Table 1 Characteristics of the included studies

Behnke 2000 [27]

Germany

RCT

Setting: in- and outpatient

Duration: hospital-based 10 days, home-based 6 months

Frequency: 7/week

46 admitted patients with AECOPD (mean age: 64–68 years, FEV₁: 36% predicted). Comorbidities: not specified.

PR consisted of conventional therapy including 30 min of daily breath exercises with respirologists and hospital-based training. Exercise training consisted of daily 6MWT and 5 self-controlled walking sessions at 75% of the treadmill walking distance of the respective day.

Supervised home-based training for 6 mo.: walking training 3/day at 125% of the best 6MWD, health check every 2 weeks (mo. 0–3) followed by phone calls from mo. 3–6.

Usual care: standard inpatient care and community care with respirologists (30 min of daily breathing exercises) but without exercise training

Both groups (intervention and usual care) were supervised by the physician.

Mortality^b Walking test^b COPD related hospital readmissions^b Dropout^a

16 dropouts (8 in PR group and 8 in control group)

Daabis 2017 [31]

Egypt

RCT

Setting: outpatient Duration: 8 weeks Frequency: 3/week

30 admitted patients with AECOPD (mean age: 58–61 years, FEV₁: 53–56% of predicted). Comorbidities: not specified.

PR consisted of patient assessment, exercise training (ET), patient education including self-management of the disease, nutrition and lifestyle issues. Exercise training consisted of ET with 30-min of walking at the intensity of 75% 6MWT including 30-min of low-intensity RT.

Outpatient PR

Medical treatment.

All patients received standard treatment with optimal medical treatment.

HRQoL^a Walking distance^a

No dropouts reported

Deepak 2014 [32]

India

RCT

Setting outpatient Duration: 12 weeks

60 admitted patients with AECOPD (mean age: 59 years, FEV₁: 47–53% of predicted, 93% men). Comorbidities: not specified.

PR consisted of patient assessment, exercise testing, exercise training (mixture of limb strengthening and aerobic activities, tailored to individual baseline function), education, nutrition and psycho-social rehabilitation.

Outpatient PR

Conventional treatment without PR.

All patients received conventional management consisting of medical treatment.

HRQoL^a Walking distance^a

4 dropouts

Eaton 2009 [28]

New Zealand

RCT

Setting: in- and outpatient

Duration: 8 weeks Frequency: 2/week

97 admitted patients with AECOPD (mean age: 70 years, FEV₁: 35–36% of predicted, 42–45% men). Comorbidities: Measured with Charlson index (PR group: 3.1; control: 3.2).

PR consisted of a daily 30-min structured, supervised exercise regimen that included walking and upper and lower limb strengthening exercises.

Hospital-based outpatient program consisting of 1-h sessions of supervised exercise training and educational sessions (e.g. coping with dyspnea, management of ADL, nutritional advises, airway clearance).

Usual care standardized in according with the ATS/ERS COPD guidelines and standardized advises on the benefits of exercise and maintaining daily activities.

All patients received usual care standardized in according with the ATS/ERS COPD guidelines.

Walking distance^a COPD related hospital readmissions^b Dropout^a

13 dropouts (8 in PR group and 5 in control group)

Kirsten 1998 [29]

Germany

RCT

Setting: inpatient Duration: 10 days

Frequency: 7/week

31 admitted patients with AECOPD (mean age: 62–66 years, FEV₁: 34–38% of predicted, 90% men). Comorbidities: not specified.

PR consisted of 6MWT each day and additional 5 walking sessions per day at ≥75% of the respective walking distance.

Inpatient supervised walking sessions 5/day.

Usual care with optimal medical treatment.

All patients received standard medical treatment.

Walking test^a

2 dropouts (not reported in which group)

Ko 2011 [34]

China

RCT

Setting: outpatient Duration: 8 weeks Frequency: 3/week

60 admitted patients with AECOPD (mean age: 73–74 years, FEV₁: 41–46% of predicted, 98% men). Comorbidities: coronary artery disease, cardiac arrhythmic, heart failure, hypertension, diabetes.

PR consisted of supervised exercise training including treadmill, arm cycling, arm and leg strength training at 60–70% of VO_2max or HR_max and were advised to perform at least 20 min home exercises a day. Education on proper breathing techniques and how to cope with daily activities.

Supervised outpatient exercise training.

Usual care with instructions to perform regular exercise at home (walking and muscle stretching exercise).

Both groups were seen by the nurse specialist at the baseline assessment.

HRQoL^b Mortality^a,b Walking test^b

Dropout^a,b

9 dropouts (5 in PR group and 4 in control group) at the end of treatment. 6 dropouts (2 in PR group and 4 in control group) at the longest follow-up.

Ko 2017 [33]

China

RCT

Setting: outpatient Duration: 8 weeks (1 year follow up) Frequency: 3/week

180 admitted patients with AECOPD (mean age: 75 years, FEV₁: 42–47% of predicted, 94–97% men). Comorbidities: hypertension, type 2 diabetes, hyperlipidemia, ischemic heart disease, heart failure, old pulmonary tuberculosis.

