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Distractive Auditory Stimuli Reduce the Unpleasantness of Dyspnea During Exercise in Patients With COPD^*

^* From the Department of Psychology (Drs. von Leupoldt and Dahme), University of Hamburg, Hamburg; Atem-Reha GmbH (Dr. Taube and Mr. Schubert-Heukeshoven), Hamburg; and the Pulmonary Research Institute (Dr. Magnussen), Hospital Grosshansdorf, Grosshansdorf, Germany.

Correspondence to: Andreas von Leupoldt, PhD, Department of Psychology, University of Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany; e-mail: andreas.vonleupoldt{at}uni-hamburg.de

Abstract

Background: Dyspnea is the primary symptom limiting exercise in patients with COPD. Recent research has demonstrated that psychological factors can substantially influence the perception of dyspnea, but little is known about the modulation of perceived intensity or unpleasantness of dyspnea by attentional distraction. Therefore, we examined the impact of distractive auditory stimuli on the perception of exercise-induced dyspnea and the affective state in patients with COPD during 6-min walking tests (6MWTs).

Methods: Twenty patients with mild-to-severe COPD (mean FEV₁, 55.9% predicted) underwent two 6MWTs. Under one exercise condition, distractive auditory stimuli were presented with headphones, while the other condition was performed without auditory distraction. Lung function (FEV₁), heart rate (HR), pulse oximetric saturation (SpO₂), perceived intensity of dyspnea (ie, visual analog scale for perceived intensity of dyspnea [VAS-I]), and perceived unpleasantness of dyspnea (visual analog scale for perceived unpleasantness of dyspnea [VAS-U]) were measured before and after exercise. In addition, the global level of dyspnea (Borg score), positive affectivity (PA), and negative affectivity were assessed after both conditions.

Results: A similar exercise level during both conditions was confirmed by comparable results in FEV₁, HR, SpO₂, and distances walked. During auditory distraction, Borg scores and increases in VAS-U were smaller, while PA was higher compared to the nondistraction condition (p < 0.05). VAS-I did not show differences across conditions.

Conclusions: Distractive auditory stimuli decrease the global level of exercise-induced dyspnea in patients with COPD by reducing the perceived unpleasantness of dyspnea and lead to an additional increase in PA. Auditory distraction might therefore serve as an intervention for the reduction of dyspnea during exercise in this patient group.

Key Words: attention • COPD • distraction • dyspnea • emotion • exercise