Chest
Volume 128, Issue 2, August 2005, Pages 663-672
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Clinical Investigations
The Effectiveness of Different Combinations of Pulmonary Rehabilitation Program Components: A Randomized Controlled Trial

https://doi.org/10.1378/chest.128.2.663Get rights and content

Study objectives

To study the short-term and long-term effects of combining activity training or lectures to exercise training on quality of life, functional status, and exercise tolerance

Setting

Outpatient pulmonary rehabilitation center

Participants

Forty-three outpatients with COPD

Interventions

Patients were randomized to one of three treatment groups: exercise training alone, exercise training plus activity training, and exercise training plus a lecture series. The mean treatment period was 10 weeks

Measurement

The Chronic Respiratory Disease Questionnaire, the modified version of the Pulmonary Functional Status and Dyspnea Questionnaire, and the COPD Self-Efficacy Scale were administered at baseline, and 6, 12, 18, and 24 weeks from the beginning of the rehabilitation program. The 6-min walk test was used to measure exercise tolerance

Results

Benefits of activity training combined with exercise included less dyspnea (p ≤ 0.04) and fatigue (p ≤ 0.01), and increased activity involvement (p ≤ 0.02) and total functional status (p ≤ 0.02) in the short term compared to comparison treatment groups for comparatively older participants. Compared to the lecture series adjunct, the activity training adjunct resulted in significantly higher gains in total quality of life (p = 0.04) maintained at 24 weeks. Significantly worse emotional function and functional status resulted from the lecture series adjunct in the oldest participants (p ≤ 0.03). Treatment groups did not differ significantly on exercise tolerance or self-efficacy

Conclusions

Evidence for additional benefits of activity-specific training combined with exercise was found. A behavioral method emphasizing structured controlled breathing and supervised physical activity was statistically significantly more effective than didactic instruction in facilitating additional gains and meeting participants’ learning needs

Section snippets

Materials and Methods

The research design consisted of one between-subjects factor (treatment group) and one within-subjects factor (time). The treatment group had three levels: exercise training alone (ETA) [standard, usual care], exercise training plus activity training (ETAT), and exercise training plus a lecture series (ETLS). Patients were randomized to one of the three treatment groups. Five quality-of-life and functional status data points were collected for each participant: baseline (preintervention), and

Results

The recruitment period of the study was from January 2001 to March 2002. Sixty-four percent (n = 43) of invited patients were recruited for the study (Fig 2). This sample size was chosen based on the number of participants that could feasibly be recruited within a 15-month period.A prioripower analysis was difficult because of limited literature available to estimate means and SDs, size of interaction, and main treatment group effects, and covariance effects of different treatment combinations.

Functional Status

Age was found to have a linear effect and to predict ETAT treatment effectiveness for functional status. Participants of older age in the ETAT group experienced the greatest improvements in functional status as compared to the other two groups at 12 weeks. The ETAT treatment appeared to have no greater effect on functional status for participants of comparatively young age.

The finding that age predicts functional status treatment effectiveness is consistent with the theoretical information of

Conclusion

A strength of this study was the inclusion of two experimental treatment groups that allowed for comparison of treatment combination effects, including teaching methods and content, and increased control of the placebo effect of attention.42 An important focus was on the effect of dyspnea management strategies directed toward daily activity performance in contrast to most other pulmonary outcome studies that have primarily investigated the effect of dyspnea management on exercise performance.

It

Acknowledgments

The authors thank Dr. Deborah Labovitz (New York University, Department of Occupational Therapy) for research guidance, Dr. Jeremy Weedon (SUNY, Downstate Medical Center, Scientific Computing Center) for data analysis; the New York State Occupational Therapy Association for a research committee grant; and Nellcor Mallinckrodt Inc. for the loan of pulse oximeters.

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