Exercise-based Pulmonary Rehabilitation Research Articles

Virtual Physical Therapy Practices in Canadian Exercise-Based Pulmonary Rehabilitation Programs

Purpose: To understand the current physical therapy virtual care practices in Canadian pulmonary rehabilitation programs. Methods: Exercise-based pulmonary rehabilitation programs were identified through Canadian pulmonary associations available on public websites. Physiotherapists at eligible sites were emailed a web-based survey (REDCap) between March and June 2023. Results: 31/61 survey recipients from 56 programs completed the survey (response rate = 51%). A majority of participants ( n = 20, 65%) reported using a hybrid (mix of virtual and in-person) delivery model in the preceding 6 months. Assessments of exercise capacity, respiratory status, exertional oxygen requirements, and physical function were primarily conducted in-person, whereas exercise prescription and progression, respiratory treatment, psychosocial support, vital sign monitoring, and education were conducted both in-person and virtually. Commonly reported enablers to virtual care were patient preference, medical stability, and availability of technological equipment. Clinical practice guidelines alongside continuing education and training opportunities were identified as important resources needed to optimize virtual or hybrid rehabilitation delivery. Conclusions: Following the COVID-19 pandemic there has been a shift towards a hybrid model of exercise-based pulmonary rehabilitation delivered by physiotherapists. Expanding the evidence base particularly around the clinical utility of virtual assessment may further inform virtual care practices.

Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease Patients with Underlying Alpha-1 Antitrypsin Deficiency: A Systematic Review and Practical Recommendations.

Alpha-1 antitrypsin deficiency (AATD) is an often-overlooked genetic condition that makes individuals susceptible to early onset of chronic obstructive pulmonary disease (COPD). The established benefits of exercise-based pulmonary rehabilitation (PR) for usual COPD patients are unclear for those with underlying AATD, especially given potentially differing muscle adaptations to exercise. This review seeks to compare PR outcomes between AATD and usual COPD patients and to consolidate current knowledge on exercise intervention outcomes for the AATD population. A thorough search of 4 databases (Ovid, Medline, CINAHL, CENTRAL) was conducted based on 3 search concepts: (1) alpha-1 antitrypsin deficiency, (2) pulmonary rehabilitation OR exercise, and (3) muscle morphology. A dual review process and quality assessment were independently implemented throughout all stages of the review. Four studies highlighted modest exercise capacity and quality of life in AATD patients undergoing PR. However, one study reported unique muscle and mitochondrial responses compared to usual COPD patients. Additionally, a moderate exercise session did not alter pro-inflammatory cytokine levels in AATD patients, despite higher levels of tumor necrosis factor-α levels in muscle biopsies compared to usual COPD patients. The current literature base insufficiently addresses the efficacy of PR on AATD, with indications that exercise adaptation may deviate from that of usual COPD patients. Further research is needed to optimize PR, particularly in identifying the most suitable exercise intensity, and delivery setting, and addressing specific educational needs for individuals with AATD.

Effects of exercise-based pulmonary rehabilitation on severe/very severe COPD: a systematic review and meta-analysis.

Pulmonary rehabilitation (PR) has been considered to be an effective treatment method for various respiratory diseases. However, the effects of exercise-based PR on patients with severe/very severe chronic obstructive pulmonary disease (COPD) are unclear. This review aimed to investigate the effects of exercise-based PR on patients with severe/very severe COPD. PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov databases were searched from inception to December 23, 2022, without language restrictions. Randomized controlled trials (RCTs) investigating the effects of exercise-based PR on patients with severe/very severe COPD were included. Study selection, data extraction, and risk of bias assessment were conducted independently. RevMan software (version 5.3) was used for meta-analysis. The quality of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation system. Six studies (263 patients) were identified. Compared with the control group, the 6-min walking distance [MD = 52.91, 95% CI (3.80, 102.03)], the St. George's Respiratory Questionnaire total scores [MD = -7.70, 95% CI (-14.32, -1.08)] and the Borg scale scores [MD = -0.68, 95% CI (-1.28, -0.08)] in the experimental group improved, respectively. The St. George's Respiratory Questionnaire and Borg scale scores were rated as 'moderate quality' and 'low quality', respectively, and the 6-min walking distance was rated as 'very low quality'. Exercise-based PR may improve the exercise capacity, quality of life and dyspnea of patients with severe/very severe COPD, which can be regarded as an adjuvant treatment. High quality and large sample RCTs are needed. This systematic review and meta-analysis protocol was prospectively registered with PROSPERO (No. CRD42022294085).

