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

Abstract

Purpose

Both 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 methods

Adult 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.

Results

Of 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.

Conclusion

The 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.

Keywords:

• supervised exercise
• physical capacity
• 6-minute walk distance

Acknowledgments

This work was supported in part by the Australian Physiotherapy Association Beryl Haynes Memorial Fund Grant, Australia; the Royal Hobart Hospital Research Foundation Grant, Hobart, TAS, Australia, and a University of Tasmania Scholarship, Hobart, TAS, Australia. The authors would like to thank the Physiotherapy Department, Royal Hobart Hospital, Hobart, TAS, Australia where this research took place. We thank Associate Professor Leigh Blizzard, Menzies Research Institute Tasmania, University of Tasmania for his invaluable assistance with statistical analysis. Finally, we are indebted to the people with COPD who willingly gave of their time and of themselves to participate in our research.

Disclosure

Helen L Cameron-Tucker received financial support for this research from the Australian Physiotherapy Association Beryl Haynes Memorial Fund Grant, Australia; the Royal Hobart Hospital Research Foundation Grant, Hobart, TAS, Australia, and a University of Tasmania Scholarship, Hobart, TAS, Australia. There are no other potential conflicts of interest pertaining to this work.