Impact of brief or extended exercise training on the benefit of a dyspnea self-management program in COPD.
OBJECTIVE
To evaluate the differences in the long-term outcomes of dyspnea, exercise performance, health-related quality of life, and health resource utilization following a dyspnea self-management program with 3 different "doses" of supervised exercise.


METHODS
In a prospective, randomized, single-blind, 1-year trial, patients with stable chronic obstructive pulmonary disease (N = 103; age 66 +/- 8, females 57; FEV1 44.8% +/- 14% predicted) were randomly assigned to either: (1) Dyspnea self-management program (DM); (2) DM plus 4 supervised exercise sessions (DM-exposure); or (3) DM plus 24 supervised exercise sessions (DM-training). The dyspnea self-management program included individualized education and demonstration of dyspnea self-management strategies, an individualized home walking prescription, and biweekly nurse telephone calls. Outcomes were measured at baseline and every 2 months for 1 year.


RESULTS
The DM-training group had significantly greater improvements in dyspnea during incremental treadmill test and in exercise performance on the incremental and endurance treadmill tests at 6 and 12 months compared with the other 2 groups. Dyspnea with activities of daily living and self-reported physical functioning significantly improved for all groups over time. The dose-response relationship between supervised exercise and improvement in dyspnea present at 2 months was not sustained over the year.


CONCLUSIONS
Consistent with previous findings from evaluation studies of pulmonary rehabilitation programs, the greater number of supervised exercise training sessions improved laboratory dyspnea and performance more than the other two doses of exercise. In the long term, the improvement in dyspnea with activities of daily living and physical functioning was similar for all 3 groups.
Carrieri-Kohlman
Virginia
V
Department of Physiological Nursing, University of California, San Francisco, 94143-0610, USA. ginger.carrieri-kohlman@nursing.ucsf.edu
Nguyen
Huong Q
HQ
Donesky-Cuenco
DorAnne
D
Demir-Deviren
Sibel
S
Neuhaus
John
J
Stulbarg
Michael S
MS
D000368:Aged; D004417:Dyspnea / Q000175:diagnosis / Q000534:rehabilitation*; D005081:Exercise Therapy; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010809:Physical Fitness / Q000502:physiology; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000534:rehabilitation*; D011788:Quality of Life; D012016:Reference Values; D012129:Respiratory Function Tests; D018570:Risk Assessment; D012648:Self Care / Q000379:methods; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome