Cost effectiveness of extending the community pulmonary rehabilitation phase 3 program

Participants randomised to the intervention arm will continue attending their weekly Phase 3 maintenance pulmonary rehabilitation at their current venue for another 6 months. The pulmonary rehabilitation is delivered by a senior physiotherapist from Community Physiotherapy Services at one of seven community centres in metropolitan Western Australia (i.e. Beechboro, Craigie, Hamersley, Jolimont, Joondalup, Morley and Swan). Each 75-minute pulmonary rehabilitation group session will comprise a 20-minute walking program, flexibility and stretching exercises (i.e. calf stretches, chest stretch and chest turns), and a six-station exercise circuit within the enclosed community centre. The circuit comprises unsupported upper limb exercises (i.e. arm raises, forward punches, elbow curls and upright row) and lower limb exercises (i.e. step-ups, sit to stand, wall squats, mini-squats, heel raises). The modalities of exercise used in the exercise circuit are individualised to each participant based on their responses to the dyspnoea domain of the chronic respiratory disease questionnaire (CRQ). In addition participants will be instructed to walk at least 20 minutes and perform the prescribed exercises on 4 or 5 days a week at home. The prescribed exercises are those performed during the pulmonary rehabilitation class - i.e. stretching exercises, leg exercises and arm exercises. Participants will be provided with a diary to record their compliance to the home exercise program. The diaries will be completed on a weekly basis and collected every 3 months via reply-paid post. A research associate will send out monthly reminders by short message service (SMS) reminding participants to complete their exercise diary. The intervention arm is called "Community Program" for the purpose of this trial.