Chronic disease self-management and exercise in COPD as pulmonary rehabilitation: a randomized controlled trial

Abstract

PurposeBoth exercise and self-management are advocated in pulmonary rehabilitation for people with chronic obstructive pulmonary disease (COPD). The widely used 6-week, group-based Chronic Disease Self-Management Program (CDSMP) increases self-reported exercise, despite supervised exercise not being a program component. This has been little explored in COPD. Whether adding supervised exercise to the CDSMP would add benefit is unknown. We investigated the CDSMP in COPD, with and without a formal supervised exercise component, to address this question.Patients and methodsAdult outpatients with COPD were randomized to the CDSMP with or without one hour of weekly supervised exercise over 6 weeks. The primary outcome measure was 6-minute walk test distance (6MWD). Secondary outcomes included self-reported exercise, exercise stage of change, exercise self-efficacy, breathlessness, quality of life, and self-management behaviors. Within- and between-group differences were analyzed on an intention-to-treat basis.ResultsOf 84 subjects recruited, 15 withdrew. 6MWD increased similarly in both groups: CDSMP-plus-exercise (intervention group) by 18.6±46.2 m; CDSMP-alone (control group) by 20.0±46.2 m. There was no significant difference for any secondary outcome.ConclusionThe CDSMP produced à small statistically significant increase in 6MWD. The addition of a single supervised exercise session did not further increase exercise capacity. Our findings confirm the efficacy of a behaviorally based intervention in COPD, but this would seem to be less than expected from conventional exercise-based pulmonary rehabilitation, raising the question of how, if at all, the small gains observed in this study may be augmented.

A randomized controlled trial of telephone-mentoring with home-based walking preceding rehabilitation in COPD

“…PR followed the format of our previous study, consisting of 1 hour, once-weekly of 8 weeks of structured group education with self-management skills development (the CDSMP) and 1 hour of gym-based weekly supervised exercise 21. Supervised exercise was delivered in the same week but on a subsequent day to the education sessions.…”

“…We recently investigated the addition of an hour of supervised exercise to the CDSMP for people with COPD in a randomized controlled clinical trial, finding a small statistically significant increase in physical capacity 21. However, the increase of 20 m was less than half that reported in a review of traditional PR7 and less than the accepted minimal clinical important difference reported by others 25,26.…”

“…To better meet clinical demand for PR, augmenting the gains we observed in the CDSMP21 and with telephone-based self-management support in COPD19,20 hold promise. In this study, we investigated the effects of telephone-based health-mentoring (tele-rehab) targeting home-based walking on physical capacity and self-reported physical activity.…”

Síndrome EPOC/asma en rehabilitación pulmonar: revisión sistemática - metaanálisis 2010 a 2015

“…Uno y otro contaron con un adecuado proceso de aleatorización y ocultamiento, al igual que un desarrollo apropiado en la exposición de resultados. En el reporte de citaciones se sostuvo un alto riesgo de sesgo en el ocultamiento de los desenlaces pese a la consistencia interna de las 12 publicaciones (Figura 2) (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35).…”

Tratamiento farmacológico y no farmacológico de la enfermedad pulmonar obstructiva crónica

“…Los beneficios de la rehabilitación pulmonar, incluyen disminución de la sintomatología, aumento de la capacidad para realizar actividad física, aumento de la función musculoesquelética, mejora de la calidad de vida, disminución del número de hospitalizaciones por exacerbaciones; asimismo, la rehabilitación pulmonar fortalece el empoderamiento del individuo que padece la enfermedad y reduce la ansiedad y la depresión (Nivel de evidencia A) (5,(42)(43)(44).…”