Effects of full-body exercise-based pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis: a systematic review and meta-analysis protocol

IntroductionIdiopathic pulmonary fibrosis (IPF) is a chronic lung disease characterised by progressive and irreversible fibrosis of the lung parenchyma, resulting in reduced lung function. Since conventional medicines can be associated...

Exercise rehabilitation in pediatric asthma: A systematicreview and network meta-analysis.

This systematic review delineates various exercise-based pulmonary rehabilitation (PR) designs and quantifies how they may be optimized in pediatric asthma treatment. Comprehensive systematic review, network meta-analysis, and quality analyses using PubMed, Embase, Cochrane Library, Web of Science Core Collection, and Medline searches. Discrete and combined endurance, respiratory, resistance, strength, and interval training. Forced expiratory volume at 1 s to predicted value ratio (FEV1 % pred), forced vital capacity to predicted value ratio (FVC% pred), forced expiratory flow between 25% and 75% of vital capacity ratio (FEF25%-75%), the Pediatric Asthma Quality of Life Questionnaire (PAQLQ), and the 6-minwalk test (6MWT). Twenty-four randomized controlled trials (RCTs) involving a combined 1031 patients were included. Endurance training was the most common form of PR (58.3%), typically conducted through outpatient clinics (29.2%). Network meta-analysis showed that compared with other PR, interval training significantly improved PAQLQ total scores, and activity, symptom, and emotional domains. Interval training also had a significant effect on the 6MWT. No adverse events were reported. Exercise training did not have a significant effect on FEV1 % pred; however, combined endurance and respiratory training significantly improved both FVC% pred and FEF25%-75%. Exercise-based PR is safe and effective in childhood asthma treatment. Interval training may be a core component for improving quality of life and exercise capacity in this patient population, while combined respiratory and endurance training may significantly affect lung function. The clinical efficacy of these results should be confirmed through high-quality RCTs.

Exercise adaptations in COPD: the pulmonary perspective.

In chronic obstructive pulmonary disease (COPD), the progressive loss of lung tissue is widely considered irreversible. Thus, various treatment and rehabilitation schemes, including exercise-based pulmonary rehabilitation (PR) are thought to slow down but not reverse or halt the disease. Nonetheless, the adult lung conceals the intrinsic capacity for de novo lung tissue formation in the form of abundant progenitor/stem cell populations. In COPD, these maintain their differentiation potential but appear to be halted by a state of cellular senescence in the mesenchyme, which normally functions to support and coordinate their function. We propose that notably high-intensity interval training may improve pulmonary gas exchange during exercise in patients with COPD by interrupting mesenchymal senescence, thus reestablishing adaptive angiogenesis. By means of this, the downward spiral of dyspnea, poor quality of life, physical inactivity, and early death often observed in COPD may be interrupted. If this is the case, the perception of the regenerative capacity of the lungs will be fundamentally changed, which will warrant future clinical trials on various exercise schemes and other treatments targeting the formation of new lung tissue in COPD.

The Effect of Exercise-Based Pulmonary Rehabilitation on Quality of Life in Recovered COVID-19 Patients; a Quasi-Experimental Study

Introduction:The coronavirus disease 2019 (COVID-19) is associated with a variety of physical and emotional disorders, and subsequently lower Quality of Life (QOL). This study aimed to investigate the effect of a 2-week exercise-based pulmonary rehabilitation on clinical characteristics and QOL of severe COVID-19 patients after discharge from intensive care unit (ICU).Methods:In this quasi-experimental study, eligible severe COVID-19 cases, who had survived and were discharged from ICU were selected using convenience sampling method. O2 saturation (SpO2), pulse rate, dyspnea, and QOL were evaluated and compared before and after two weeks of exercise-based pulmonary rehabilitation (PR).Results:35 cases with the mean age of 57.86 ± 11.73 (18-75) years were studied (51.4% female). The mean SpO2 increased from 90.41 ± 3.97 to 95.11 ± 1.96% after two weeks of pulmonary rehabilitation (p<0.0001). In addition, the mean pulse rate (98.97±16.23 to 88.91±14.03 pulse/minute; p<0.001) and the mean dyspnea severity (5.6±1.97 to 3.45±1.97; p<0.0001) decreased after two weeks of intervention. Besides, the mean total QOL and its dimensions, including general health (p<0.0001), physical status (p<0.0001), emotional status (p = 0.036), and social function (p<0.0001) of patients, had significantly increased after intervention. Conclusion: Based on the findings of this study, it seems that two-week exercise-based pulmonary rehabilitation could be effective in increasing the SpO2, decreasing dyspnea and pulse rate, and improving the QOL of patients with severe COVID-19 after discharge from ICU.

