Modest sized efficacy trials demonstrate substantial health benefits, that wane as Pulmonary rehabilitation is discontinued. We need to test the health and resource implications of "chronic" (e.g., 12 or 24 mos) pulmonary rehabilitation. Such information will benefit health systems seeking to implement care models for high-risk, costly, patients - patients with COPD are of increasing interest to health systems. Such a comparative effectiveness trial should also involve behavioral interventions to promote self-management and involve caregivers.

Pulmonary rehabilitation is the most effective therapy for COPD, leading to reduced shortness of breath and improved exercise capacity. It is under-utilized because of the relative paucity of studies evaluating its efficacy on mortality, hospitalization and hospital readmission.

Feasibility is very high. In the NIH National Emphysema Treatment Trial, a standardized pulmonary rehabilitation program was developed and implemented at multiple sites, many of which did not have existing pulmonary rehabilitation programs. The effective of this pulmonary rehabilitation program was documented (Chest 2005; 128:3799). Challenges include maintenance of the benefits of pulmonary rehabilitation using modern approaches to increase adherence.

The ability to reach more patients in need of recommended treatment for the COPD patient.
The availability is not always easy with transportation, cost, and coverage issues being the importatnt factors.

Easily feasible to address for home or community availability, like YMCAs, Senior Centers.

Pulmonary rehabilitation is a critical component in the treatment of COPD patients but several barriers persist that have resulted in very limited access to rehab, low referral rates for eligible patients and limited standardization of best practices within the rehab facilities that do exist. Large, definitive studies accounting for patient subgroups, site characteristics and program components can generate the level of evidence needed to expand access, educate providers and improve referral systems and create quality programs. This level of evidence is necessary to change policy to properly value the role of pulmonary rehabilitation and to convince integrated health systems in a value based market that pulmonary rehabilitation is beyond a doubt, a requirement of providing quality COPD care.

Improve functional capacity and quality of life of patients with congenital heart disease.

Preliminary data has been promising but larger clinical trials are needed.