患者干预前和干预后6个月的肺功能情况、血气分析及生活质量状况。结果干预前两组患者动脉血气分析和肺功能各项指标、SGRQ问卷各维度评分和总分比较,差异无统计学意义(P0.05);干预6个月后观察组动脉血气分析和肺功能各项指标、SGRQ问卷各维度评分和总分均优于对照组,两组比较差异有统计学意义(P0.01)。结论肺康复锻炼联合呼吸操干预能明显改善COPD患者的肺功能,提高患者的生活质量。     

呼吸康复训练治疗慢性阻塞性肺疾病稳定期患者的效果观察

80例COPD稳定期患者根据数字表法随机分为2组,对照组(n=40例)采用对症支持治疗,观察组(n=40例)在对照组治疗基础上进行呼吸训练。比较两组患者呼吸训练前和呼吸训练1年后肺生理学功能、6MWD、呼吸困难评分、ADL总分及LSIA总分等指标变化。结果观察组患者训练后FEV1、FEV1%和FEV1/FVC等肺功能指标较训练前及对照组训练后明显改善(P<0.05);观察组患者训练后6MWD、呼吸困难评分、ADL总分、LSIA总分等指标较训练前及对照组训练后明显改善(P<0.05)。呼吸康复训练可明显改善COPD稳定期患者肺功能及呼吸困难等症状,从而提高患者生活质量。     

肺康复训练辅助支气管舒张药物治疗中重度慢性阻塞性肺疾病的疗效

目的 探讨肺康复训练辅助支气管舒张药物对中重度慢性阻塞性肺疾病(COPD)的治疗效果。方法 将60例中重度COPD患者按随机数字表法分为观察组和对照组,每组30例。对照组按常规给予支气管舒张药物治疗,观察组在对照组治疗基础上,给予肺康复训练治疗。比较2组治疗前及治疗6个月后的肺功能指标[用力肺活量(FVC)、第1秒用力呼气容积(FEV1)占预计值百分比(FEV1%)]、血气分析指标[动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)]、6min步行距离(6MWD)、生活质量(SGRQ)评分、呼吸困难指数(mMRC)。结果2组治疗后FVC、FEV1%、PaCO2、PaO2、6MWD、SGRQ评分、mMRC值均较治疗前显著改善,且观察组改善程度明显优于对照组,差异均有统计学意义(P<0.05)。结论 采用肺康复训练辅助支气管舒张药物治疗中重度COPD效果显著,可有效改善肺功能和运动耐力,提高患者生活质量。 更多还原     

肺康复治疗在慢性阻塞性肺疾病急性加重期中的应用

目的探讨适合于急性加重期慢性阻塞性肺疾病(COPD)的肺康复治疗方法,对其有效性、可行性、安全性进行评价。方法将48例COPD急性加重期患者按随机数字表法分为康复组与对照组,每组24例。2组均行抗感染、化痰、平喘及对症支持治疗,康复组在对症支持治疗基础上行肺康复治疗(包括健康教育、运动康复)。比较2组治疗前后肺功能、运动能力与生活质量的变化情况。肺功能指标包括:1s用力呼气容积(FEV1)、用力肺活量(FVC)、FVC占预计值百分率、FEV1占预计值百分率及最大呼吸量(MVV);运动能力指标为6 min步行距离(6MWD);生活质量采用圣·乔治呼吸疾病问卷(SGRQ)进行评价。结果康复组完成试验18例;对照组完成试验19例。2组肺功能各项指标治疗前后比较差异均无统计学意义(P>0.05);治疗后康复组6MWD值较对照组显著增加,SGRQ评分较对照组显著下降(P<0.05)。结论急性加重期COPD采用肺康复治疗可获得运动能力及生活质量的显著改善,采用BORG呼吸困难指数掌握运动强度的急性加重期COPD肺康复方案安全可行。更多还原     

运动中吸氧对慢性阻塞性肺疾病运动康复效果的影响

目的 比较运动时吸氧与不吸氧对慢性阻塞性肺疾病(COPD)患者肺功能康复效果的影响.方法 将32例肺功能Ⅱ～Ⅳ级的稳定期COPD患者分为2组,吸氧组和对照组,每组16例.两组患者分别于运动康复开始前及结束后1周内完成St.George呼吸困难问卷、基础肺功能测定、6 min步行距离测定(6MWD)、运动心肺功能测定及下肢疲劳度评分(Borg Scale,BS).结果 肺康复训练后,吸氧组的最大氧耗量与对照组相比上升(P<0.05),其余指标无显著性差异.结论 在运动时给COPD患者补充供氧可以改善运动耐力,提高肺康复效果.     

