Safe and effective prescription of exercise in acute exacerbations of chronic obstructive pulmonary disease: rationale and methods for an integrated knowledge translation study.
BACKGROUND
Patients hospitalized with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) engage in low levels of activity, putting them at risk for relapse and future readmissions. There is little direction for health care providers regarding the parameters for safe exercise during an AECOPD that is effective for increasing activity tolerance before discharge from hospital, especially for patients with associated comorbid conditions.


OBJECTIVE
To report the rationale for and methods of a study to develop evidence-informed care recommendations that guide health care providers in the assessment, prescription, monitoring and progression of exercise for patients hospitalized with AECOPD.


METHODS
The present study was a multicomponent knowledge translation project incorporating evidence from systematic reviews of exercise involving populations with chronic obstructive pulmonary disease and⁄or common comorbidities. A Delphi process was then used to obtain expert opinion from clinicians, academics and patients to identify the parameters of safe and effective exercise for patients with AECOPD.


RESULTS
Clinical decision-making tool(s) for patients and practitioners supported by a detailed knowledge dissemination, implementation and evaluation framework.


CONCLUSIONS
The present study addressed an important knowledge gap: the lack of availability of parameters to guide safe and effective exercise prescription for hospitalized patients with AECOPD, with or without comorbid conditions. In the absence of such parameters, health care professionals may adopt an 'activity as tolerated' approach, which may not improve physical activity levels in their patients. The present study synthesizes the best available evidence and expert opinion, and will generate decision-making tools for use by patients and their health care providers.
James Hogg Research Centre, St. Paul's Hospital, University of British Columbia. pat.camp@hli.ubc.ca
Pat
P
Camp
W Darlene
WD
Reid
Cristiane
C
Yamabayashi
Dina
D
Brooks
Donna
D
Goodridge
Frank
F
Chung
Darcy D
DD
Marciniuk
Andrea
A
Neufeld
Alsion
A
Hoens
D003661:Decision Support Techniques; D003697:Delphi Technique; D018450:Disease Progression; D055317:Evidence-Based Practice; D005081:Exercise Therapy / Q000009:adverse effects; D017079:Exercise Tolerance / Q000502:physiology; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D007297:Inpatients; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000628:therapy*; D057170:Translational Research, Biomedical / Q000379:methods*