Early home-based pulmonary rehabilitation after hospitalisation in chronic obstructive pulmonary disease (COPD)

People who agree to take part in the study will be randomly allocated to undertake pulmonary rehabilitation at home (early HomeBase)(commenced within 2 weeks of hospital discharge) or usual post-hospital care. People allocated to undertake early home-based pulmonary rehabilitation (n=83) will receive, in addition to standard (usual) care, an initial home visit from a physiotherapist to establish the exercise training program, facilitate setting of exercise goals and to ensure safety. This will be followed by seven once-weekly phone consultations with a physiotherapist, specially trained in motivational interviewing, to undertake self-management training and promote exercise progression. The total program duration is 8-weeks. The home-based exercise training program will consist of a walking program (including use of a pedometer) and light weights for the arms and legs using readily available equipment in the home (eg. water bottles). Participants will be encouraged to undertake exercise on at least 5 days in the week, and to record their exercise participation in a home exercise diary. The overall goal of the program is for participants to work towards achieving at least thirty minutes of aerobic training on most days of the week. Exercise training intensity and session duration will be individualised and guided by participants perceived breathlessness (e.g BORG breathlessness scale, range 3-4). Home exercise diaries will be reviewed during the weekly telephone call consultation with the physiotherapist. All participants will receive standard (usual) care, including medical management for their exacerbation based on COPD-X guidelines (which may include inhaled bronchodilators, systemic glucocorticoids and antibiotic therapy as indicated, controlled oxygen therapy and ventilatory assistance as required) and physiotherapy, commencing on the first day of admission. In line with guideline recommendations for management of an acute exacerbation of COPD, standard (usual) care may include referral to traditional outpatient (centre-based) pulmonary rehabilitation after discharge from hospital. Participants randomised to the intervention (early HomeBase) group will be precluded from attending outpatient pulmonary rehabiliation during the intervention period (ie. Weeks 0-10 post hospital discharge). This is to prevent participants undertaking two pulmonary rehabilitation programs at the same time (home and centre-based). Participants in the intervention group will not be precluded from referral to or attending outpatient pulmonary rehabilitation at any time during the 12 month followup period. At the beginning and end of the 8 weeks of the intervention phase, and after 12-months followup, participants will undergo measurements of functional capacity and health status. Hospital medical records and GP records will be reviewed to determine the need and frequency of hospital admissions. This will be tracked for 12 months for all participants.