Does a Personalised Behavioural Intervention Enhance Physical Activity in Home-Based vs Centre-Based Pulmonary Rehabilitation: A Retrospective Analysis

Background Physical activity is a critical outcome for individuals with COPD, but improvements following Pulmonary Rehabilitation (PR) completion are inconsistent. Centre-based PR is the gold standard for COPD, but high drop-out rates and low adherence drive demand for alternative options. This retrospective analysis aimed to compare the impact of home-based PR in Portugal and centre-based PR in the UK on physical activity levels. Methods 75 patients with COPD were included: 27 completed an 8-week home-based PR programme, and 48 completed an 8-week centre-based PR programme. Within the centre-based PR programme, 24 patients underwent PR with physical activity promotion (PR + PA), which included motivational interviews, pedometer monitoring and feedback, and goal setting, while the remaining 24 completed PR alone. Physical activity was measured using a pedometer (Yamax EX 510) for the home-based programme and an accelerometer (Actigraph GT3X) for the centre-based programmes. Results Both home-based PR and centre-based PR + PA achieved clinically meaningful improvements in physical activity (> 600 steps/day). Home-based PR was significantly superior to centre-based PR + PA (p < 0.048) and centre-based PR (p < 0.001) for physical activity. Centre-based PR + PA was also significantly more effective than centre-based PR (p < 0.001) for physical activity. Both centre-based PR + PA and centre-based PR achieved significant and clinically meaningful improvements in functional capacity compared to home-based PR (p < 0.013). No significant differences in quality of life, anxiety and depression, and breathlessness were reported between home-based and centre-based PR. Conclusion Home-based PR demonstrates superior improvements in physical activity compared to centre-based PR. However, only centre-based PR programmes provide superior improvements in functional capacity. These critical distinctions in key findings promote the need for more personalised, patient-centred approaches to PR, which align delivery methods with individual goals, baseline characteristics, and availability to services. Trial registration: NCT03749655 & NCT05315505.