Exploration of the feasibility to combine patients with chronic obstructive pulmonary disease and chronic heart failure in self-management groups with focus on exercise self-efficacy

Figures & data

Figure 1. Conceptual model for the relation between variables in patients with chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD), with indication of the used measuring instruments. mMRC: modified Medical Research Council Dyspnea scale; HAD: Hospital Anxiety and Depression Scale, EQ5D5L-VAS: Visual Analogue Scale of the EuroQol group.

Table 1. Patient characteristics.

	All patients	COPD	CHF	COPD and CHF
	n = 150	n = 60	n = 60	n = 30
Men, n (%)	75 (50)	23 (38)	40 (67)*	12 (40)
Age, years, mean (SD)	73 (8)	69 (8)	78 (8)*	72 (6)
Living alone, n (%)	58 (39)	20 (34)	26 (43)	12 (40)
Employed, n (%)	20 (8)	14 (22)	5 (8)*	1 (3)
Current daily smoking, n (%)	27 (18)	17 (28)	5 (9)*	6 (21)
Physical activity, n (%)
No	42 (28)	20 (35)	13 (22)	9 (32)
15 min/day	38 (26)	14 (24)	18 (31)	6 (21)
30 min/day	39 (27)	13 (22)	16 (27)	10 (36)
>30 min/day and at least once a week more intensive training	26 (18)	11 (19)	12 (20)	3 (11)
NYHA classification, n (%) n = 78
I			3 (5)	2 (9)
II			25 (44)	9 (43)
IIIa			19 (33)	3 (14)
IIIb			8 (14)	6 (29)
IV			2 (4)	1 (5)

COPD: chronic obstructive pulmonary disease; CHF: chronic heart failure; NYHA: New York Heart Association; SD: standard deviation.

*Statistically significant difference between the COPD and CHF groups at a p < .05 level.

Table 2. Comparison of the level of exercise self-efficacy, symptoms, functional status and health status between patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF).

	All patients	COPD	CHF
	n = 150	n = 60	n = 60
Swedish Exercise Self-Efficacy Scale, mean (SD)^a n = 129	23.0 (8.2)	24.5 (8.3)	22.5 (8.2)
mMRC, n (%) n = 145
0	26 (17)	12 (20)	8 (14)
1	55 (37)	25 (42)	22 (40)
2	44 (29)	17 (29)	19 (34)
3	17 (11)	5 (9)	5 (9)
4	3 (2)	0 (0)	2 (3)
Fatigue total score^b, median (IQR) n = 134	5 (2.75–6.25)	5 (2–6)	5 (3–7)
Depression score (HADS), median (IQR)^b n = 136	3 (1–5.75)	2 (1–5)	3 (1–6)
Anxiety score (HADS), median (IQR)^b n = 136	4 (1–7)	4 (2–8)	4 (1–8)
Severity of pain, n (%) n = 146
No pain	30 (20)	13 (22)	10 (17)
Slight pain	41 (28)	17 (29)	18 (31)
Moderate pain	58 (40)	23 (40)	24 (42)
Severe pain	17 (12)	5 (9)	6 (10)
Extreme pain	0 (0)	0 (0)	0 (0)
Six-minute walking distance, meters, mean (SD)^b n = 145	379 (104)	409 (83)	356 (98)*
Health status, VAS score, median (IQR)^b n = 144	65 (50–80)	67.5 (50–78.5)	65 (50–80)

COPD: chronic obstructive pulmonary disease; CHF: chronic heart failure; SD: standard deviation; mMRC: modified Medical Research Council Dyspnea score; IQR: interquartile range; HADS: Hospital Anxiety and Depression Scale; VAS: Visual Analogue Scale.

^aStudent’s t-test.

^bMann–Whitney U-test.

*Statistically significant difference between the groups at a p < .05 level.

Table 3. Correlation matrix for variables within the model: for patients with COPD, patients with CHF and the whole patient population.

