Adherence to a home-walking prescription in patients with chronic obstructive pulmonary disease

• Published in: Heart & lung 2007-09, Vol.36 (5), p.348-363
• Main Authors: Donesky-Cuenco, DorAnne, PhD, RN, Janson, Susan, DNSc, RN, FAAN, Neuhaus, John, PhD, Neilands, Torsten B., PhD, Carrieri-Kohlman, Virginia, DNSc, RN, FAAN
• Format: Article
• Language: English
• Subjects: Aged; Ambulatory Care; Cardiovascular; Chronic obstructive pulmonary disease; Clinical trials; Critical Care; Dyspnea - physiopathology; Dyspnea - rehabilitation; Exercise Therapy - methods; Exercise Therapy - statistics & numerical data; Exercise Tolerance; Female; Health behavior; Humans; Longitudinal Studies; Male; Mental Status Schedule; Middle Aged; Patient Compliance - statistics & numerical data; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Disease, Chronic Obstructive - psychology; Pulmonary Disease, Chronic Obstructive - rehabilitation; Pulmonary/Respiratory; Respiratory diseases; Respiratory Function Tests; Sickness Impact Profile; Studies; Treatment Outcome; Walking; Walking - statistics & numerical data
• ISSN: 0147-9563; 1527-3288
• DOI: 10.1016/j.hrtlng.2006.11.004

Background We know little about long-term exercise behavior and adherence in patients with chronic obstructive pulmonary disease (COPD). Purpose 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. Design This was a secondary analysis of a randomized controlled trial. Subjects A total of 103 participants with COPD who were randomly assigned to one of three versions of a dyspnea self-management program participated. Measures 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. Results 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. Conclusions 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.