title: Chronic disease self-management and exercise in COPD as pulmonary rehabilitation: a randomized controlled trial.
abstract: OBJECTIVE
  Both exercise and self-management are advocated in pulmonary rehabilitation for people with chronic obstructive pulmonary disease (COPD). The widely used 6-week, group-based Chronic Disease Self-Management Program (CDSMP) increases self-reported exercise, despite supervised exercise not being a program component. This has been little explored in COPD. Whether adding supervised exercise to the CDSMP would add benefit is unknown. We investigated the CDSMP in COPD, with and without a formal supervised exercise component, to address this question.
  
  
  METHODS
  Adult outpatients with COPD were randomized to the CDSMP with or without one hour of weekly supervised exercise over 6 weeks. The primary outcome measure was 6-minute walk test distance (6MWD). Secondary outcomes included self-reported exercise, exercise stage of change, exercise self-efficacy, breathlessness, quality of life, and self-management behaviors. Within- and between-group differences were analyzed on an intention-to-treat basis.
  
  
  RESULTS
  Of 84 subjects recruited, 15 withdrew. 6MWD increased similarly in both groups: CDSMP-plus-exercise (intervention group) by 18.6±46.2 m; CDSMP-alone (control group) by 20.0±46.2 m. There was no significant difference for any secondary outcome.
  
  
  CONCLUSIONS
  The CDSMP produced à small statistically significant increase in 6MWD. The addition of a single supervised exercise session did not further increase exercise capacity. Our findings confirm the efficacy of a behaviorally based intervention in COPD, but this would seem to be less than expected from conventional exercise-based pulmonary rehabilitation, raising the question of how, if at all, the small gains observed in this study may be augmented.
authors.affiliation: Centre of Research Excellence for Chronic Respiratory Disease and Lung Aging, School of Medicine, University of Tasmania, Hobart, TAS, Australia.
authors.forename: Helen L
authors.initials: HL
authors.lastname: Cameron-Tucker
authors.affiliation: Centre of Research Excellence for Chronic Respiratory Disease and Lung Aging, School of Medicine, University of Tasmania, Hobart, TAS, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Wood-Baker
authors.affiliation: Faculty of Education, University of Tasmania, Hobart, TAS, Australia.
authors.forename: Christine
authors.initials: C
authors.lastname: Owen
authors.affiliation: Department of Respiratory Medicine, Royal Hobart Hospital, Hobart, TAS, Australia.
authors.forename: Lyn
authors.initials: L
authors.lastname: Joseph
authors.affiliation: Centre of Research Excellence for Chronic Respiratory Disease and Lung Aging, School of Medicine, University of Tasmania, Hobart, TAS, Australia.
authors.forename: E Haydn
authors.initials: EH
authors.lastname: Walters
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D005080:Exercise Test; D005081:Exercise Therapy; D017079:Exercise Tolerance; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation; D020127:Recovery of Function; D012648:Self Care; D013648:Tasmania; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking
keywords: 6-minute walk distance; physical capacity; supervised exercise