	Functional capacity	Health status	Dyspnea	Fatigue	Pain	Depressive symptoms	Anxiety symptoms
Patients with COPD, n = 60
Exercise self-efficacy	0.02	0.46*	−0.30	−0.16	−0.36	−0.43*	−0.37*
Functional capacity		0.36*	−0.13	−0.11	−0.19	−0.13	−0.16
Health status			−0.35*	−0.34	−0.49*	−0.45*	−0.35
Patients with CHF, n = 60
Exercise self-efficacy	0.13	0.17	−0.33	−0.35	−0.27	−0.28	−0.19
Functional capacity		0.09	−0.09	−0.15	−0.29	−0.32	−0.27
Health status			−0.15	−0.38	−0.42*	−0.47*	−0.36*
Whole group, n = 150
Exercise self-efficacy	0.26*	0.31*	−0.38*	−0.25*	−0.31*	−0.38*	−0.26*
Functional capacity		0.23*	−0.25*	−0.15	−0.27*	−0.24*	−0.17
Health status			−0.25*	−0.25*	−0.35*	−0.46*	−0.33*

Spearman correlation coefficients between the different variables for patients with chronic obstructive pulmonary disease (COPD), patients with chronic heart failure (CHF) and all patients with COPD and/or CHF.

*Statistically significant correlation coefficients at a p < .05 level.

Table 4. Linear regression analysis with exercise self-efficacy score as dependent variable (n = 129).

	Regression coefficient, unadjusted (95% CI)	Regression coefficient, adjusted for diagnosis, sex and age (95% CI)
Diagnosis
Chronic heart failure	Ref	Ref
COPD	2.03 (−1.14–5.20)	0.82 (−2.67–4.32)
COPD and/or CHF	−1.51 (−5.36–2.34)	−2.28 (−6.28–1.73)
Sex
Men	Ref	Ref
Women	−0.14 (−3.00–2.72)	0.09 (−2.83–3.00)
Age	−0.18 (−0.35– − 0.01)*	−0.18 (−0.37–0.01)
Living alone	−3.15 (−6.04– −0.26)*	−2.75 (−5.82–0.33)
Daily smoking	−0.51 (−4.19–3.17)	−2.86 (−6.91–1.18)
Physical activity
No	Ref	Ref
15 min/day	1.50 (−2.15–5.15)	1.44 (−2.20–5.07)
30 min/day	4.75 (1.10–8.40)*	5.49 (1.84–9.15)**
>30 min/day mMRC	8.56 (4.55–12.58)***	8.60 (4.59–12.61)***
0	Ref	Ref
1	−4.73 (−8.62– −0.84)*	−4.45 (−8.41– −0.50)*
2	−6.65 (−10.68– −2.63)**	−6.60 (−10.68– −2.52)**
3 + 4	−10.67(−15.45– − 5.59)***	−9.76 (−14.66– −4.87)***
Fatigue total score	−0.71 (−1.25– −0,17)*	−0.87 (−1,41– −0,32)**
Pain
No pain	Ref	Ref
Slight pain	2.72 (−1.14–6.58)	2.51 (−1.37–6.39)
Moderate pain	−4.07 (−7.72– −0.42)*	−3.87 (−7.52– − 0.21)*
Severe pain	−5.57 (−10.35– −0.79)*	−5.32 (−10.13– − 0.52)*
Depression score (HAD)	−1.00 (−1.43– −0.57)***	−0.98 (−1.42– −0.55)***
Anxiety score (HAD)	−0.62 (−0.95– −0.28)***	−0.65 (−0.10– −0.32)***
6MWD	0.02 (0.007–0.03)**	0.02 (0.003–0.03)*
Health status	0.13 (0.05–0.20)**	0.13 (0.05–0.20)**

Linear regression analysis with exercise self-efficacy score as dependent variable (n = 129), unadjusted and adjusted for diagnosis, sex and age. CI: confidence interval; ns: not statistically significant; CHF: chronic heart failure; COPD: chronic obstructive pulmonary disease. mMRC: modified Medical Research Council Dyspnea Scale; HAD: Hospital Anxiety and Depression Scale; 6MWD: six-minute walking distance, health status measured by the Visual Analogue Scale of the EuroQol group.

*p < .05, **p < .005, ***p < .001.