Chest

Chest

Volume 122, Issue 3, September 2002, Pages 948-954
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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.

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

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    Copyright © 2002 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.