BODE指数在我国农村慢性阻塞性肺疾病患者中的应用价值

目的 探讨我国农村地区慢性阻塞性肺疾病(COPD)患者BODE指数与生活质量的相关性及其应用价值.方法 选择广东省英德市九龙镇COPD稳定期患者26例.测定并计算其BODE指数各项目的评分.采用St George呼吸问卷(SGRQ)评价患者的生活质量.结果 患者BODE指数分级与SGRQ总分、症状分、活动分、影响分均具有相关性(r值分别为0.674、0.430、0.460、0.495,P均＜0.05);GOLD分级仅与SGRQ总分和活动分具有相关性(r值分别为0.447、0.418,P均＜0.05).多元线性逐步回归分析发现BODE指数中影响SGRQ总分的因素是6 min步行距离(t=-2.397,P=0.025)和呼吸困难(t=2.257,P=0.034).结论 农村COPD患者BODE指数和生活质量密切相关,BODE指数中6 min步行距离和呼吸困难对生活质量的影响最大.

Abstract：

Objective To evaluate the application value of BODE and the relationship between BODE index and life quality in patients with chronic obstructive pulmonary disease (COPD) in rural China. Methods A total of 26 rural patients with stable COPD were enrolled. BODE index and it's four components including body mass index ( BMI ), airflow obstruction ( FEV1 % ), dyspnea ( MMRC ) and exercise capacity ( 6MWD ) were calculated. St. Georgeps Respiratory Questionnaire (SGRQ) were used to evaluate health-related quality of life of these patients. Results The BODE index was significantly correlated with the SGRQ total score , symptom ,activity and impact score ( r = 0. 674,0. 430,0. 460,0. 495 respectively, Ps ＜ 0. 05 ). GOLD grade was only significantly correlated with the SGRQ total score and active score( r =0. 447,0. 418 ,Ps ＜0. 05 ). Stepwise liner multiple regression analysis showed that activity score of SGRRQ was an influence factor of BODE index. 6MWD of BODE index( t = - 2. 397, P = 0. 025 ) and MMRC ( t = 2. 257, P = 0. 034 ) were independently correlated with activity scores of SGRQ . Conclusion BODE index and life quality had significant relationship. 6MWD and MMRC of BODE index were the most powerful influence factors of life quality in rural COPD patients.     

圣乔治呼吸问卷与慢性阻塞性肺疾病稳定期患者客观指标的相关性研究

目的:研究圣乔治呼吸问卷(St George's respiratory questionnaire,SGRQ)与慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)稳定期患者客观指标的相关性。方法:对44例COPD稳定期患者进行SGRQ评分,并测定体质量指数(BMI)、一秒用力呼气容积/预计值(FEV1/pre%)、功能性呼吸困难分级(MMRC)、6分钟步行距离(6MWD)、BODE指数。结果:SGRQ总分及其3个组成部分(即呼吸症状、活动受限、疾病影响评分)均与FEV1%pre、MMRC、6MWD、BODE指数等客观指标显著相关,而与BMI无相关性。结论:SGRQ与COPD稳定期患者的FEV1%pre、MMRC、6MWD、BODE指数等客观指标显著相关。     

慢性阻塞性肺疾病患者运动能力与生活质量的相关性研究

目的:探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者运动能力、生活质量现状及相关性。方法:2018年9月至2019年5月对复旦大学附属中山医院154例COPD患者进行横断面调查,采用6 min行走距离(six-minute walk distance,6 MWD)评估患者运动能力,使用一般资料调查表、圣·乔治呼吸问卷(SGRQ)进行调查分析。结果:患者6 MWD为(379.65±121.05)m; SGRQ问卷得分为(42.12±17.54)分;6 MWD与SGRQ得分负相关,差异有统计学意义(r=-0.422,P0.001);患者的年龄、体质量指数(BMI)、吸烟指数、疾病严重程度和6 MWD对生活质量(SGRQ得分)有影响;6 MWD、高龄、吸烟指数和BMI是患者生活质量水平的影响因素。结论:COPD患者生活质量、运动能力处于较低水平。生活质量与运动能力、年龄、BMI等显著相关。     

