The Impact of Home-Based vs Centre-Based Pulmonary Rehabilitation on Physical Activity in Patients with COPD: A Comparison of Portuguese and UK Programmes

Introduction: Centre-based Pulmonary Rehabilitation (PR) is the gold standard non-pharmacological treatment for individuals with Chronic Obstructive Pulmonary Disease (COPD). However, high drop-out rates and low adherence have led to the increasing prevalence of home-based alternatives. Physical activity (PA) is a critical outcome for individuals with COPD, but improvements following PR completion are inconsistent. This retrospective analysis aimed to compare the impact of home-based PR in Portugal and centre-based PR in the UK on PA. Methods: This analysis included 75 individuals with COPD: 27 completed an 8-week Portuguese home-based PR programme, and 48 completed an 8-week UK centre-based PR programme. Of the UK cohort, 24 underwent PR with PA promotion (PR+PA), which included motivational interviews, pedometer monitoring and feedback, and goal setting, while the remaining 24 completed PR alone. PA was measured using a pedometer (Yamax EX 510) for the home-based programme and an accelerometer (Actigraph GT3X) for the centre-based programmes. Exercise capacity was assessed across all programmes using the six-minute walk test (6MWT). Results: Home-based PR significantly increased PA by a clinically meaningful margin (∆2636±2805 steps/day, p < 0.001) compared to both centre-based PR+PA (∆976±925 steps/day, p < 0.001) and PR alone (∆-40±626 steps/day, p = 0.155). Both home-based PR and centre-based PR+PA achieved clinically meaningful improvements in PA (>600 steps/day). Centre-based PR alone and PR+PA significantly improved exercise capacity (38±48 m and 54±42 m, respectively, p < 0.001) compared to home-based PR (9±100 m, p = 0.154). Discussion: Portuguese home-based PR demonstrates superior improvements in PA compared to UK centre-based PR. However, centre-based PR remains more effective for improving exercise capacity in COPD patients. These findings highlight the importance of tailoring PR programmes to individual patient needs and preferences to maximize outcomes.