Renae J. McNamara

Water-based exercise in COPD with physical comorbidities: a randomised controlled trial

Land-based exercise is often difficult for people with chronic obstructive pulmonary disease (COPD) who have coexisting obesity or musculoskeletal or neurological conditions. This randomised controlled trial aimed to determine the effectiveness of water-based exercise training in improving exercise capacity and quality of life compared to land-based exercise training and control (no exercise) in people with COPD and physical comorbidities. Participants referred to pulmonary rehabilitation were randomly allocated to a water-based exercise, land-based exercise or the control group. The two exercise groups trained for 8 weeks, completing three sessions per week. 45 out of 53 participants (mean±sd age 72±9 years; forced expiratory volume in 1 s 59±15% predicted) completed the study. Compared to controls, water-based exercise training significantly increased 6-min walking distance, incremental and endurance shuttle walk distances, and improved Chronic Respiratory Disease Questionnaire (CRDQ) dyspnoea and fatigue. Compared to land-based exercise training, water-based exercise training significantly increased incremental shuttle walk distance (mean difference 39 m, 95% CI 5–72 m), endurance shuttle walk distance (mean difference 228 m, 95% CI 19–438 m) and improved CRDQ fatigue. Water-based exercise training was significantly more effective than land-based exercise training and control in increasing peak and endurance exercise capacity and improving aspects of quality of life in people with COPD and physical comorbidities.

Australian and New Zealand Pulmonary Rehabilitation Guidelines

The aim of the Pulmonary Rehabilitation Guidelines (Guidelines) is to provide evidence‐based recommendations for the practice of pulmonary rehabilitation (PR) specific to Australian and New Zealand healthcare contexts.

Home‐based telerehabilitation via real‐time videoconferencing improves endurance exercise capacity in patients with COPD: The randomized controlled TeleR Study

Telerehabilitation has the potential to increase access to pulmonary rehabilitation (PR) for patients with COPD who have difficulty accessing centre‐based PR due to poor mobility, lack of transport and cost of travel. We aimed to determine the effect of supervised, home‐based, real‐time videoconferencing telerehabilitation on exercise capacity, self‐efficacy, health‐related quality of life (HRQoL) and physical activity in patients with COPD compared with usual care without exercise training.

Reporting of exercise attendance rates for people with chronic obstructive pulmonary disease: A systematic review

While recommendations for the duration, frequency, mode and intensity of exercise programmes for people with chronic obstructive pulmonary disease (COPD) are specified in consensus statements, criteria for exercise session attendance are less clear. The review questions were: (i) how commonly are a priori criteria and attendance rates reported for people with COPD participating in exercise programmes and (ii) what is the strength of association between attendance and improvements in functional exercise capacity. Database searches identified primary studies of people with COPD participating in exercise or pulmonary rehabilitation programmes of at least 2 weeks duration. Primary outcomes were a priori criteria for attendance, reports of attendance at supervised exercise sessions and mean improvements in functional exercise assessments. Data extraction processes were confirmed prospectively (>80% agreement). Variants of exercise attendance data were described. Linear associations between attendance and improvements in exercise outcomes were explored (Pearson r, P < 0.05). Of the 234 included studies, 86 (37%) reported attendance and 29 (12%) provided a priori criteria for attendance. In the small sample of studies which reported attendance and functional exercise data before and after the intervention, there was little to no relationship between improvements in functional exercise capacity and training volume (prescribed r = −0.03, P = 0.88; attended r = −0.24, P = 0.18). Reporting of exercise programme attendance rates is low and of variable quality for people with COPD. Consistent and explicit reporting of exercise attendance in people with COPD will enable calculation of dose–response relationships and determine the value of a priori exercise attendance criteria.

Physical comorbidities affect physical activity in chronic obstructive pulmonary disease: A prospective cohort study

The prevalence of physical comorbidities such as obesity, musculoskeletal or neurological conditions in people with chronic obstructive pulmonary disease (COPD) is high, yet little is known about the impact of these physical comorbidities on physical activity. The primary aim of the study was to compare the physical activity levels of people with COPD with physical comorbidities (COPD + PC) to people with COPD without physical comorbidities (COPD) and healthy age‐matched volunteers (control group).

Community-based exercise training for people with chronic respiratory and chronic cardiac disease: a mixed-methods evaluation.

Background Poor uptake and adherence are problematic for hospital-based pulmonary and heart failure rehabilitation programs, often because of access difficulties. The aims of this mixed-methods study were to determine the feasibility of a supervised exercise training program in a community gymnasium in people with chronic respiratory and chronic cardiac disease, to explore the experiences of participants and physiotherapists and to determine if a community venue improved access and adherence to rehabilitation. Methods Adults with chronic respiratory and/or chronic cardiac disease referred to a hospital-based pulmonary and heart failure rehabilitation program were screened to determine their suitability to exercise in a community venue. Eligible patients were offered the opportunity to attend supervised exercise training for 8 weeks in a community gymnasium. Semi-structured interviews were conducted with participants and physiotherapists at the completion of the program. Results Thirty-one people with chronic respiratory and chronic cardiac disease (34% males, mean [standard deviation] age 72 [10] years) commenced the community-based exercise training program. Twenty-two (71%) completed the program. All participants who completed the program, and the physiotherapists delivering the program, were highly satisfied, with reports of the community venue being well-equipped, convenient, and easily accessible. Using a community gymnasium promoted a sense of normality and instilled confidence in some to continue exercising at a similar venue post rehabilitation. However, factors such as cost and lack of motivation continue to be barriers. Conclusion The convenience and accessibility of a community venue for rehabilitation contributed to high levels of satisfaction and a positive experience for people with chronic respiratory and chronic cardiac disease and physiotherapists.

