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Abstract
Introduction The IMPRESS standards for pulmonary rehabilitation (PR) recommend that programmes should include two supervised exercise sessions per week for at least 4 weeks, and written prescriptions of exercise training with evidence of progress reported in training diaries. However, subjective self-reported assessment is associated with bias, and may not accurately represent actual exercise intensity and duration. Patients require familiarisation with equipment and training regimes during a PR programme. We hypothesised that active energy expenditure and time spent in at least moderate physical activity, measured objectively with a validated activity monitor (SenseWear armband—SWA), would show no significant increase within the first 4 weeks of a PR programme.
Method 34 COPD patients (17M: 17F), starting an 8-week outpatient PR programme consisting of two supervised exercise sessions per week, consented to wearing SWA for one entire exercise training session each week for the whole PR programme (T1–T8). Output from the SWA includes active energy expenditure (AEE) and time spent in at least moderate intensity physical activity (PA time) that is, >3.0 METS. AEE and PA time recorded at T1, T4 and T8 were evaluated using Friedman tests. Incremental shuttle walk (ISW) and COPD Assessment Test (CAT) were measured before (T0) and after (T9) PR. Differences in pre to post-outcome measures were assessed using paired t tests.
Results Results are presented as median (25th, 75th percentile). There was no significant difference in PA time or AEE between T1 (11.5 (4.0 to 27.0) min; 43.5 (19.5 to 124.3) Kcal) and T4 (10.5 (7.5 to 24.8); 48.5 (32.3 to 106.0) Kcal, p>0.05) despite progress documented in training diaries. PA time significantly increased from T1 to T8 (19.5 (8.8 to 34.0) min, p=0.02), as did AEE (92.0 (37.0 to 146.3) Kcal, p=0.006). Following PR there was also a significant improvement in ISW (52.1 (95% CI 29.2 to 75.1) m, p<0.001) and CAT score (−3.0 (95% CI 0.3 to 5.8) p=0.03).
Conclusion 4-week PR programmes may be insufficient in duration for patients to become familiarised with equipment and exercise regimes.
PA time during pulmonary rehabilitation classes over an 8-week outpatient programme. Data presented as median (IQR) *p<0.05 significant difference compared to week 1.