Effect of exercise-based pulmonary rehabilitation in patients with bronchiectasis: A meta-analysis

ObjectiveWe aimed to assess the effectiveness of exercise training in patients with bronchiectasis in terms of exercise capacity, pulmonary function, and quality of life. MethodsPubMed, Embase, and the Cochrane Library were searched for randomized controlled trials (RCTs) examining pulmonary rehabilitation to treat bronchiectasis, and the search timeline was from inception through November 2020. Two researchers independently screened the literature, extracted data, evaluated the risk of bias in the included studies, and used Review Manager 5.3 software to perform the meta-analysis. The primary outcomes were incremental shuttle walk distance (ISWD) and 6-minute walk distance (6-MWD) at 8 weeks. The secondary outcomes were forced expiratory volume in 1 second (FEV1), St. George's Respiratory Questionnaire (SGRQ) score, and Leicester Cough Questionnaire (LCQ) score at 8 weeks. ResultsA total of five RCTs with a total of 198 patients were included. A pooled analysis showed that improvements in ISWD (mean difference [MD] = 92.47 m, 95% confidence interval [CI] 49.87, 135.08; P < 0.0001), 6-MWD (MD = 31.01 m, 95% CI 1.60, 60.42; P = 0.04), and FEV1 (MD = 0.08 L, 95% CI 0.04, 0.12; P = 0.0002) in the pulmonary rehabilitation group were more marked than in the control group. There was no significant difference between the two groups in terms of the improvement in SGRQ and LCQ scores. ConclusionsPulmonary rehabilitation improves exercise capacity and pulmonary function (specifically FEV1) in patients with bronchiectasis. However, due to limitations in the number and quality of current studies, the above conclusions need to be verified in future research.

Exercise-Based Pulmonary Rehabilitation for Interstitial Lung Diseases: A Review of Components, Prescription, Efficacy, and Safety.

Interstitial lung diseases (ILDs) comprise a heterogeneous group of disorders (such as idiopathic pulmonary fibrosis, sarcoidosis, asbestosis, and pneumonitis) characterized by lung parenchymal impairment, inflammation, and fibrosis. The shortness of breath (i.e., dyspnea) is a hallmark and disabling symptom of ILDs. Patients with ILDs may also exhibit skeletal muscle dysfunction, oxygen desaturation, abnormal respiratory patterns, pulmonary hypertension, and decreased cardiac function, contributing to exercise intolerance and limitation of day-to-day activities. Pulmonary rehabilitation (PR) including physical exercise is an evidence-based approach to benefit functional capacity, dyspnea, and quality of life in ILD patients. However, despite recent advances and similarities with other lung diseases, the field of PR for patients with ILD requires further evidence. This mini-review aims to explore the exercise-based PR delivered around the world and evidence supporting prescription modes, considering type, intensity, and frequency components, as well as efficacy and safety of exercise training in ILDs. This review will be able to strengthen the rationale for exercise training recommendations as a core component of the PR for ILD patients.

Revisiting pulmonary rehabilitation during COVID-19 pandemic: a narrative review.

There has been an apparent association between the risks of complications with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with a history of existing chronic respiratory diseases during the pandemic of coronavirus disease 2019 (COVID-19). SARS-CoV-2 poses a severe risk in cardiopulmonary management. Moreover, chronic respiratory diseases may further amplify the risk of morbidity and mortality among the afflicted population in the pandemic era. The present review outlines the importance of pulmonary rehabilitation (PR) in persons with chronic respiratory diseases (Chronic obstructive pulmonary disease (COPD) and Asthma) during the COVID-19 era. In this context, amongst the population with a pre-existing pulmonary diagnosis who have contracted SARS-CoV-2, following initial medical management and acute recovery, exercise-based pulmonary rehabilitation (PR) may play a crucial role in long-term management and recovery. The energy conservation techniques will play a pragmatic role in PR of mild to moderate severity cases to counter post-COVID-19 fatigue. Moreover, there is also an urgent need to effectively address post-COVID-19 anxiety and depression, affecting the PR delivery system.

