Contemporary alternative settings

Abstract

Centre-based pulmonary rehabilitation programs deliver important improvements in exercise capacity, symptoms and quality of life, but uptake is often poor. Alternative models for pulmonary rehabilitation are emerging which may deliver similar clinical benefits and provide patients with a broader range of choices. Home-based pulmonary rehabilitation for COPD has been studied in many clinical trials, with most reporting benefits that are similar to centre-based programs. Home-based models vary in the amount of supervision provided and equipment required; although no 'best' model has emerged, it is likely that regular contact with health professionals is key to ensure that exercise programs are progressed and comprehensive care is delivered. Community pulmonary rehabilitation that includes exercise of sufficient intensity and frequency also delivers improvements in health-related quality of life for people with COPD, and provides opportunity for better integration with primary care. Water-based exercise and Tai Chi deliver important clinical benefits for people with COPD, and Nordic walking is emerging as a promising candidate. It is not clear whether any of these models are suitable for people with other chronic lung diseases, or those who are recovering from an exacerbation of COPD. Existing centre-based pulmonary rehabilitation programs also provide opportunities to improve access to care, such as symptom-based models that includes both COPD and chronic heart failure, and integration of advance care planning. Contemporary alternative models for pulmonary rehabilitation are promising methods for expanding patient choice and enhancing patient-centred care for people with chronic lung disease.