Abstract
ABSTRACT Although patients with chronic obstructive pulmonary disease (COPD) benefit in many ways after participating in pulmonary rehabilitation programs, high dropout rates are still observed among participants. This study aims to analyze the adherence rate and perceived satisfaction in individuals with chronic obstructive pulmonary disease who underwent high-intensity physical training on land (LG) and in water (WG). This study is an additional analysis from a randomized controlled trial. In total, 36 subjects (51%) completed the intervention. All participants underwent six months of high-intensity endurance and strength training. Adherence was assessed by the proportion of patients who completed the training program. Perceived satisfaction was evaluated using a questionnaire composed of structured and semi-structured questions. The interviews were recorded, transcribed, and analyzed according to the criteria of our thematic analysis. The Shapiro-Wilk test was used to assess data normality, and dropout rates were compared using the chi-square test. Statistical significance was set at 5%. Regarding adherence, 59% of WG participants and 44% of LG participants completed the program, with no difference between the groups (p>0.05). Individuals from both groups were equally satisfied after six months of physical training (<90%); the therapist-patient relationship and treatment effectiveness being important factors for this perception. Qualitative analysis also showed that WG participants reported a more prominent improvement in their respiratory symptoms, leisure, sensation of pain, and sleep. In conclusion, patients with COPD were satisfied after six months of high-intensity physical training in water and on land, noting that water exercising promoted additional benefits compared to land exercising. There seems to be no superiority to any of the regimens (water or land) regarding the adherence to the training programs.
Highlights
Chronic obstructive pulmonary disease (COPD) is associated with several respiratory and non-respiratory manifestations, such as dyspnea, muscle weakness, and reduced levels of physical activity in daily life (PADL)[1,2,3]
The sample consisted of individuals diagnosed with COPD1; who were stable; aged ≥50 years old; without comorbidities that might have interfered in the evaluations; and did not follow any exercise program in the previous year
Qualitative analysis showed that patients who trained in water reported more prominent benefits than those who trained on land
Summary
Chronic obstructive pulmonary disease (COPD) is associated with several respiratory and non-respiratory manifestations, such as dyspnea, muscle weakness, and reduced levels of physical activity in daily life (PADL)[1,2,3]. The benefits of pulmonary rehabilitation (PR) for these individuals are already established; they include improvements in exercise capacity, muscle strength, overall symptoms, and quality of life,4-5even though high dropout rates are often observed[6], which possibly minimize its positive effects. Other factors may influence adherence rates and have not yet been investigated in this population – for instance, training environment and perceived satisfaction. Conventional training programs for individuals with COPD are composed of endurance and strength exercises, performed using cycle ergometers, treadmills, and multigym stations[6]. Water-based training has similar or greater benefits than land-based training.[13,14,15] Besides, water’s properties reduce the inherent risk of musculoskeletal injuries due to impact[16]
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