title: The affective dimension of dyspnea improves in a dyspnea self-management program with exercise training.
abstract: BACKGROUND
  The perception of dyspnea includes both sensory and affective dimensions that are shaped by emotions and psychological, social, and environmental experiences. Previous investigators have studied either measurement or strategies to decrease the affective dimension with laboratory-induced dyspnea. Few have reported the effect of a therapeutic clinical intervention on the affective dimension of dyspnea.
  
  
  OBJECTIVE
  (1) To evaluate the effects of three different versions of a dyspnea self-management program (DM) on the affective dimension of dyspnea, measured by dyspnea-related anxiety (DA) and dyspnea-related distress (DD); and (2) to determine the stability of DA and DD over two baseline incremental treadmill tests (ITTs).
  
  
  METHODS
  Participants with chronic obstructive pulmonary disease were randomly assigned to three 12 month DMs with varying doses of supervised exercise (DM, DM-Exposure, and DM-Training). The measurements of the affective dimension, DA and DD, were rated during ITTs on two baseline days and at two, six, and 12 months. Changes over time in DA and DD were analyzed using linear mixed-effects models.
  
  
  RESULTS
  Participants in the DM-Training group who received 24 nurse-coached exercise sessions had significantly greater reductions in DA and DD compared with those who had four exercise sessions (DM-Exposure) or only received a home-walking program (DM). Reductions in DA and DD in the DM-Training group were only maintained through six months. There were no significant differences in ratings of DA and DD at end between the two baseline ITTs.
  
  
  CONCLUSIONS
  These findings provide initial support for the positive impact of a self-management program with nurse-coached exercise on the affective dimension of dyspnea. Further investigation of interventions that target the affective dimension in addition to the sensory dimension of dyspnea should be encouraged.
authors: University of California, San Francisco, San Francisco, California, USA. Electronic address: doranne.donesky@nursing.ucsf.edu.
authors: Doranne
authors: D
authors: Donesky
authors: Kaiser Permanente Southern California, Pasadena, California, USA.
authors: Huong Q
authors: HQ
authors: Nguyen
authors: University of California, San Francisco, San Francisco, California, USA.
authors: Steven M
authors: SM
authors: Paul
authors: University of California, San Francisco, San Francisco, California, USA.
authors: Virginia
authors: V
authors: Carrieri-Kohlman
mesh_terms: D000368:Aged; D001007:Anxiety / Q000628:therapy; D004417:Dyspnea / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D012648:Self Care / Q000379:methods*; D013147:Spirometry; D013997:Time Factors; D016896:Treatment Outcome
keywords: Dyspnea; affective dimension; chronic obstructive pulmonary disease; exercise; shortness of breath; symptom management