慢性阻塞性肺疾病评估测试问卷对慢性阻塞性肺疾病稳定期患者生活质量的评估价值

目的：探究慢性阻塞性肺疾病评估测试问卷（chronic obstructive pulmonary disease assessment test,CAT）对慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）稳定期患者生活质量的评估价值.方法：对40例COPD稳定期患者进行CAT评分以及圣乔治呼吸问卷（St George＇s respiratory questionnaire,SGRQ）评分,并测定体质量指数（BMI）、第1秒用力呼气容积/预计值（percentage of forced expiratory volume in 1 second in predicated value,FEV1％ pred）、改良的英国医学研究委员会呼吸困难量表（modified Medical Research Council dyspnea scale,MMRC）评分、6 min步行距离（six-minute walk distance,6MWD）、BODE（B为体质量指数,O为气道阻塞程度,D为呼吸困难分数,E为运动耐力）指数,并对结果进行相关性分析.结果：CAT评分与FEV1％pred、6MWD呈显著负相关（r分别为-0.71和-0.85,P＜0.01）,与MMRC评分、BODE指数呈显著正相关（r分别为0.78和0.83,P＜0.01）,与SGRQ总分及3个组成部分即呼吸症状、活动受限、疾病影响评分均呈显著正相关（r为0.92～0.97,P＜0.01）,与BMI无相关性.结论：CAT问卷可作为评估COPD稳定期患者生活质量的有效手段.     

Effectiveness of Pulmonary Rehabilitation in Exercise Capacity and Quality of Life in Chronic Obstructive Pulmonary Disease Patients With and Without Global Fat-Free Mass Depletion

Objective

To investigate the effectiveness of pulmonary rehabilitation (PR) in exercise capacity and quality of life in patients with chronic obstructive pulmonary disease (COPD) with and without global fat-free mass (FFM) depletion.

Design

Retrospective case-control.

Setting

Outpatient clinic, university center.

Participants

COPD patients (N=102) that completed PR were initially evaluated.

Intervention

PR including whole-body and weight training for 12 weeks, 3 times per week.

Main Outcome Measures

St. George Respiratory Questionnaire (SGRQ), 6-minute walk distance (6MWD), and FFM evaluation applied before and after PR.

Results

Patients were stratified according to their FFM status measured by bioelectric impedance. They were considered depleted if the FFM index was ≤15kg/m² in women and ≤16kg/m² in men. From the initial sample, all depleted patients (n=31) composed the FFM depleted group. It was composed predominantly by women (68%) with a mean age ± SD of 64.4±7.3 years and a forced expiratory volume in 1 second of 33.6%=−13.2% predicted. Paired for sex and age, 31 nondepleted patients were selected from the initial sample to compose the nondepleted group. Improvement in the 6MWD was similar in these 2 groups after PR. Both groups improved SGRQ scores, although the observed power was small and did not allow adequate comparison between depleted and nondepleted patients. There was no difference between groups in weight change, whereas FFM tended to be greater in depleted patients. This increase had no correlation with the 6MWD or the SGRQ.

Conclusions

Benefits of PR to exercise capacity were similar comparing FFM depleted and nondepleted COPD patients. Although FFM change tended to be greater in depleted patients, this increase had no definite relation with clinical outcomes.     

Pulmonary rehabilitation improves depression, anxiety, dyspnea and health status in patients with COPD

