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The Effectiveness of Different Combinations of Pulmonary Rehabilitation Program Components^*

A Randomized Controlled Trial

^* From the Department of Occupational Therapy (Dr. Migliore Norweg) and Department of Teaching and Learning (Dr. Malgady), New York University; and New York University Medical Center, Rusk Institute of Rehabilitation Medicine (Dr. Whiteson, Ms. Mola, and Dr. Rey), New York, NY.

Correspondence to: Anna Migliore Norweg, PhD, OTR, State University of New York (SUNY), Downstate Medical Center, Occupational Therapy Program, 450 Clarkson Ave, Box 81, Brooklyn, NY 11203; e-mail: amigliore{at}downstate.edu

Study objectives: To study the short-term and long-term effects of combining activity training or lectures to exercise training on quality of life, functional status, and exercise tolerance.

Design: Randomized clinical trial.

Setting: Outpatient pulmonary rehabilitation center.

Participants: Forty-three outpatients with COPD.

Interventions: Patients were randomized to one of three treatment groups: exercise training alone, exercise training plus activity training, and exercise training plus a lecture series. The mean treatment period was 10 weeks.

Measurement: The Chronic Respiratory Disease Questionnaire, the modified version of the Pulmonary Functional Status and Dyspnea Questionnaire, and the COPD Self-Efficacy Scale were administered at baseline, and 6, 12, 18, and 24 weeks from the beginning of the rehabilitation program. The 6-min walk test was used to measure exercise tolerance.

Results: Benefits of activity training combined with exercise included less dyspnea (p 0.04) and fatigue (p 0.01), and increased activity involvement (p 0.02) and total functional status (p 0.02) in the short term compared to comparison treatment groups for comparatively older participants. Compared to the lecture series adjunct, the activity training adjunct resulted in significantly higher gains in total quality of life (p = 0.04) maintained at 24 weeks. Significantly worse emotional function and functional status resulted from the lecture series adjunct in the oldest participants (p 0.03). Treatment groups did not differ significantly on exercise tolerance or self-efficacy.

Conclusions: Evidence for additional benefits of activity-specific training combined with exercise was found. A behavioral method emphasizing structured controlled breathing and supervised physical activity was statistically significantly more effective than didactic instruction in facilitating additional gains and meeting participants’ learning needs.

Key Words: COPD • dyspnea management • functional status • health-related quality of life

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