PR consisted of education (smoking cessation, technique of using medications, nutrition, dyspnea management, self-management, psychological distress, exercise benefits and strategies, breathing and sputum-removal techniques) and individual physical training program to perform at home or a short course of outpatient PR.

Patients are offered supervised exercise training 3/week, if declining they are offered instructions for self-training, education, and telephone calls.

Usual care with medical treatment.

All patients received standard treatment with optimal medical therapy.

HRQoL^b Mortality^a

Walking test^b Days in hospital^a

38 dropouts (17 in PR group and 21 in control group)

Man 2004 [35]

England

RCT

Setting: outpatient Duration: 8 weeks Frequency: 2/week

42 admitted patients with AECOPD (mean age: 70 years, FEV₁: 37–42% of predicted, 40% men). Comorbidities: not specified.

Supervised multidisciplinary PR, 1-h of exercise (aerobic walking and cycling, strength training for the upper and lower limb) and 1-h of education (with an emphasis on self-management of the disease, nutrition and lifestyle issues).

Supervised multidisciplinary PR.

Usual care with optimal medical treatment.

All admitted patients received standard treatment and home diaries which included a disease specific information pack.

HRQoF^b Mortality^b Walking test^b COPD related hospital readmissions^b Dropout^a

8 dropouts (3 in PR group and 5 in control group)

Murphy 2005 [39]

Ireland

RCT

Setting: outpatient home-based

Duration: 6 weeks Frequency: 2/week

31 admitted patients with AECOPD (mean age: 65–67 years, FEV₁: 38–42% of predicted, 65% men). Comorbidities: not specified.

PR consisted of 30–40-min supervised home-based exercise program, aerobic exercises including stepping up and down a stair, sitting to stand from a chair, upper limb strength exercises with low-impact elastic band at 3–5 on the Borg breathlessness score.

Supervised home-based exercise program.

Standard medical treatment without any form of PR exercises or lifestyle changes advice.

All patients received standard medical treatment.

Walking test^a COPD related hospital readmissions^b

Dropout^a

5 dropouts (3 in PR group and 2 in control group)

Puhan 2012 [30]

Switzerland

RCT

Setting: in- and outpatient Duration: 12 weeks Frequency: 24 sessions (range 18–36)

36 admitted patients with AECOPD (mean age: 67 years, FEV₁: 43–46% of predicted, 58% men). Comorbidities: cardiovascular, endocrine, musculoskeletal, other.

Early inpatient PR within 2 weeks after exacerbation, exercise training included endurance, strength and calisthenics training in addition with education (e.g. individual action plan, mediational use, exercise at home, coping with daily activities, smoking cessation).

Outpatient PR, exercise training included endurance, strength and calisthenics training in addition with education (as described under intervention).

Late PR starting 6 mo. after exacerbation, exercise training included endurance, strength and calisthenics training in addition with education.

Recommended number of exercise session 24 (ranged between 18 and 36).

Mortality^a Dropout^a

8 dropouts (4 in PR group and 4 in control group)

Revitt 2018 [37]

United Kingdom

RCT

Setting: inpatient Duration: 6 weeks

Frequency: 2/week

28 admitted patients with AECOPD (mean age: 66 years; FEV₁: 1.18 l). Comorbidities: not specified.

Early PR within 4 weeks of discharge. PR consisted of individualized aerobic and resistance exercises and education on chest clearance and energy conservation.

Hospital-based PR.

Late PR initiated 7 weeks after discharge including exercise and education.

All patients received the same PR program.

Dropout^a

11 dropouts (3 in control group prior to the program and 8 in PR group during the program)

Seymour 2010 [36]

United Kingdom

RCT

Setting: outpatient (hospital-led) Duration: 8 weeks Frequency: 2/week

60 admitted patients with AECOPD (mean age: 65-67 years, FEV₁: 52% of predicted, 45% men). Comorbidities: hypertension, type 2 diabetes, ischemic heart disease.

PR consisted of supervised exercise training including a mixture of limb strengthening and aerobic activities tailored to individual baseline function and education session (lasting 2 h).

Hospital-led supervised exercise training.

Usual care with optimal medical treatment.

All patients were provided with general information about COPD and offered outpatient appointments with their general practitioner or respiratory team.

HRQoF^b Walking test^a COPD related hospital readmissions^b

Dropout^b

11 dropouts (7 in PR group and 4 in control group)

Troosters 2000 [38]

Belgium

RCT

Setting: outpatient Duration: 6 mo (18 mo follow up)

Frequency: 2–3/week

100 patients with AECOPD referred to outpatient clinic (mean age: 60–63 years, FEV₁: 41–43% of predicted, 87% men). Comorbidities: not specified.

PR consisted of 90-min supervised ET and RT. ET consisting of cycling, treadmill walking, and stair climbing at 60–80% of initial W_max during cycle ergometer/maximal walking speed. RT consisting of strength exercises for 5 muscle groups, 10 reps at 60% 1RM.

Supervised outpatient exercise training.

Usual medical care consisting of standard community care with respirologist.

During exercise training supplemental oxygenwas given to maintain oxygen saturation above 90%.

Mortality^a walking test^a dropout^a,b

30 dropouts (13 in PR group and 17 in control group) at the end of treatment. 21 dropouts (11 in PR group and 10 in control group) at the longest follow-up.