Nurse-led aerobic pulmonary rehabilitation: a comprehensive evaluation of physiological indicators, exercise tolerance, and quality of life in patients with moderate to severe COPD

BackgroundPatients with moderate-to-severe chronic obstructive pulmonary disease (COPD) have difficulty performing pulmonary rehabilitation independently. In China, resources for respiratory physicians and rehabilitation specialists are limited and cannot meet the needs of all patients. The nurse-led model, leveraging the advantages of frequent nurse–patient contact, comprehensive case management capabilities, and relatively abundant resources, can help compensate for these deficiencies.ObjectiveTo investigate the effects of a nurse-led aerobic pulmonary rehabilitation model on exercise tolerance, quality of life, and physiological status in patients with moderate to severe COPD.MethodsThis study prospectively enrolled 80 patients with moderate to severe stable COPD who were treated at our hospital from January 2024 to August 2025 and were part of the intention-to-treat (ITT) population. They were randomly divided into an intervention group (n = 40) and a control group (n = 40). The control group received routine aerobic pulmonary rehabilitation nursing, while the intervention group received nurse-led multidisciplinary collaborative pulmonary rehabilitation intervention in addition to routine care. After 4 weeks, the per-protocol (PP) population totaled 74 cases (37 in each group). The primary outcome, the 6-min walk distance (6MWD), was compared between the ITT and PP populations. Secondary outcomes were assessed in the PP population, including the chronic obstructive pulmonary disease assessment test (CAT), St. George’s respiratory questionnaire (SGRQ), Barthel index (BI), and Borg scale scores.ResultsAnalysis of the primary outcome (6MWD) showed a statistically significant group-by-time interaction effect between the two groups in the ITT population (p < 0.05). At baseline, the 6MWD was 368.44 ± 45.07 m in the control group and 354.47 ± 56.17 m in the intervention group (p = 0.224). At 4 weeks, the 6MWD was 380.03 ± 44.70 m in the control group and 406.42 ± 34.01 m in the intervention group (p = 0.004), and the 6MWD in the intervention group was significantly higher than that before the intervention (p < 0.05). Consistent results were observed in the PP population (intervention group vs. control group: 405.03 ± 34.90 m vs. 378.06 ± 45.83 m, p = 0.006). Secondary outcomes were assessed only in the PP population. For CAT scores, baseline values were 12.90 ± 4.23 in the control group and 13.55 ± 3.81 in the intervention group (p = 0.488). At 4 weeks, scores decreased to 11.10 ± 2.72 and 9.15 ± 1.78 (p < 0.001). Both groups showed significant within-group improvements (p < 0.05). For SGRQ scores, no significant between-group difference was found (control: 56.80 ± 9.76 vs. intervention: 54.23 ± 7.02, p = 0.196), but intra-group comparison showed significant improvement in the intervention group compared to baseline (p < 0.05). For Borg scores, the intervention group scored significantly lower than the control group (3.26 ± 0.27 vs. 4.10 ± 0.46, p < 0.001). For BI, the intervention group scored significantly higher than the control group (64.22 ± 6.30 vs. 56.49 ± 4.40, p < 0.001). All secondary outcomes showed statistically significant group-by-time interaction effects (p < 0.05).ConclusionThe nurse-led aerobic pulmonary rehabilitation model can effectively improve exercise tolerance, respiratory status, and activities of daily living in patients with moderate to severe COPD. However, the long-term efficacy of nurse-led pulmonary rehabilitation and patient treatment adherence still require further evaluation.