In low and middle income countries (LMICs) like India, pulmonary rehabilitation (PR) is sporadically available either at a tertiary care centres or in teaching hospitals located in urban settings. There are several barriers that exist in implementation (labor intensive, time consuming, lack of trained health care professionals, high drop-out rate and cost of rehabilitation) as well as accessing (lack of awareness among CRD patients on PR, unavailability of a PR program and unwilling to spend money on PR) a PR program which hampers the uptake of PR in such settings. Christian Medical College (CMC), Vellore, India, a partner site of RESPIRE research conducted a feasibility intervention trial on chronic respiratory disease (CRD) "Prevention, detection and treatment of adult lung disease including lung cancer in a poor, rural population in Tamil Nadu: feasibility study in rural south India". About 1 year through the study, some have reported remarkable improvement to standard treatment and a significant number have shown suboptimal response to standard treatment. With a need to revamp our CRD patients' health and also to develop a low cost feasible model to endorse and encourage PR in resource-poor settings, the follow-up study was undertaken with the objective to test the feasibility of a peer-led community based comprehensive PR assisted by professionals in a rural Indian setting. Both quantitative and qualitative data were collected to test the feasibility of the study. The quantitative data collected were demographic details, medical history, smoking history, occupation history, hemoglobin level, BMI and treatment details. The baseline and endline assessment included physical activity assessment using the International Physical Activity Questionnaire, activities of daily living using London Chest Activity of Daily Living scale. The nutritional status was assessed using 24 hour recall for a week day and weekend by the Nutritionist. Anxiety and depression was assessed using the Hospital Anxiety and Depression Scale (HADS). Exercise capacity using a six-minute walk test (6-MWT), upper limb strength was assessed using the hand held dynamometer and lower limb endurance was assessed using cycle ergometer. After 8 weeks of pulmonary rehabilitation program, endline assessment was done. The qualitative data was collected at the begining and end of the PR training program. Indepth interviews were conducted among patients and peer volunteers. Data collected was transcribed and translated into English.

At the end of 8 weeks PR program, thirty patients with chronic respiratory disease should see a significant improvement in exercise capacity (mean difference in 6-minute walk test, 56.35 m; P <0.01), endurance (mean difference in cycling time, 71.4 s; P <0.01), and upper limb strength (mean difference in Hand dynamometer, 5.1 Kg; P <0.01). The results showed that a model with a center based PR in the community is feasible.