Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2025 Aug 1;8(8):e2526616.
doi: 10.1001/jamanetworkopen.2025.26616.

Minimal vs Specialized Exercise Equipment for Pulmonary Rehabilitation: A Randomized Clinical Trial

Claire M Nolan  1   2 , Callum Glen  3   4 , Jessica A Walsh  2   5 , Suhani Patel  2   6 , Ruth E Barker  2   7 , Oliver Polgar  2 , Nannette Spain  8 , Hannah Littlemore  2 , Peter Jung  1   2 , George D Edwards  2 , Timothy O Jenkins  2 , Jennifer Harvey  2   9 , Karen Ingram  2   9 , Christopher Newby  10 , Michael Steiner  11 , Rebecca Wilson  12 , Wei Gao  12   13 , Francesca Fiorentino  3   14 , Emeka Chukwusa  12 , Peter May  12 , Matthew Maddocks  12 , William D C Man  2   6   9   15
Affiliations
Randomized Controlled Trial

Minimal vs Specialized Exercise Equipment for Pulmonary Rehabilitation: A Randomized Clinical Trial

Claire M Nolan et al. JAMA Netw Open. .

Abstract

Importance: Pulmonary rehabilitation (PR) improves exercise tolerance, symptom burden, and health-related quality of life for people with chronic respiratory conditions. However, demand for PR outstrips supply. Traditionally, PR has been delivered using specialist, gym-based exercise equipment.

Objective: To investigate whether PR using minimal equipment (PR-min) is noninferior to PR using specialist gym exercise equipment (PR-gym).

Design, settings, and participants: This parallel, 2-group, assessor- and statistician-blinded, noninferiority randomized clinical trial compared PR-min with PR-gym. Eligible participants were people with chronic respiratory disease referred for PR to the Regional Pulmonary Rehabilitation Unit in northwest London, UK. Recruitment occurred from October 15, 2018, to December 21, 2021, with a final follow-up to December 14, 2022. Randomization was by an independent web-based system using minimization with 1:1 allocation. Data analysis was performed from May 2023 to January 2025.

Interventions: Both PR programs comprised 2 in-person, outpatient supervised sessions per week for 8 weeks. PR-min used minimal equipment (eg, walking circuit and body weight exercises), whereas PR-gym used specialist exercise equipment (eg, treadmills and weights machines).

Main outcomes and measures: The primary outcome was change in incremental shuttle walk (ISW) distance after PR (ie, at 8 weeks; with a predefined noninferiority margin of -24 m). Secondary outcomes included dyspnea, health-related quality of life, costs, and adverse events.

Results: A total of 436 participants (median [IQR] age, 71.7 [63.2-77.7] years; 239 [54.8%] male) were enrolled, with 218 randomized to PR-min and 218 to PR-gym. At 8 weeks, PR-min (n = 136) and PR-gym (n = 130) demonstrated significant improvements in ISW distance with no significant between-group difference in ISW distance change (mean, 1.7 m; 1-sided 97.5% CI lower bound, -16.8), which was within the -24-m noninferiority margin. The intention-to-treat analysis and a robust range of sensitivity analyses all demonstrated that PR-min was noninferior to PR-gym. Similar findings were observed for dyspnea and health-related quality of life. No excess adverse events or costs were seen with intervention.

Conclusions and relevance: This randomized clinical trial found that PR-min demonstrated noninferiority to PR-gym for exercise capacity, dyspnea, and health-related quality of life. PR-min can expand the number of settings where PR can be provided, thus improving patient accessibility.

Trial registration: isrctn.org Identifier: ISRCTN16196765.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Nolan reported receiving grants from the National Institute for Health and Care Research (NIHR) during the conduct of the study and grants from the NIHR and Brunel University London and personal fees from University College London outside the submitted work. Dr Jenkins reported receiving grants from Royal Brompton and Harefield Hospital Charity outside the submitted work. Dr Steiner reported receiving nonfinancial support from AstraZeneca outside the submitted work. Dr Maddocks reported receiving grants from NIHR Applied Research Collaboration South London during the conduct of the study and grants from UK Research and Innovation Innovate UK outside the submitted work. Dr Man reported receiving grants from the NIHR during the conduct of the study and grants from the NIHR outside the submitted work and serving as the honorary president of the Association for Respiratory Technology and Physiology. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Consolidated Standards of Reporting Trials Flowchart
Data are reported for those who returned any outcome data at research visits as well as those who provided primary outcome data. The primary outcome was the incremental shuttle walk test, which is a face-to-face supervised test. This test was not possible for a proportion of patients due to COVID-19 restrictions. PR indicates pulmonary rehabilitation; PR-gym, PR using specialist gym exercise equipment; PR-min, PR using minimal equipment.
Figure 2.
Figure 2.. Noninferiority Graphs of the Primary and Sensitivity Analyses at Visit 2
CACE indicates complier average causal effects; COPD, chronic obstructive pulmonary disease; GEE, generalized estimating equation; ISW, incremental shuttle walk; PR, pulmonary rehabilitation; PR-gym, PR using specialist gym exercise equipment; PR-min, PR using minimal equipment.
See this image and copyright information in PMC

Comment in

  • doi: 10.1001/jamanetworkopen.2025.26633

References

    1. Gómez FP, Rodriguez-Roisin R. Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for chronic obstructive pulmonary disease. Curr Opin Pulm Med. 2002;8(2):81-86. doi: 10.1097/00063198-200203000-00001 - DOI - PubMed
    1. Alison JA, McKeough ZJ, Johnston K, et al. ; Lung Foundation Australia and the Thoracic Society of Australia and New Zealand . Australian and New Zealand pulmonary rehabilitation guidelines. Respirology. 2017;22(4):800-819. doi: 10.1111/resp.13025 - DOI - PubMed
    1. Rochester CL, Alison JA, Carlin B, et al. Pulmonary rehabilitation for adults with chronic respiratory disease: an official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med. 2023;208(4):e7-e26. doi: 10.1164/rccm.202306-1066ST - DOI - PMC - PubMed
    1. Man W, Chaplin E, Daynes E, et al. British Thoracic society clinical statement on pulmonary rehabilitation. Thorax. 2023;78(suppl 4):s2-s15. doi: 10.1136/thorax-2023-220439 - DOI - PubMed
    1. McCarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2015;2015(2):CD003793. doi: 10.1002/14651858.CD003793.pub3 - DOI - PMC - PubMed

Publication types