Feasibility and preliminary effects of a structured home-based pulmonary rehabilitation on functional exercise capacity in individuals with bronchiectasis: a pilot randomised controlled trial

Abstract

Pulmonary rehabilitation is widely recognized as an effective intervention for chronic respiratory diseases; however, access to supervised programmes remains limited. Evidence on home-based pulmonary rehabilitation (H-PR) in individuals with bronchiectasis is still emerging. To evaluate the preliminary effects and feasibility of an H-PR programme on functional exercise capacity and quality of life in individuals with bronchiectasis. This pilot randomised controlled trial included 30 individuals with stable bronchiectasis, randomized to either an H-PR group (n = 15) or standard care (n = 15). The 8-week H-PR included airway clearance techniques, education, and exercise training. The primary outcome was functional exercise capacity measured by six-minute walk distance (6MWD). Secondary outcomes included health status (Bronchiectasis Health Questionnaire [BHQ]), health-related quality of life (St. George Respiratory Questionnaire [SGRQ]) and physical activity levels. Between-group differences were analysed using ANCOVA adjusted for baseline values. Twenty-eight participants completed the study. Compared with the control group, the H-PR group demonstrated significantly greater improvements in the 6MWD (mean difference 47.8 m, p < 0.001) and BHQ scores (mean difference 5.14, p < 0.001). Significant improvements were also noted in the symptoms, impact domains and total scores of the SGRQ (p < 0.05), while physical activity levels or the SGRQ activity domain did not differ significantly. Enrolment rate was 34.5%, retention rate was 93.3%, 78.6% of intervention participants achieved the predefined ≥ 70% adherence criterion, and no intervention-related adverse events occurred. This pilot randomised controlled trial suggests that an 8-week H-PR programme is feasible and shows preliminary benefits in functional exercise capacity, disease-specific health status, and respiratory-specific HRQoL in individuals with bronchiectasis. The findings provide preliminary estimates of treatment effects that can inform future definitive randomised controlled trials. H-PR may represent a practical approach in settings where supervised PR is not readily accessible. The high consent and retention rates, acceptable adherence, and absence of intervention-related adverse events support the feasibility and acceptability of this H-PR programme. However, no significant improvements were observed in physical activity levels, highlighting the need for longer-term behaviour-focused interventions. The trial was prospectively registered (CTRI/2020/01/022893) on 21/01/2020.