title: Exercise maintenance following pulmonary rehabilitation: effect of distractive stimuli.
abstract: OBJECTIVE
  To determine if distractive auditory stimuli (DAS) in the form of music would promote adherence to a walking regimen following completion of a pulmonary rehabilitation program (PRP) and, thereby, maintenance of gains achieved during the program.
  
  
  METHODS
  Experimental, randomized, two-group design with testing at baseline, 4 weeks, and 8 weeks.
  
  
  METHODS
  Outpatient.
  
  
  METHODS
  Twenty-four patients (4 men and 20 women) with moderate-to-severe COPD (FEV(1) 41.3 +/- 13% predicted [mean +/- SD]).
  
  
  METHODS
  Experimental group subjects (n = 12) were instructed to walk at their own pace for 20 to 45 min, two to five times a week, using DAS with a portable audiocassette player. The control group (n = 12) received the same instructions, but no DAS.
  
  
  RESULTS
  Primary outcome measures were perceived dyspnea during activities of daily living (ADL) and 6-min walk (6MW) distance. Secondary outcome measures were anxiety, depressive symptoms, health-related quality of life (QoL), global QoL, and breathlessness and fatigue at completion of the 6MW. In addition, all subjects recorded the distance and time walked using self-report (pedometers and daily logs). There was a significant decrease in perceived dyspnea during ADL (p = 0.0004) and a significant increase in 6MW distance (p = 0.0004) over time in the DAS group compared to the control group. DAS subjects increased 6MW distance 445 +/- 264 feet (mean +/- SD) from baseline to 8 weeks, whereas control subjects decreased 6MW distance to 169 +/- 154 feet. No significant differences were noted for the remaining variables. The cumulative distance walked by the DAS group was 19.1 +/- 16.7 miles compared to 15.4 +/- 8.0 miles for the control group, a 24% difference (p = 0.49). Despite this difference, self-report exercise log data were similar for the two groups.
  
  
  CONCLUSIONS
  Subjects who used DAS while walking had improved functional performance and decreased perceptions of dyspnea, whereas control subjects could not maintain post-PRP gains. DAS is a simple, cost-effective strategy that may have the potential to augment the effectiveness of post-PRP maintenance training.
authors.affiliation: University of Pittsburgh School of Nursing, University of Pittsburgh School of Medicine, PA, USA. bauldoff.1@osu.edu
authors.forename: Gerene S
authors.initials: GS
authors.lastname: Bauldoff
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Hoffman
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Zullo
authors.forename: Frank C
authors.initials: FC
authors.lastname: Sciurba
mesh_terms: D000368:Aged; D001288:Attention; D015444:Exercise / Q000523:psychology*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D009146:Music; D010349:Patient Compliance / Q000523:psychology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology / Q000534:rehabilitation*; D016138:Walking / Q000523:psychology