Effectiveness of a long-term home-based exercise training program in COPD patients: The HOMEX-1 RCT

Introduction: A majority of COPD patients fails to maintain training after pulmonary rehabilitation (PR). Objective: To assess the effectiveness of the newly developed, home-based, minimal equipment HOMEX strength exercise program in COPD patients over 1 year. Methods: COPD patients from 4 Swiss PR clinic were randomized into intervention (IG) or control group (usual care, CG). Primary outcome was change in dyspnea (Chronic Respiratory Questionnaire; CRQ) from baseline to 12 months, secondary outcomes change in exercise capacity (1-minute-sit-to-stand-test, 6-minute-walk-test), health status, exacerbations and symptoms. Adjusted linear regression models were used. Results: 123 COPD patients (IG: 61, CG: 62) were randomized; 61 females, age 66.8 (8.1) years, FEV1% predicted 39.4 (15.4). 104 participants completed 12-months follow-up (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 0.22-5.03, p=0.033). In all other outcomes, no significant differences between the two groups were found. Conclusions: 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.