clinically important difference in this test. Changes
in absolute values are considered to be more sensitive indicators
than changes in percentage values.18 The improvement
seen in our study suggests that a home-based pulmonary
rehabilitation program can be recommended as an alternative
to conventional pulmonary rehabilitation carried out in a hospital
setting to enhance tolerance to exercise in patients with
COPD. To the best of our knowledge, this is the first study to
demonstrate that a simple, low-cost protocol is effective for
this purpose. Likewise, the greater walk distance on the endurance
test further demonstrates the improvement these subjects
achieved with the home-based pulmonary rehabilitation
program