Adherence to a. home-walking prescription in patients with chronic obstructive pulmonary disease
We know little about long-term exercise behavior and adherence in patients with chronic obstructive pulmonary disease (COPD).
The study's purpose was (1) to describe exercise behavior and adherence to a home-walking exercise prescription over 12 months in a sample of patients with COPD; and (2) to validate categories of exercise adherence over time in this population.
This was a secondary analysis of a randomized controlled trial.
A total of 103 participants with COPD who were randomly assigned to one of three versions of a dyspnea self-management program participated.
The components of exercise frequency, duration, and intensity were measured by exercise/dyspnea daily logs, and participants were classified into categories on the basis of their pattern of exercise adherence over the year.
Participants walked an average of 3 days per week initially, with a decline to 2.5 days per week over the year. On average, participants walked longer than the prescribed duration of 20 minutes per session. Dyspnea intensity at the end of the walk tended to remain stable at a mean level of 4 over the year. Classification by adherence category distinguished differences in 6-minute walk distance, endurance treadmill test time, Short Form-36 physical function, and Short Form-36 mental health, with endurance treadmill test time and physical function improvements mirroring increases in exercise adherence, and mental health highest among occasional lapse and lowest among relapser and recycle categories.
This investigation provides a description of long-term exercise behavior and adherence in a sample of patients with COPD. The categories suggest that physical benefits are related to consistent adherence, whereas mental health improvements are related to regular exercise with some flexibility in the schedule. Future research should test interventions to improve exercise adherence in patients with COPD and identify characteristics of patients who are most likely and least likely to adhere over time.
Available from: Tanja W Effing
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ABSTRACT: Chronic obstructive pulmonary disease (COPD) is characterised by frequent day by day fluctuations and repeated severe exacerbations are common. The idea of self-management is to teach patients the skills needed to carry out medical regimens specific to COPD, guide health behaviour change, and provide emotional support for patients to control their disease. It is not clear, however, what the influence of self-management education is in patients with COPD. The medical literature was systematically searched for studies assessing the effects of self-management education in COPD. Self-management reduces hospital admissions. However, because of heterogeneity in interventions, study populations, follow-up time, and outcome measures, data are still insufficient to formulate clear recommendations regarding the form and contents of self-management education programmes in COPD. There is an evident need for more large RCTs with a long-term follow-up, before more conclusions can be drawn.
Cochrane database of systematic reviews (Online) 02/2007; 3(4):CD002990. DOI:10.1002/14651858.CD002990.pub2 · 6.03 Impact Factor
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ABSTRACT: Cardiopulmonary diseases are among the top five global health burdens. As the life-preserving ability of disease management increases, the burden of these diseases is shifting from that of acute to chronic, and many need postacute rehabilitative care for disease exacerbations and postsurgical recovery. Because the segment of the population affected by cardiopulmonary disease is burgeoning, the need for understanding postacute clinical outcomes in this group is increasing. This review summarizes existing evidence regarding the effects of postacute inpatient rehabilitation in patients with major cardiovascular and pulmonary conditions. We conducted a literature search from January 1965 to March 2008 in Medline and the Cochrane Controlled Trials Register. One of the following outcomes measures had to be reported: mortality, morbidity, physical function assessments related to mobility, subsequent hospitalizations, return to work, or cost of care. All studies had to include patients with specific cardiopulmonary diagnosis classifications. In addition, recent evidence regarding comparative outcomes in different postacute care settings (inpatient rehabilitation, skilled nursing facility, home health) and the effect of therapy intensity are presented. The limited data on the outcomes following comprehensive inpatient rehabilitation in cardiopulmonary patients indicate that consistent improvements can be expected in physical function, mobility, and disease symptoms by discharge. Additional benefits of rehabilitation include the alleviation of depression and increased quality of life. The setting for optimal inpatient rehabilitation, however, is still unclear, but preliminary data suggest that higher volumes of therapy likely generate more favorable outcomes such as discharge to home and independent mobility.
Critical Reviews in Physical and Rehabilitation Medicine 01/2008; 20(2):127-158. DOI:10.1615/CritRevPhysRehabilMed.v20.i2.30
Available from: ncbi.nlm.nih.gov
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ABSTRACT: The purpose of this study was to determine the associations between depression and the likelihood of enrollment in a health plan-sponsored physical activity program and pattern of program participation over 2 years; a secondary aim was to examine the association between participation dose and depression risk. There are no published studies on how depression influences participation in health plan-sponsored physical activity programs and how participation affects depression risk in older adults in nonresearch settings.
This study used administrative data from a Medicare Advantage plan. Participants (n=4766) were enrolled in the plan for at least 1 year prior to participating in the plan-sponsored health club benefit (Silver Sneakers). Controls were age- and gender-matched to participants (n=9035). Members were identified as having depression based on ICD-9-CM codes. Multivariate regression and generalized estimating equations models were used. Data were collected between 1998 and 2003 and analyzed in 2008.
Members who had a history of depression were as likely to participate in Silver Sneakers as nondepressed members (OR: 1.03; 95% CI=0.89, 1.20; p=0.67). The risk of lapse in Silver Sneakers attendance was 28%-55% (p<0.05) higher for depressed participants during months 15-24. For nondepressed Silver Sneakers participants, attendance of at least 2 visits/week during Year 1 was significantly associated with lower risk of depression in Year 2 (OR=0.54; 95% CI=0.37, 0.79; p=0.002); a similar but statistically nonsignificant association was observed for previously depressed participants (OR=0.51; 95% CI=0.26, 1.02; p=0.06).
While depressed older adults are as likely to enroll in a health plan-sponsored physical activity as nondepressed members, they were at higher risk of attendance lapses. Greater participation in the physical activity program was associated with lower depression risk.
American Journal of Preventive Medicine 08/2008; 35(2):111-7. DOI:10.1016/j.amepre.2008.04.014 · 4.53 Impact Factor
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