Water-based exercise in chronic obstructive pulmonary disease

Abstract Background: Water-based exercise has long been used as a therapeutic modality for the treatment of a wide variety of health conditions. However, head out of water immersion (HOWI) was previously thought to be detrimental to the respiratory system and was not recommended for people with chronic obstructive pulmonary disease (COPD). Recent research has provided evidence to the contrary. In fact, HOWI and physical exercise training in water may improve exercise capacity and health-related quality of life in people with COPD. Objective: To review the physiological effects of HOWI and the safety and efficacy of water-based exercise for people with COPD. Major findings: HOWI and exercise in water can be performed safely without any adverse events and with maintenance of oxygen saturation even in those with severe COPD. Evidence is beginning to emerge on the beneficial effects of water-based exercise training on exercise capacity and quality of life in COPD although further high quality research is required. Conclusion: Water-based exercise is safe and provides a promising treatment approach which may be used to assist in the management of COPD.

Satisfaction and Experience with a Supervised Home-Based Real-Time Videoconferencing Telerehabilitation Exercise Program in People with Chronic Obstructive Pulmonary Disease (COPD)

Telerehabilitation, consisting of supervised home-based exercise training via real-time videoconferencing, is an alternative method to deliver pulmonary rehabilitation with potential to improve access. The aims were to determine the level of satisfaction and experience of an eight-week supervised home-based telerehabilitation exercise program using real-time videoconferencing in people with COPD. Quantitative measures were the Client Satisfaction Questionnaire-8 (CSQ-8) and a purpose-designed satisfaction survey. A qualitative component was conducted using semi-structured interviews. Nineteen participants (mean (SD) age 73 (8) years, forced expiratory volume in 1 second (FEV1) 60 (23) % predicted) showed a high level of satisfaction in the CSQ-8 score and 100% of participants reported a high level of satisfaction with the quality of exercise sessions delivered using real-time videoconferencing in participant satisfaction survey. Eleven participants undertook semi-structured interviews. Key themes in four areas relating to the telerehabilitation service emerged: positive virtual interaction through technology; health benefits; and satisfaction with the convenience and use of equipment. Participants were highly satisfied with the telerehabilitation exercise program delivered via videoconferencing.

Measurement of daily physical activity using the SenseWear Armband Compliance, comfort, adverse side effects and usability

Little is known about the acceptability of wearing physical activity-monitoring devices. This study aimed to examine the compliance, comfort, incidence of adverse side effects, and usability when wearing the SenseWear Armband (SWA) for daily physical activity assessment. In a prospective study, 314 participants (252 people with COPD, 36 people with a dust-related respiratory disease and 26 healthy age-matched people) completed a purpose-designed questionnaire following a 7-day period of wearing the SWA. Compliance, comfort levels during the day and night, adverse side effects and ease of using the device were recorded. Non-compliance with wearing the SWA over 7 days was 8%. The main reasons for removing the device were adverse side effects and discomfort. The SWA comfort level during the day was rated by 11% of participants as uncomfortable/very uncomfortable, with higher levels of discomfort reported during the night (16%). Nearly half of the participants (46%) experienced at least one adverse skin irritation side effect from wearing the SWA including itchiness, skin irritation and rashes, and/or bruising. Compliance with wearing the SWA for measurement of daily physical activity was found to be good, despite reports of discomfort and a high incidence of adverse side effects.

Acceptability of the aquatic environment for exercise training by people with chronic obstructive pulmonary disease with physical comorbidities: Additional results from a randomised controlled trial

OBJECTIVES Water-based exercise training is a relatively new concept in the management of people with COPD. This study aimed to examine the acceptability of the aquatic environment as a medium for exercise training in people with COPD with physical comorbidities. DESIGN Following a supervised eight week, three times a week, water-based exercise training programme conducted in a hospital hydrotherapy pool as part of a randomised controlled trial, participants completed a questionnaire about their experience with exercise training in the pool including adverse events, barriers and factors enabling exercise programme completion, satisfaction with the aquatic environment and their preference for an exercise training environment. RESULTS All 18 participants (mean (SD) age 72 (10) years; FEV1% predicted 60 (10) %) who commenced the water-based exercise training programme completed the questionnaire. Three participants withdrew from training. High acceptability of the water and air temperature, shower and change-room facilities, staff assistance and modes of pool entry was reported (94% to 100%). Six factors were highly rated as enabling exercise programme adherence and completion: staff support (chosen by 93% of participants), enjoyment (80%), sense of achievement (80%), noticeable improvements (73%), personal motivation (73%) and participant support (53%). Eighty-nine percent of the participants indicated they would continue with water-based exercise. CONCLUSIONS This study provides the first insight into the acceptability of the aquatic environment for exercise training in people with COPD and indicates water-based exercise and the aquatic environment is well accepted.