Clinical Improvement and Effectiveness of Exercise-Based Pulmonary Rehabilitation in Patients With Idiopathic Pulmonary Fibrosis: A BRIEF ANALYTICAL REVIEW.

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive lung disease associated with high mortality rates and poor clinical condition. Exercise-based pulmonary rehabilitation (EBPR) has been demonstrated to be effective in improving 6-min walk distance (6MWD), although the clinical improvement and effectiveness are less characterized. The current review examined the existing evidence of EBPR among patients with IPF and aimed to analyze the effect of EBPR on clinical improvement and effectiveness. A systematic databases search (MEDLINE/PubMed, EMBASE, and the Cochrane Library) was conducted for available publications as of January 2020. Randomized controlled trials (RCTs) and meta-analyses of RCTs examining the effect of EBPR in patients with IPF were reviewed. Mean difference for RCTs and weighted mean difference for meta-analyses between the EBPR arm and the usual-care arm in 6MWD were compared with the established minimal clinically important difference (MCID) of 30 m. Clinical improvement following EBPR was determined when mean difference and weighted mean difference were equal or exceeding the MCID. Effectiveness of EBPR was assessed using the number needed to treat (NNT) analysis. Five independent RCTs (including 21-61 patients/study) and five meta-analyses (including two to five studies with 62-169 patients/meta-analysis) were included. The mean difference of 6MWD ranged from 16-81 m in RCTs. Three of five RCTs demonstrated an average improvement that meets or exceeds the MCID. Two RCTs showed favorable improvement in 6MWD but did not reach the MCID. The weighted mean difference of 6MWD ranged from 27-49 m in the meta-analyses. Four of five meta-analyses showed an average improvement that meets or exceeds the MCID. One early meta-analysis of only two RCTs showed significant improvement, although did not reach the MCID. The NNT in three RCTs and four meta-analyses that met clinical improvement in 6MWD was one. This review provides novel evidence with respect to clinical improvement and high effectiveness of EBPR among patients with IPF. The results suggest that, on average, the majority of patients would be expected to clinically improve by completing the EBPR program. The findings further support the prescription of EBPR as clinically effective therapy and implementation as standard of care for patients with IPF. Future studies examining clinical improvement and effectiveness utilizing additional outcomes with the MCID are warranted.

Structural analysis of retinal blood vessels in patients with COPD during a pulmonary rehabilitation program

Cardiovascular diseases are frequently present in chronic obstructive pulmonary disease (COPD). Population-based studies found associations between retinal vessel diameters and cardiovascular health, but it is unknown whether this also applies to COPD patients. Therefore, we measured retinal vessel diameters in COPD patients and aimed to determine the association with cardiovascular risk factors, lung function, and functional outcomes. In addition, we investigated whether an exercise-based pulmonary rehabilitation (PR) program would change retinal vessel diameters, as a proxy for improved microvascular health. Demographics and clinical characteristics, including pulmonary function, exercise capacity, blood pressure, blood measurements and level of systemic inflammation were obtained from 246 patients during routine assessment before and after PR. Retinal vessel diameters were measured from digital retinal images. Older age and higher systolic blood pressure were associated with narrower retinal arterioles (β: −0.224; p = 0.042 and β: −0.136; p < 0.001, respectively). Older age, higher systolic blood pressure and lower level of systemic inflammation were associated with narrower retinal venules (β: −0.654; −0.229; and −13.767, respectively; p < 0.05). No associations were found between retinal vessel diameters and lung function parameters or functional outcomes. After PR, no significant changes in retinal venular or arteriolar diameter were found. To conclude, retinal vessel diameters of COPD patients were significantly associated with systolic blood pressure and systemic inflammation, whilst there was no evidence for an association with lung function parameters, functional outcomes or other cardiovascular risk factors. Furthermore, an exercise-based PR program did not affect retinal vessel diameter.

