Low-resource settings

Low-resource settings are defined as those where there is limited equipment and facilities for exercise testing and/or training, poor funding and infrastructure, low levels of staffing and/or lack of staff with qualifications for providing PR. Emerging evidence suggests that endurance and resistance training programmes that require minimal equipment suitable for low-resource settings, such as walking training and elastic resistance bands, may improve functional exercise capacity, muscle strength and HRQoL. However, the number and overall quality of studies is low and further robust research is needed. In low-resource settings, ongoing issues include the lack of availability of HCPs with the expertise to provide PR, no evaluation of the effectiveness of education or self-management components of PR in these settings, and difficulties for patients to attend supervised sessions. However, there is some weak evidence that following centre-based assessment and education, unsupervised home PR programmes may improve health outcomes for people with COPD.