Summary
Background and purpose: The exercise training included in pulmonary rehabilitation (PR) programmes improves exercise capacity and quality of life in patients with chronic obstructive pulmonary disease (COPD). Nevertheless, the duration of these effects is limited, and the implementation of PR is still insufficient. Moreover, the physical activity level of COPD patients is low, and it is not modified with the classic PR programmes. The purpose of this study was to assess the effects of a community-based PR programme designed to increase physical activity in COPD patients.
Methods: Stable COPD patients were assigned to either an experimental group (EG, n = 17) who followed a community-based 8-week programme consisting of exercise training through walking and a plan to increase activity, using a pedometer for feedback; or a control group (n = 16), who followed general recommendations to walk more every day. The following were evaluated post intervention, after 3 months, and after 12 months: exercise capacity (endurance shuttle test [EST]), physical activity (steps/day and modified Baecke questionnaire), quality of life (St. George's Respiratory Questionnaire [SGRQ]), dyspnoea (modified Medical Research Council scale), and exacerbations.
Results: Post Intervention, the EG showed significant improvements in EST times (7.6 min [4.4, 10.7]), distance (549 m [282, 815]; p < 0.01, both), number of steps (3,361 [1,553, 5,118]), and Baecke scores (1.6 [0.2, 3.1], p < 0.01). SGRQ scores decreased (-5.4 [-8.6, -2.4], p < 0.01). These results remained evident after 3 and 12 months (p < 0.01). There were no differences between the groups nor in the exacerbations or dyspnoea. A significant association was found between increase in physical activity level, improvement in exercise capacity, and quality of life during the period monitored.
Conclusions: A community-based programme of exercise training through walking and increased physical activity, using pedometers as feedback, produces short- and long-term improvements in exercise capacity, physical activity level, and quality of life in COPD patients.

Relevance
Simple community‐based PR programmes can prolong the duration of the effects of exercise training and improve the adherence of patients for physical activity, as we have showed with this programme. This protocol of exercise training and behavioural change is easily applicable to clinical practice, with a low cost. The following could be interesting: (a) its development in private clinics and primary care centres, as alternative in those patients who cannot access to a rehabilitation centre; (b) the maintenance of the effects after PR; and (c) to promote the practice of exercise and increase the PAL in the patients (in combination with the classic programmes or after them).
Moreover, the results impel us to continue researching in other effective interventions to make PR more available for COPD patients and their applicability in the most severe patients, in comparison with classic PR programmes. In the same way, it would be necessary to know more about the factors that influence the adherence of patients to exercise.