The effectiveness of home-based balance and pulmonary rehabilitation program in individuals with chronic obstructive pulmonary disease: a randomized controlled trial

BACKGROUND: Balance impairment and increased fall risk have been demonstrated in individuals with chronic obstructive pulmonary disease (COPD). However, studies investigating the effects of balance training especially when combined with pulmonary rehabilitation (PR) program in home-based setting are scarce. AIM: To examine whether adding balance training to home-based pulmonary rehabilitation improves balance, fall risk, and disease-related symptoms in individuals with COPD. DESIGN: Randomized, controlled, assessor-blinded trial with parallel two-group design. SETTING: Home-based setting. POPULATION: Forty-eight individuals diagnosed with COPD. METHODS: Participants with COPD were randomly allocated to either a home-based PR or home-based balance training combined with PR (PR-BT) group (24 per group). Both groups exercised three days per week for eight-week. Primary outcomes were fall risk index and functional balance as measured by the Physiological Profile Assessment (PPA) and Timed Up and Go (TUG), respectively. Secondary outcomes were the Activities-specific Balance Confidence (ABC), Modified Medical Research Council dyspnea (mMRC), Six-Minute Walk Test (6MWT), and COPD assessment test (CAT). All outcome measures were assessed at baseline, post-intervention, and three-month follow-up. RESULTS: All participants completed the trial, with no reported adverse events. At post-intervention, the PR-BT group demonstrated significantly greater improvements in PPA fall risk score (PR-BT: 1.1±0.8, PR: 2.4±1.5), TUG (PR-BT: 10.7±1.3, PR: 14.4±4.4 s) and these improvements remained at three-month follow-up (all P<0.01). The ABC, mMRC, and CAT scores were also significant better for the PR-BT than the PR group both after intervention and at three-month follow-up (all P<0.05). CONCLUSIONS: Eight-week home-based balance and PR program is effective in improving balance as well as dyspnea, and well-being in individuals with COPD. CLINICAL REHABILITATION IMPACT: Home-based balance and PR program is a promising approach for COPD rehabilitation especially in patients who are at risk of falls.