Chest
Volume 122, Issue 3, September 2002, Pages 948-954
Journal home page for Chest

Clinical Investigations
COPD
Exercise Maintenance Following Pulmonary Rehabilitation: Effect of Distractive Stimuli

https://doi.org/10.1378/chest.122.3.948Get rights and content

Study objective

To determine if distractive auditory stimuli (DAS) in the form of music would promote adherence to a walking regimen following completion of a pulmonary rehabilitation program (PRP) and, thereby, maintenance of gains achieved during the program.

Design

Experimental, randomized, two-group design with testing at baseline, 4 weeks, and 8 weeks.

Setting

Outpatient.

Patients

Twenty-four patients (4 men and 20 women) with moderate-to-severe COPD (FEV1 41.3 ± 13% predicted [mean ± SD]).

Intervention

Experimental group subjects (n = 12) were instructed to walk at their own pace for 20 to 45 min, two to five times a week, using DAS with a portable audiocassette player. The control group (n = 12) received the same instructions, but no DAS.

Measurements and results

Primary outcome measures were perceived dyspnea during activities of daily living (ADL) and 6-min walk (6MW) distance. Secondary outcome measures were anxiety, depressive symptoms, health-related quality of life (QoL), global QoL, and breathlessness and fatigue at completion of the 6MW. In addition, all subjects recorded the distance and time walked using self-report (pedometers and daily logs). There was a significant decrease in perceived dyspnea during ADL (p = 0.0004) and a significant increase in 6MW distance (p = 0.0004) over time in the DAS group compared to the control group. DAS subjects increased 6MW distance 445 ± 264 feet (mean ± SD) from baseline to 8 weeks, whereas control subjects decreased 6MW distance to 169 ± 154 feet. No significant differences were noted for the remaining variables. The cumulative distance walked by the DAS group was 19.1 ± 16.7 miles compared to 15.4 ± 8.0 miles for the control group, a 24% difference (p = 0.49). Despite this difference, self-report exercise log data were similar for the two groups.

Conclusion

Subjects who used DAS while walking had improved functional performance and decreased perceptions of dyspnea, whereas control subjects could not maintain post-PRP gains. DAS is a simple, cost-effective strategy that may have the potential to augment the effectiveness of post-PRP maintenance training.

Section snippets

Specific Aims

We sought to determine if DAS in the form of music would facilitate adherence to a walking regimen following completion of a PRP and, thereby, augment the effectiveness of post-PRP maintenance training as indicated by perceptions of dyspnea during activities of daily living (ADL) and 6-min walk (6MW) distance.

Materials and Methods

The sample was a convenience sample of 24 patients (83% female) aged 68.1 ± 8 years (mean ± SD), defined as the first 24 subjects who met the inclusion criteria, consented to participate, and completed 8 weeks of data collection. Of these, 5 patients (16.7%) were African American and 19 patients (83.3%) were white. Six additional patients (all men) were approached but refused to participate because they did not wish to be randomized. Entry criteria were the following: (1) diagnosis of COPD (FEV1

Results

There were no significant differences at baseline in any measured variables (Table 1). When demographics were examined, control group subjects were older (p = 0.05) than DAS subjects. No between-group differences were found for marital status (p = 0.58), years of education (p = 0.07), ethnicity (p = 0.29), employment (p = 0.89), or oxygen requirement (p = 0.83).

Using multivariate analysis of variance, no significant difference was noted between groups (F = 1.277, degrees of freedom [df] = 11,

Discussion

The major findings of this study were the following: (1) subjects who used DAS (music) during post-PRP maintenance training improved functional performance reflected in an increase in 6MW distance and a decrease in perceived dyspnea compared to control subjects; and (2) depressive symptoms decreased over time in both groups. No significant differences were noted between groups, over time, or interaction of group and time for anxiety, global QoL, HRQoL (total or subscores), or symptoms during

Conclusion

PRPs significantly increase functional capacity and reduce symptoms in patients with COPD. Unfortunately, the majority of patients experience a significant loss of the training effect within 1 year following completion of a formal program. This study suggests important benefits from the use of distraction as a means to maintain functional performance. The major findings were that subjects who used DAS (music) while walking improved post-PRP 6MW distance and decreased perceptions of dyspnea

Acknowledgment

The authors thank Judith Erlen, RN, PhD, and Mildred Jones, RN, PhD, who served as members of the dissertation committee for this study; Andrew Petrini, MS, Lorraine Brock, RN, Todd Pollock, MS, B.J. Veschio, RRT, and Terry Riffer, MS, who served as case finders; and Fred Tasota, RN, MSN, for editorial assistance.

References (30)

  • HM Thomas

    Pulmonary rehabilitation: does site matter?

    Chest

    (1996)
  • Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based guidelines

    ACCP/AACVPR Pulmonary Rehabilitation Guidelines Panel: American College of Chest Physicians; American Association of Cardiovascular and Pulmonary Rehabilitation

    Chest

    (1997)
  • RM Kaplan et al.

    Self-efficacy expectations predict survival for patients with chronic obstructive pulmonary disease

    Health Psychol

    (1994)
  • F Haas et al.

    Desensitization to dyspnea in chronic obstructive pulmonary disease

  • EB Binnings

    The effect of an auditory distraction on anxiety in ambulatory surgical patients experiencing regional anesthesia

    AANA J

    (1987)
  • Cited by (93)

    • Measuring intensity during free-living physical activities in people with chronic obstructive pulmonary disease: A systematic literature review

      2022, Annals of Physical and Rehabilitation Medicine
      Citation Excerpt :

      The most frequently used outcomes, outcome measures and instruments to assess single free-living PA-related intensity were dyspnoea with the modified Borg scale; cardiac function via HR, measured with HR monitors; and pulmonary gas exchange, especially VO2, measured with portable gas analysers. In total, 32 studies referred to absolute intensity [20, 22-28, 30, 31, 33, 34, 36-38, 40-47, 49, 51, 52, 56, 57, 60-63] and 32 to relative intensity [20, 22-26, 29-36, 39, 40, 42, 46-48, 50-55, 57, 58, 60-62]. From the latest studies, 2 estimated maximum intensity using equations [47, 54].

    • Physical exercise in chronic diseases

      2018, Nutrition and Skeletal Muscle
    • Evaluation of Dyspnea in the Elderly

      2017, Clinics in Geriatric Medicine
    • Distractive auditory stimuli in the form of music in individuals with COPD: A systematic review

      2015, Chest
      Citation Excerpt :

      Four studies applied aerobicand walking-based training,33,35,36,52 and a single study focused on upper limb (UL) training.34 One study explored effects during a single exercise session,52 and one study applied training for 1 month34; one for 2 months33; and two for 3 months,5,36 of which one incorporated longer-term training.36 The details of the exercise testing are included in Table 2.

    • Rhythmic auditory stimulation increases 6-Minute walk distance in individuals with COPD: A repeated measures study

      2020, Heart and Lung
      Citation Excerpt :

      Desensitization and distraction have been effective in reducing dyspnea and anxiety.26,31–33 For this reason, music has been used extensively as a cognitive behavioral distractive strategy to increase physical performance in chronically ill participant's distracting them from uncomfortable symptoms.7,8,34,35 Bauldoff, et al. reported that perceived dyspnea was reduced during the 6MWT coupled with an increase in walk distance in the group that received the music compared to the group that did not during a home-based walking program.7

    View all citing articles on Scopus

    Supported by the National Institute of Nursing Research, National Institutes of Health grant No. 1F31 NR07599.

    View full text