People with chronic respiratory diseases benefit from pulmonary rehabilitation (PR) in terms of exercise tolerance, symptom load, and health-related quality of life. But there is a greater need for PR than there is supply.
PR has always been administered with specialized, gym-based workout equipment. This study examined the potential non-inferiority of PR utilizing specialized gym workout equipment (PR-gym) vs PR using minimum equipment (PR-min).
PR-min and PR-gym were compared in this parallel, two-group, noninferiority randomized clinical study that was blinded by assessors and statisticians. People with chronic respiratory conditions who were referred for PR to the Regional Pulmonary Rehabilitation Unit in northwest London, UK, were eligible to participate. Between October 15, 2018, and December 21, 2021, recruitment was place, with a final follow-up scheduled on December 14, 2022.
An separate web-based method that used minimization and 1:1 allocation was used for randomization. The period of data analysis was May 2023–January 2025. For 8 weeks, all PR programs included 2 in-person, outpatient supervised sessions per week. While PR-gym utilized specialized workout equipment (such as treadmills and weight machines), PR-min used less equipment (such as walking circuits and body weight exercises).
With 218 randomly assigned to PR-min and 218 to PR-gym, a total of 436 individuals (median [IQR] age, 71.7 [63.2-77.7] years; 239 [54.8%] male) were included.
ISW distance was significantly improved at 8 weeks by PR-min (n = 136) and PR-gym (n = 130), with no significant difference between groups (mean, 1.7 m; 1-sided 97.5% CI lower limit, −16.8), falling within the −24-m noninferiority margin.
A comprehensive set of sensitivity analyses and the intention-to-treat analysis showed that PR-min was not inferior than PR-gym.
Comparable results were seen for health-related quality of life and dyspnea. Also, the intervention did not result in any excessive negative occurrences or expenses.
Overall, PR-min was linked to improvements in exercise capacity and health-related quality of life that were comparable to those linked to PR-gym. This noninferiority lasted for a whole year without incurring any extra expenses.
Source:
Nolan, C. M., Glen, C., Walsh, J. A., Patel, S., Barker, R. E., Polgar, O., Spain, N., Littlemore, H., Jung, P., Edwards, G. D., Jenkins, T. O., Harvey, J., Ingram, K., Newby, C., Steiner, M., Wilson, R., Gao, W., Fiorentino, F., Chukwusa, E., … Man, W. D. C. (2025). Minimal vs specialized exercise equipment for pulmonary rehabilitation: A randomized clinical trial. JAMA Network Open, 8(8), e2526616. https://doi.org/10.1001/jamanetworkopen.2025.26616
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