The effectiveness of different combinations of pulmonary rehabilitation program components: a randomized controlled trial.
OBJECTIVE
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.


METHODS
Randomized clinical trial.


METHODS
Outpatient pulmonary rehabilitation center.


METHODS
Forty-three outpatients with COPD.


METHODS
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.


METHODS
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 < or = 0.04) and fatigue (p < or = 0.01), and increased activity involvement (p < or = 0.02) and total functional status (p < or = 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 < or = 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.
Norweg
Anna Migliore
AM
Department of Occupational Therapy, New York University, USA. amigliore@downstate.edu
Whiteson
Jonathan
J
Malgady
Robert
R
Mola
Ana
A
Rey
Mariano
M
D000367:Age Factors; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D015397:Program Evaluation; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000534:rehabilitation*; D011788:Quality of Life; D012129:Respiratory Function Tests