A Cochrane review [Abstract] 1 included 65 studies with a total of 3 822 subjects. In all the included studies more than 90% of participants had the clinical diagnosis of chronic obstructive pulmonary disease (COPD). Interventions comprised any rehabilitation programs of at least four weeks duration that included any exercise therapy involving physical activity considered to be aerobically demanding, with or without any form of education and/or psychological support. Statistically significant improvements were found for all the included outcomes, i.e. health-related quality of life (QoL) as the primary outcome and exercise capacity as the secondary outcome. In four important domains of QoL (Chronic Respiratory Questionnaire [CRQ]), the effect was larger than the minimal clinically important difference of 0.5 units: Dyspnoea: MD 0.79, 95% confidence interval (CI) 0.56 to 1.03; n = 1283; 19 studies (moderate-quality evidence); Fatigue: MD 0.68, 95% CI 0.45 to 0.92; n = 1291; 19 studies (low-quality evidence); Emotional function: MD 0.56, 95% CI 0.34 to 0.78; n = 1291; 19 studies; Mastery: MD 0.71, 95% CI 0.47 to 0.95; n = 1212; 19 studies; (low-quality evidence). Statistically significant improvements were noted in all domains of the St. George's Respiratory Questionnaire (SGRQ), and improvement in total score was better than 4 units (MD -6.89, 95% CI -9.26 to -4.52; n= 1146; 19; studies (low-quality evidence). Both functional exercise and maximal exercise showed statistically significant improvement. An increase in maximal exercise capacity (mean Wmax [W]) in participants allocated to pulmonary rehabilitation compared with usual care (MD 6.77, 95% CI 1.89 to 11.65; n = 779; 16 studies) was reported. In relation to functional exercise capacity, the six-minute walk distance mean treatment effect was greater than the threshold of clinical significance (MD 43.93, 95% CI 32.64 to 55.21; n = 1879; 38 studies).
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