OBJECTIVE: To determine the impact of an 8-wk program of comprehensive pulmonary rehabilitation on depression, anxiety, dyspnea, and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). DESIGN: We studied 24 patients with severe COPD randomized either to pulmonary rehabilitation (PR), (n = 10; FEV1 30 +/- 9%) or control (C; n = 14; FEV1 34 +/- 11%). The PR program included disease education, energy conservation techniques, relaxation, and exercise including 20-min arm elevation with dumbbells and 20-min leg exercise sessions three times a week for 8 wks. At baseline and after completion of the program, all patients were evaluated using the Beck Depression Inventory, State Trait Anxiety Inventory (STAI), Modified Medical Research Council Scale (MRC), and St. George's Respiratory Questionnaire (SGRQ). RESULTS: After PR, there was a significant improvement in the severity of depression (P < 0.01), a decrease in symptoms (P < 0.05), an increase in daily living activities (P < 0.05), and a decrease in the total score of the SGRO (P < 0.01). Dyspnea measured by the MRC scale was significantly better in the PR group (P < 0.01). CONCLUSIONS: The present study shows that in patients with severe COPD, pulmonary rehabilitation induces important changes on depression and anxiety independent of changes in dyspnea and health-related quality-of-life.     

Relapse of health related quality of life and psychological health in patients with chronic obstructive pulmonary disease 6 months after rehabilitation

Scand J Caring Sci; 2012; 26; 219–227 Relapse of health related quality of life and psychological health in patients with chronic obstructive pulmonary disease 6 months after rehabilitation Aims: This study aimed to evaluate the short‐ and long‐term effects of 4‐week inpatient rehabilitation on health‐related quality of life (HRQL), anxiety and depression in patients with chronic obstructive pulmonary disease (COPD) and investigate the influence of clinical and socio‐demographical factors on unaltered or improved HRQL after discharge. Methods: A total of 111 consecutive cases with mild‐to‐very severe COPD were recruited from three rehabilitation centres and measured at baseline (t1), 4 weeks (t2) and 6‐month follow‐up (t3). Disease severity was assessed by spirometric tests, HRQL by The St. George’s Respiratory Questionnaire (SGRQ) and anxiety and depression by The Hospital Anxiety and Depression Scale (HADS). Socio‐demography and co‐morbidity was also reported. Changes in SGRQ and HADS scores from baseline to follow‐up were analysed by paired‐sample t‐test, and logistic regression was used to investigate the influence of different factors on HRQL after discharge. Results: Health‐related quality of life and depression improved between t1 and t2: a change of ?3.6 for the SGRQ impact score (p= 0.009), ?2.8 for the SGRQ total score (p = 0.012), a clinical relevant change of ?4.0 for the SGRQ symptom score (p = 0.012) and a reduction of ?0.7 for the HADS depression score (p = 0.011). Between t2 and t3, all SGRQ and HADS scores deteriorated with enhancement of SGRQ impact score (+3.5, p = 0.016), SGRQ total score (+2.5, p = 0.029), HADS anxiety score (+1.1, p = 0.000), HADS depression score (+0.6, p = 0.022) and HADS total score (+1.7, p = 0.000). No significant differences between t1 and t3 were found, except for HADS anxiety score (+0.9, p = 0.003). Patients living alone were 2.9 times more likely to maintain or improve HRQL 6 months after rehabilitation than patients living with someone (95% CI 1.1–7.8, p = 0.039). Conclusion: Short‐term benefits on HRQL and depression after rehabilitation relapsed at 6‐month follow‐up, but without any further deterioration from baseline. Living alone may be beneficial to maintain or improve HRQL after discharge.     

Medium term effects of including manual therapy in a pulmonary rehabilitation program for chronic obstructive pulmonary disease (COPD): a randomized controlled pilot trial.

Study design: Randomized clinical trial.

Objective: To investigate the effect of including manual therapy (MT) in a pulmonary rehabilitation program for patients with chronic obstructive pulmonary disease (COPD).

Background: The primary source of exercise limitation in people with COPD is dyspnea. The dyspnea is partly caused by changes in chest wall mechanics, with an increase in chest wall rigidity (CWR) contributing to a decrease in lung function. As MT is known to increase joint mobility, administering MT to people with COPD carries with it the potential to influence CWR and lung function.

Methods: Thirty-three participants with COPD, aged between 55 and 70 years (mean?=?65·5±4 years), were randomly assigned to three groups: pulmonary rehabilitation (PR) only, soft tissue therapy (ST) and PR, and ST, spinal manipulative therapy (SM), and PR. Outcome measures including forced expiratory volume in the 1st second (FEV₁), forced vital capacity (FVC), 6-minute walking test (6MWT), St. George's respiratory questionnaire (SGRQ), and the hospital anxiety and depression (HAD) scale were recorded at 0, 8, 16, and 24 weeks.

