Chronic obstructive pulmonary disease (COPD) is a common condition that can cause breathlessness and reduced physical capacity. Pulmonary rehabilitation (PR) is an effective treatment, but traditional programs often require patients to attend sessions several times per week, which may limit participation.

This study aims to compare the effectiveness of two supervised pulmonary rehabilitation programs: one performed 3 days per week and another performed 1 day per week, both over an 8-week period and including additional home-based exercises.

The main objective is to determine whether the lower-frequency program is not inferior to the higher-frequency program in improving functional capacity, measured by the six-minute walk test. Secondary outcomes include dyspnea, quality of life, muscle strength, physical activity, adherence, exacerbations, and safety.

The results of this study may help optimize pulmonary rehabilitation programs and improve accessibility for patients with COPD.

This is a randomized, parallel-group clinical trial designed to evaluate the non-inferiority of a supervised pulmonary rehabilitation (PR) program performed once weekly compared with a program performed three times weekly in patients with stable chronic obstructive pulmonary disease (COPD).

Participants will be recruited from a tertiary care hospital and randomly assigned to one of two intervention groups: (1) supervised PR three days per week or (2) supervised PR one day per week. Both interventions will be conducted over 8 weeks and will include structured exercise training and educational components, complemented by a home-based program.

The primary outcome is functional capacity assessed by the six-minute walk test. Secondary outcomes include dyspnea, health-related quality of life, peripheral muscle strength, physical activity levels, adherence to the intervention, incidence of exacerbations, and safety.

Statistical analyses will be conducted according to both intention-to-treat and per-protocol principles. A non-inferiority framework will be applied, and appropriate mixed-effects models will be used to assess differences between groups over time.

IInclusion criteria

• Diagnosis of COPD confirmed by spirometry (FEV₁/FVC <0.70)
• Modified Medical Research Council (mMRC) dyspnoea scale ≥2
• Ability to actively participate and perform physical exercise
• Signed informed consent

Exclusion criteria

• Unstable cardiac or musculoskeletal comorbidity contraindicating or limiting exercise
• Moderate to severe cognitive impairment or inability to understand instructions
• Recent participation (<6 months) in a complete pulmonary rehabilitation programme
• Inability to attend the centre 1-3 days/week according to group allocation
• Current participation in any structured pulmonary rehabilitation programme or supervised rehabilitation intervention in another centre.
• Active oncological treatment

Due to the nature of the intervention, participants and care providers cannot be blinded. Outcome assessors are blinded to group allocation. Baseline and post-intervention evaluations are conducted by different assessors. Personnel performing functional tests, muscle strength assessments, and administering clinical scales remain unaware of treatment allocation.