Rethinking Pulmonary Rehabilitation - a Three-arm Randomised Multicentre Trial

PTR is delivered from promoter hospital to a group of 4-6 patients who exercise at home and communicate via tablet-camera.

Each session is 60 min; 35 min exercise/ 25 min patient education, two times per week for a duration of 10-weeks (primary endpoint).

Specific exercises are evidence-based; been used in several intervention studies on patients with COPD.

Exercises involves larger muscle groups with 50/50 exercises for upper and lower extremities. Volume, intensity and content exercise protocol follow both national and international exercise recommendations.

The education sessions consist of dialogue, reflections around empowerment and better living with COPD.

Every fourth education session consists of 25 min Mindfulness exercises developed for COPD patients.

After 10-weeks of PTR, participants are offered once weekly PTR for 60min in groups of 4-8 persons throughout a 65-week maintenance period (secondary endpoint 75-weeks from baseline).

HPR is an individual self-initiated home-based PR aiming to achieve 20 min of self-initiated muscle-endurance based exercise; 3-days/weekly for 10-weeks (primary endpoint).

Exercises are evidence-based; used in several intervention studies on patients with COPD and involves larger muscle groups with 50/50 exercises for upper/lower extremities.

First session is a home visit by a respiratory physiotherapist. During the visit the physiotherapist and patient establish exercise goals, exercise prescription and provision of mindfulness exercises and educationbook.

The home visit is followed by one weekly session for 10-weeks. A menu of topics relevant to COPD and self-management is discussed. A session is delivered from promoter hospital via tablet-camera or telephone call (patients' preference).

After 10-weeks of HPR, participants are offered once weekly PTR for 60min in groups of 4-8 persons throughout a 65-week maintenance period (secondary endpoint 75-weeks from baseline).

Receive usual care; medication, scheduled follow-up visit and possible phone contact with GP and the outpatient respiratory department.

Except for assessment visits 10-, 35-, and 75-weeks from baseline no intervention is offered.

If a patient changes his/her mind and wishes to participate in a conventional hospital- or community-based PR program, it will be granted as this is a highly recommended treatment (e.g. rehabilitation after hospital admitted exacerbation).