Marlies Zwerink

Effect of outpatient exercise training programmes in patients with chronic heart failure: a systematic review.

Background: Advantages of outpatient exercise training are reduced waiting lists, better compliance, reduced time investment by the patient with reduced travel expenses, and less dependence on other people to participate. Therefore, this systematic review studies the effects of outpatient exercise training programmes compared with usual care on exercise capacity, exercise performance, quality of life, and safety in patients with chronic heart failure. Design: Systematic review with meta-analysis. Methods: Randomized controlled trials concerning patients with chronic heart failure, with a left ventricular ejection fraction ≤40%, were included. A meta-analysis was performed. Results: Twenty-two studies were included. VO2max, 6-min walking test, and quality of life showed significant differences in favour of the intervention group of 1.85 ml/kg/min, 47.9 m, and 6.9 points, respectively. In none of the studies, a significant relationship was found between exercise training and adverse events. Conclusion: This meta-analysis illustrates the efficacy and safety of outpatient training programmes for patients with chronic heart failure.

A community-based exercise programme in COPD self-management: Two years follow-up of the COPE-II study

INTRODUCTION It is still unknown how best to maintain effects of exercise programmes in COPD in the long-term. We present the long-term effects of a community-based exercise programme incorporated in a self-management programme, compared to a self-management programme only in patients with COPD. METHODS All included patients participated in four self-management sessions. Additionally, patients in the intervention group participated in an 11-month community-based exercise programme led by physiotherapists. Patients trained three times/week for six months and two times/week during the subsequent five months. To encourage a behavioural change towards exercise, one of these weekly training sessions was home-based (unsupervised). No formal exercise training was offered to intervention patients in the second year. RESULTS The intervention was assigned to 80 patients, and the control condition to 79 patients. 82.5% and 78.5% of the intervention and control group, respectively, completed 24 months follow-up. Modified intention-to-treat analyses were performed. Although statistically significant after 12 months (35.1 m (95%CI: 8.4-61.8)), the between-group difference on maximal exercise capacity was not statistically significant after 24 months (12.2 m (95%CI: -16.6 to 41.0). Nevertheless, the between-group difference in daily physical activity was maintained after 24 months (1193 steps/day (95%CI: 203-2182)). A beneficial effect was also found on CRQ dyspnoea score but not on other CRQ domains, CCQ and HADS. CONCLUSIONS Our intervention was effective in achieving a behavioural change reflected by a sustained increase in daily physical activity, not accompanied by a sustained increase in maximal exercise capacity after two years of follow-up (ISRCTN81447311).

(Cost-)effectiveness of self-treatment of exacerbations in patients with COPD : 2 years follow-up of a RCT

Long‐term effectiveness of action plans in patients with chronic obstructive pulmonary disease (COPD) is minimally investigated. We have evaluated the (cost‐)effectiveness of a self‐management programme with or without self‐treatment of exacerbations after 2 years follow‐up.

Cost-Effectiveness of a Community-Based Exercise Programme in COPD Self-Management

Abstract Introduction: Information regarding cost-effectiveness of community-based exercise programmes in COPD is scarce. Therefore, we have investigated whether a community-based exercise programme is a cost-effective component of self-management for patients with COPD after 2 years of follow-up. Methods: All included COPD patients participated in four self-management sessions. Additionally, patients in the COPE-active group participated in an 11-month community-based exercise programme led by physiotherapists. Patients trained 3 times/week for 6 months and two times/week during the subsequent 5 months. In both periods, one of these weekly training sessions was home-based (unsupervised). No formal physiotherapy sessions were offered to COPE-active patients in the second year. A decision analytical model with a 24-month perspective was used to evaluate cost-effectiveness. Incremental cost-effectiveness ratios (ICER) were calculated and cost-effectiveness planes were created. Results: Data of 77 patients participating in the exercise programme and 76 patients in the control group were analysed. The ICER for an additional patient prevented from deteriorating at least 47.5 meters on the ISWT was €6257. The ICER for an additional patient with a clinically relevant improvement (≥ 500 steps/day) in physical activity was €1564, and the ICER for an additional quality-adjusted life year (QALY) was €10 950. Conclusion: Due to a lack of maintenance of beneficial effects on our primary outcome exercise capacity after 2 years of follow-up and higher costs of the programme, the community-based exercise programme cannot be considered cost-effective compared to self-management programmes only. Nevertheless, the ICERs for the secondary outcomes physical activity and QALY are generally considered acceptable.

(Cost-)effectiveness of self-treatment of exacerbations in patients with COPD: 2 years follow-up of a RCT: Self-treatment of COPD exacerbations

Long‐term effectiveness of action plans in patients with chronic obstructive pulmonary disease (COPD) is minimally investigated. We have evaluated the (cost‐)effectiveness of a self‐management programme with or without self‐treatment of exacerbations after 2 years follow‐up.

(Cost-)effectiveness of self-treatment of exacerbations in patients with COPD

Long‐term effectiveness of action plans in patients with chronic obstructive pulmonary disease (COPD) is minimally investigated. We have evaluated the (cost‐)effectiveness of a self‐management programme with or without self‐treatment of exacerbations after 2 years follow‐up.