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anxiety, chronic obstructive pulmonary disease, depression, health-related quality of life, rehabilitation



  1. Haugen, Torbjorn S. MD, PhD
  2. Stavem, Knut MD, PhD


PURPOSE: The primary aim of this study was to evaluate if pulmonary rehabilitation in a subtropical climate during winter had better long-term effects on health-related quality of life and symptoms of anxiety and depression than an equivalent pulmonary rehabilitation program in a colder climate. The secondary aim was to assess short-term differences in the same outcomes.


METHODS: Referred patients with chronic obstructive pulmonary disease were randomized to and completed rehabilitation in a subtropical climate in Spain (n = 60) or in a temperate climate in Norway (n = 36). Health-related quality of life was assessed with St. George's Respiratory Questionnaire, and symptoms of anxiety and depression were assessed with the Hospital Anxiety and Depression Scale at the start of rehabilitation, at discharge, and 8 months later.


RESULTS: There were no significant differences between the 2 groups in mean changes in St George's Respiratory Questionnaire dimensions or total score (-3.0; 97.5% confidence interval [CI], -8.6 to 2.6, P = .22) or Hospital Anxiety and Depression Scale anxiety (-1.2; 97.5% CI, -2.7 to 0.3, P = .08) or depression (-0.3; 97.5% CI, -1.7 to 1.1, P = .62) score from the start of rehabilitation to 9 months thereafter. During rehabilitation, the Spain group improved more than the Norway group in the activity score of the St George's Respiratory Questionnaire (-6.2; 97.5% CI, -12.4 to -0.1, P = .02) and in the Hospital Anxiety and Depression Scale anxiety score (-1.7; 97.5% CI, -2.9 to -0.6, P = .001).


CONCLUSIONS: No significant long-term differences in improvement in health-related quality of life or psychological well-being was demonstrated after chronic obstructive pulmonary disease rehabilitation in a subtropical versus a temperate climate.