TOPLINE:

Among patients with chronic respiratory conditions, a pulmonary rehabilitation (PR) program using minimal equipment demonstrated improvements in exercise capacity and health-related quality of life, as well as reductions in dyspnea severity, that were comparable to those observed with a program using specialized gym equipment. Benefits persisted through 12 months, with similar serious adverse events.

METHODOLOGY:

• Researchers conducted a noninferiority randomized clinical trial to determine whether a minimal-equipment PR program is noninferior to a standard PR program using specialized gym equipment.
• Overall, 436 patients with chronic respiratory disease (median age, 71.7 years; 54.8% men) were randomly assigned to receive PR twice a week for 8 weeks using either minimal equipment (n = 218) or gym-based equipment (n = 218).
• The minimal-equipment program used walking circuits, body weight exercises, and resistance band training; the gym-based program used treadmills, cycle ergometers, and equipment for resistance training of the lower limbs.
• The primary outcome was change in exercise capacity, measured in terms of change in the incremental shuttle walk distance after 8 weeks, with a predefined noninferiority margin of -24 m.
• Key secondary outcomes included changes in dyspnea severity and health-related quality of life, which were assessed using questionnaires, and the occurrence of adverse events.

TAKEAWAY:

• Among the 266 patients with complete data, minimal-equipment PR demonstrated noninferiority to gym-based PR in terms of change in the incremental shuttle walk distance at 8 weeks (mean between-group difference, 1.7 m; one-sided 97.5% CI lower bound, -16.8).
• Similarly, in a subgroup of 165 patients with chronic obstructive pulmonary disease, minimal-equipment PR was noninferior to gym-based PR in terms of the primary outcome (mean between-group difference, 0.9 m; one-sided 97.5% CI lower bound, -23.8).
• At 8 weeks, changes in dyspnea severity and health-related quality of life were comparable between the two groups; these benefits persisted through 12 months, with minimal-equipment PR remaining noninferior to gym-based PR for incremental shuttle walk distance.
• The number of serious adverse events was comparable between groups — none were linked to the minimal-equipment PR intervention, while one was attributed to gym-based PR; however, more deaths were reported in the minimal-equipment PR group than in the gym-based PR group.

IN PRACTICE:

“Keeping exercise equipment simple and keeping it minimal should be incorporated in policy action toward making evidence-based pulmonary rehabilitation models more accessible to people living with chronic respiratory disease,” experts wrote in an accompanying commentary.

SOURCE:

The study was led by Claire M. Nolan, PhD, College of Health, Medicine, and Life Sciences, Brunel University of London, Uxbridge, England. It was published online on August 12, 2025, in JAMA Network Open.

LIMITATIONS:

COVID-related restrictions led to missing data. Noninferiority could not be demonstrated for participants in the upper quartile of baseline incremental shuttle walk distance, suggesting that minimal-equipment PR may be less effective for individuals with higher functioning capacity. PR adherence was also lower than expected.

DISCLOSURES:

The study was supported by the United Kingdom Clinical Research Collaboration-registered King’s Clinical Trials Unit at King’s Health Partners, partially funded by the National Institute for Health and Care Research (NIHR) Biomedical Research Centre for Mental Health at South London, and some other sources. Some authors disclosed receiving research grants, personal fees, or nonfinancial support or having other ties with NIHR, Brunel University of London, University College London, London, England, or other organizations.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.