The effects of pulmonary rehabilitation on endothelial function and arterial stiffness in patients with chronic obstructive pulmonary disease

Cardiovascular disease is a major cause of mortality in chronic obstructive pulmonary disease (COPD) and endothelial dysfunction may enhance the mortality risk. Exercise training has shown to be beneficial for improvement of endothelial function in patients with cardiovascular disease, but this remains unclear in COPD. Thus, this study aimed to assess the effect of exercise-based pulmonary rehabilitation (PR) on endothelium function, arterial stiffness and plasma nitrite levels in patients with COPD. Patients with COPD engaged a 48-session PR program. Reactive hyperaemia index (RHI), augmentation index (AIx), and heart rate (HR) assed by peripheral arterial tonometry (PAT), plasma nitrite levels, systemic blood pressure, functional capacity (six-minute walk test) and the BODE index were assessed at baseline and after 24 and 48 sessions of PR. Plasma nitrite levels were also assessed before and after the first session of PR. Twenty-one subjects were included and completed 24 PR sessions, and 16 subjects completed 48 sessions. It was observed that a poorer AIx adjusted for HR in frequent COPD exacerbators (4.67 ± 16.5 vs. 20.9 ± 12.9; p = .02). PR improved functional capacity (380 ± 107 m vs. 442 ± 115 m; p < .001) and the BODE index (6 [2.8] vs. 4 [3]; p = .001), but did not change HR, systemic arterial pressure, RHI, AIx, and plasma nitrite levels during the follow-up. Plasma nitrite levels reduced after the first session of PR (0.074 [0.079] μM vs. 0.061 [0.04] μM; p = .027). The acute change in plasma nitrite levels correlated with RHI in patients with preserved endothelial function (r = 0.71; p = .01). Although exercise-based PR improved functional capacity and the BODE index, it did not change endothelial function and arterial stiffness in patients with COPD.

Effect of Rehabilitation Protocol on Dyspnea and Fatigue for Patients with Chronic Obstructive Pulmonary Disease

Background: Pulmonary Rehabilitation (PR) is corner stone in management of chronic obstructive pulmonary disease (COPD). PR is an effective therapy in the integrated care of the patient with chronic respiratory disease. Exercise-based pulmonary rehabilitation has proven to reduce subjective dyspnea, fatigue, exacerbations and frequency for re-hospitalization. Aim of the study: evaluate the effect of rehabilitation protocol on reducing dyspnea and fatigue for Patients with COPD. Research Design: Quasi-experimental research design was utilized in the current study. Setting: The current study was carried out in Inpatient Chest Department and follow up in the Chest Outpatient Clinic at Cardiothoracic Hospital. Sample: A Purposive sample of (66) patients (male and female adult) were assigned in the current study, they classified in two equal groups (n= 33) for a control group and (n= 33) for study group. Tool: Three tools were utilized to collect to current study, First tool: Interview Questioner and Medical Data Sheet, Second tool: COPD Assessment Test (CAT) and Third tool: Respiratory Assessment Sheet. Results: There were highly statistically significant differences among both study and control group regarding Modified Medical Research Council Dyspnea Scale MMRC in 6th and 8th week observations. Conclusions: The study findings concluded that dyspnea and fatigue have negatively effect on patient with COPD. Short term pulmonary rehabilitation program has improved exercise capacity, pulmonary function in COPD patients. Recommendation: Increased patient understanding about COPD risk parameters. Booklet of comprehensive health education program for patients with COPD. Home-based pulmonary rehabilitation follow up, including regular contact to facilitate exercise participation and progression.

Interventions to increase referral to and uptake of Pulmonary Rehabilitation programmes for people with Chronic Obstructive Pulmonary Disease (COPD): A systematic review