Results: There was a significant difference in FVC between the three groups at 24 weeks (P?=?0·04). For the ST+SM+PR group versus PR only the increase was 0·40 l (CI: 0·02, 0·79; P?=?0·03). No major or moderate adverse events (AE) were reported following the administration of 131 ST and 272 SM interventions.

Discussion: The increase in FVC is a unique finding. Although the underlying mechanisms responsible for this outcome are not yet understood, the most likely explanation is the synergistic effect resulting from the combination of interventions. These results support the call for a larger clinical trial in the use of MT for COPD.     

小剂量克拉霉素对慢性阻塞性肺疾病的临床应用研究

目的观察小剂量克拉霉素对稳定期重度慢性阻塞性肺疾病（COPD）患者的肺功能、生活质量、急性发作的影响。方法将60例稳定期重度COPD患者随机分成观察组和对照组。观察组给予克拉霉素片250mg一日一次口服．持续12周．对照组不用任何药物。观察两组患者治疗前后的第一秒用力呼气容积占预计值百分比（FEV1％）、圣乔治呼吸问卷（SGRQ）测定的生活质量,并记录两组12周内急性发作的人数。结果观察组治疗后FEV1％、SGRQ评分与对照组比较,差异均有统计学意义（t分别=3．11、2．17、2．26、4．97、3．23,P均〈0．05）;与治疗前比较,差异均有统计学意义（t分别=2．33、2．79、2．03、3．44、3．14,P均〈0．05）。仅2例有轻微胃肠道反应,继续用药后症状减轻,所有患者均完成12周的治疗。治疗后复查肝肾功能均在正常范围。12周内观察组急性发作4人,对照组急性发作11人。两组比较,差异有统计学意义（x^2=4．36．P〈0．05）。结论长期应用小剂量克拉霉素可以改善稳定期重度COPD的肺功能、生活质量、减少急性发作。     

The relationship between physical activity and health status in patients with chronic obstructive pulmonary disease following pulmonary rehabilitation

Aim: To investigate the relationship between physical activity (PA) and measures of health-related quality of life (HRQoL) and hospital admissions in people with chronic obstructive pulmonary disease (COPD) following pulmonary rehabilitation (PR). Method: CINAHL, Medline, PubMed, AMED, PsycINFO and Cochrane Library (database inception to July 2014) were searched. Relevant outcomes included relationships between PA and HRQoL, lung function (forced expiratory volume in one?second, FEV₁) and/or hospital admission. Six quantitative and 11 qualitative studies were included and Harden’s method of data synthesis in a mixed-methods systematic review was applied. Results: Six months following PR, increase activity levels was associated with improvement of 62m in 6MWD, 2.31 and 15.55 points increase in SGRQ and CRDQ total scores, respectively, 1.3% FEV₁ and reduced dyspnoea. No study reported on hospital admission. Reported relationships were facilitated by healthcare professionals, social supporters, motivation and encouragement, reduced fear and seeing benefits and hindered by changing physical health, environment, lack of motivation, fear and social isolation. Conclusion: The associations between increased levels of PA and quality of life, respiratory function and dyspnoea are largely based on 6MWD and PA questionnaires. Objective measurement of free living activity in exercise maintenance phase is required along with participants’ views.

• Implications for rehabilitation

• Pulmonary rehabilitation (PR) is a non-therapeutic intervention in which a team of multidisciplinary health care professionals use individually tailored supervised exercise training, self-management education, psychological and social support to optimize the physical and social performance and autonomy of patients with chronic respiratory impairment. Initial benefits from PR decline after program completion.

• Clinical guidelines advocate increase exercise and activity in sustaining initial benefits of PR. Following PR, increased levels of physical activity in people with COPD undertaking exercise maintenance programmes are positively related with improvements in exercise capacity, quality of life and dyspnoea.

• Barriers to activity participation in exercise maintenance programmes, which need to be overcome, are fear, lack of motivation, environmental factors, such as social isolation and changes in physical health. Rehabilitation professionals and social supporters can make rehabilitation more long-lasting and facilitate people with COPD to participate in activity by motivating and encouraging them, reducing their fears and reinforcing the benefits of activity participation.