Minimal vs specialized exercise equipment for pulmonary rehabilitation
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Importance: Pulmonary rehabilitation (PR) improves exercise tolerance, symptom burden, and health-related quality of life for people with chronic respiratory conditions. However, demand for PR outstrips supply. Traditionally, PR has been delivered using specialist, gym-based exercise equipment.
Objective: To investigate whether PR using minimal equipment (PR-min) is noninferior to PR using specialist gym exercise equipment (PR-gym).
Design, Settings, and Participants: This parallel, 2-group, assessor- and statistician-blinded, noninferiority randomized clinical trial compared PR-min with PR-gym. Eligible participants were people with chronic respiratory disease referred for PR to the Regional Pulmonary Rehabilitation Unit in northwest London, UK. Recruitment occurred from October 15, 2018, to December 21, 2021, with a final follow-up to December 14, 2022. Randomization was by an independent web-based system using minimization with 1:1 allocation. Data analysis was performed from May 2023 to January 2025.
Interventions: Both PR programs comprised 2 in-person, outpatient supervised sessions per week for 8 weeks. PR-min used minimal equipment (eg, walking circuit and body weight exercises), whereas PR-gym used specialist exercise equipment (eg, treadmills and weights machines).
Main Outcomes and Measures: The primary outcome was change in incremental shuttle walk (ISW) distance after PR (ie, at 8 weeks; with a predefined noninferiority margin of −24 m). Secondary outcomes included dyspnea, health-related quality of life, costs, and adverse events.
Results: A total of 436 participants (median [IQR] age, 71.7 [63.2-77.7] years; 239 [54.8%] male) were enrolled, with 218 randomized to PR-min and 218 to PR-gym. At 8 weeks, PR-min (n = 136) and PR-gym (n = 130) demonstrated significant improvements in ISW distance with no significant between-group difference in ISW distance change (mean, 1.7 m; 1-sided 97.5% CI lower bound, −16.8), which was within the −24-m noninferiority margin. The intention-to-treat analysis and a robust range of sensitivity analyses all demonstrated that PR-min was noninferior to PR-gym. Similar findings were observed for dyspnea and health-related quality of life. No excess adverse events or costs were seen with intervention.
Conclusions and Relevance: This randomized clinical trial found that PR-min demonstrated noninferiority to PR-gym for exercise capacity, dyspnea, and health-related quality of life. PR-min can expand the number of settings where PR can be provided, thus improving patient accessibility.
Trial Registration: isrctn.org Identifier: ISRCTN16196765
Objective: To investigate whether PR using minimal equipment (PR-min) is noninferior to PR using specialist gym exercise equipment (PR-gym).
Design, Settings, and Participants: This parallel, 2-group, assessor- and statistician-blinded, noninferiority randomized clinical trial compared PR-min with PR-gym. Eligible participants were people with chronic respiratory disease referred for PR to the Regional Pulmonary Rehabilitation Unit in northwest London, UK. Recruitment occurred from October 15, 2018, to December 21, 2021, with a final follow-up to December 14, 2022. Randomization was by an independent web-based system using minimization with 1:1 allocation. Data analysis was performed from May 2023 to January 2025.
Interventions: Both PR programs comprised 2 in-person, outpatient supervised sessions per week for 8 weeks. PR-min used minimal equipment (eg, walking circuit and body weight exercises), whereas PR-gym used specialist exercise equipment (eg, treadmills and weights machines).
Main Outcomes and Measures: The primary outcome was change in incremental shuttle walk (ISW) distance after PR (ie, at 8 weeks; with a predefined noninferiority margin of −24 m). Secondary outcomes included dyspnea, health-related quality of life, costs, and adverse events.
Results: A total of 436 participants (median [IQR] age, 71.7 [63.2-77.7] years; 239 [54.8%] male) were enrolled, with 218 randomized to PR-min and 218 to PR-gym. At 8 weeks, PR-min (n = 136) and PR-gym (n = 130) demonstrated significant improvements in ISW distance with no significant between-group difference in ISW distance change (mean, 1.7 m; 1-sided 97.5% CI lower bound, −16.8), which was within the −24-m noninferiority margin. The intention-to-treat analysis and a robust range of sensitivity analyses all demonstrated that PR-min was noninferior to PR-gym. Similar findings were observed for dyspnea and health-related quality of life. No excess adverse events or costs were seen with intervention.
Conclusions and Relevance: This randomized clinical trial found that PR-min demonstrated noninferiority to PR-gym for exercise capacity, dyspnea, and health-related quality of life. PR-min can expand the number of settings where PR can be provided, thus improving patient accessibility.
Trial Registration: isrctn.org Identifier: ISRCTN16196765
Date Issued
2025-08-01
Date Acceptance
2025-06-05
Citation
JAMA Network Open, 2025, 8 (8)
ISSN
2574-3805
Publisher
JAMA Network
Start Page
e2526616
End Page
e2526616
Journal / Book Title
JAMA Network Open
Volume
8
Issue
8
Copyright Statement
This is an open access article distributed under the terms of the CC-BY License. © 2025 Nolan CM et al. JAMA Network Open.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/40794408
PII: 2837445
Subjects
Humans
Male
Female
Middle Aged
Exercise Therapy
Aged
Quality of Life
Exercise Tolerance
Publication Status
Published
Coverage Spatial
United States
Article Number
e2526616
Date Publish Online
2025-08-12