Introduction and objectives Pulmonary Rehabilitation (PR) reduces the number and duration of hospital admissions, readmissions and improves health-related quality of life, e.g. breathlessness and fatigue, in patients with COPD. Despite evidence, guidelines and quality standards, PR is significantly underutilised with under-referral (15% of normative need) and limited uptake ( We aimed to address the research question: How effective are interventions to improve referral to and uptake of exercise-based pulmonary rehabilitation programmes in patients with COPD when compared to standard care or no intervention? Methods Systematic review following recognised methods, including all published observational, interventional, qualitative and quantitative studies of interventions specifically intended to increase levels of referral and/or uptake of pulmonary rehabilitation in patients with COPD. Exclusion criteria: individual case studies, conference abstracts and opinion pieces. No date or language restrictions. Search terms included: ‘pulmonary rehabilitation’ AND ‘referral’ OR ‘uptake’ applied to MEDLINE, EMBASE, CINAHL, PsychINFO, ASSIA, BNI, Web of Science and Cochrane Library from inception to June 2016 supplemented by review of reference lists and citation search. Titles, abstracts and full papers were reviewed independently, quality appraised (using Cochrane Collaboration’s tool for RCTs and ROBINS-I, AMSTAR) and entered into summary tables. The protocol was registered (PROSPERO) and reported according to PRISMA guidelines. Results We screened 3217 references, from which 7 papers including 6345 patients and 22 clinicians met inclusion criteria. Most studies (n = 5) were UK based. Designs, interventions and scope of studies were diverse with interventions often part of multifaceted evidence based management of COPD. Examples included computer based prompts at practice nurse review, patient information, financial incentives. Most studies (n = 5) reported improvements in referral or uptake of PR (range 0% – 25% increase), however most had methodological limitations with risk of bias. Due to heterogeneity, studies were not considered combinable and meta-analysis was inappropriate. Conclusions There is limited evidence for the efficacy of interventions to increase referral and uptake of PR. Existing studies are diverse and further testing using robust methods in various populations and settings is required to optimise access to PR.

Exercise training in idiopathic pulmonary fibrosis: is it ofbenefit?

Key pointsExercise training has been proven to be a safe and effective behavioural intervention for prevention and rehabilitation of chronic conditions.Despite the complexity of the signs and symptoms presented in IPF, supervised exercise training is a feasible and effective treatment for clinical improvement.Emerging data show significant enhancements in exercise capacity, dyspnoea and quality of life among IPF patients after exercise training interventions.Understanding of the principles of exercise training and the pathophysiology of IPF are essential for effective exercise programme delivery.Educational aimsTo describe the current evidence supporting exercise training for IPF.To highlight the importance of exercise physiology principles in rehabilitation treatment of patients with IPF.To introduce an effective practical exercise programme for IPF.To discuss the possible underlying physiological mechanisms of training effects in IPF.Exercise is a well-documented safe and effective intervention for prevention and rehabilitation of chronic diseases. Idiopathic pulmonary fibrosis (IPF) is a chronic deadly lung disease associated with severe signs and symptoms, exercise intolerance, diminished quality of life and poor prognosis. In the short term, supervised exercise training programmes have demonstrated clinical benefits in improving exercise capacity, dyspnoea and quality of life in patients with IPF. The underlying mechanisms of chronic adaption to a regular exercise regimen in IPF have yet to be well described and require further investigation. The available data underscore the importance of implementing training principles to target the pathophysiological impairments of IPF in order to optimise training adaption and enhance the outcomes. The current exercise training data in IPF provide sufficient evidence of clinical benefit for consideration to be given to recommending exercise-based pulmonary rehabilitation as standard of care for IPF.

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

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.

EFFECTS OF VIDEO MODELING ON SELF-EFFICACY AND EXERCISE PERFORMANCE OF COPD PATIENTS

The purpose of this study was to study the effect of an exercise-based pulmonary rehabilitation program for persons with chronic obstructive pulmonary disease (COPD). Effects of a complemented video-modeling strategy were studied and compared to the control group which adopted behavioral training strategies in the exercise program only. Eleven patients with COPD received a one-month (three times per week) behavioral exercise program with video modeling. Another eleven patients participated in a control group which performed the same exercise without video modeling. The patients' exercise intensity was monitored by pre-study stress tests to ensure that the participants were all having a comparable level of sub-maximal exercise. They participated in an exercise program which included gradual upgrading of walking on the treadmill, or cycling, and a five-point rating scale assessed their performance level. Their self-efficacy was assessed by using an exercise self-efficacy scale complemented with open-ended questions to elicit their viewpoints on factors affecting their exercise performance, including the video modeling strategy. From the results, both groups showed statistically significant improvement in exercise performance and self-efficacy. Participants in the video-modeling group showed greater — though not statistically significant — improvement compared to the control group in both exercise performance and self-efficacy. The video modeling group generally held positive viewpoints on using video modeling as an effective training strategy to improve the outcome of the pulmonary rehabilitation program.