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Adherence to a Maintenance Exercise Program 1 Year After Pulmonary Rehabilitation: WHAT ARE THE PREDICTORS OF DROPOUT?

Heerema-Poelman, Ankie PT; Stuive, Ilse PhD; Wempe, Johan B. MD, PhD

Journal of Cardiopulmonary Rehabilitation and Prevention: November/December 2013 - Volume 33 - Issue 6 - p 419–426
doi: 10.1097/HCR.0b013e3182a5274a
Pulmonary Rehabilitation

PURPOSE: To evaluate adherence to a maintenance exercise program in patients with chronic obstructive pulmonary disease (COPD) and explore predictors for adherence.

METHODS: Seventy patients with COPD were referred to a home-care maintenance exercise program after completing pulmonary rehabilitation (PR) in the rehabilitation center. Adherence (yes/no) to the maintenance program was assessed by a self-reported questionnaire, where adherence was defined as attending the maintenance program 1 year after PR. Early dropouts received a self-reported questionnaire after 6 months and the remaining patients after 12 months. Lung function, exercise capacity, exercise self-efficacy, illness perceptions, health-related quality of life, levels of anxiety and depression, duration of PR, and the number of exacerbations were studied as possible predictors of adherence.

RESULTS: Ten patients died or were lost to followup. Of the remaining 60 patients, 73.3% and 63.3% were adherent to the maintenance exercise program after 6 and 12 months, respectively. Forced expiratory volume in 1 second (FEV1) (P = .021), Hospital Anxiety and Depression Scale depression score (P = .025), and duration of PR (P = .018) were significant predictors of adherence to the maintenance program.

CONCLUSION: Adherence to the maintenance exercise program included a 36.7% drop-out rate during the first year after completing PR. Experiencing exacerbations was the most reported reason for dropout. Poorer lung function, shorter initial PR course measured by reviewing patient records, and higher level of depressive symptoms were predictive of drop-out to the maintenance program. Adherence to the maintenance program needs to be improved for patients with lower FEV1, with signs of depression, or with a shorter initial PR course.

Adherence to a maintenance exercise program and its predictors for dropout were studied in patients with COPD. Thirty-six percent of the included patients dropped out during the first year. Poorer lung function, a shorter rehabilitation course, and higher level of depressive symptoms are predictive for dropout.

Centre for Rehabilitation, University Medical Center Groningen, Groningen, the Netherlands.

Correspondence: Ankie Heerema-Poelman, PT, Centre for Rehabilitation Beatrixoord, University Medical Centre Groningen, Dilgtweg 5, 9751 ND Haren, the Netherlands (

The authors declare no conflicts of interest.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins