Chest
Volume 110, Issue 6, December 1996, Pages 1526-1535
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Clinical Investigations: Xercise/Cleroderma
Exercise Training Decreases Dyspnea and the Distress and Anxiety Associated With It: Monitoring Alone May Be as Effective as Coaching

https://doi.org/10.1378/chest.110.6.1526Get rights and content

Study objective

To determine whether exercise training with coaching is more effective than exercise training alone in reducing dyspnea and the anxiety and distress associated with it and improving exercise performance, self-efficacy for walking, and dyspnea with activities of daily living.

Design

Randomized clinical trial of 51 dyspnea-limited patients with COPD assigned to monitored (n=27) or coached (n=24) exercise groups.

Setting

Outpatient area of university teaching hospital.

Intervention

Both groups completed 12 supervised treadmill training sessions (phase 1) over 4 weeks followed by 8 weeks of home walking (phase 2). The CE group also received coaching during training.

Measurements

Perceived work of breathing, dyspnea intensity, distress associated with dyspnea, and anxiety associated with dyspnea were rated on a visual analog scale during incremental treadmill testing and after 6-min walks before and after phase 1. Dyspnea with activities of daily living, self-efficacy for walking, state anxiety, and 6-min walks were measured before and after both phases.

Results

Dyspnea and the associated distress and anxiety improved significantly for both groups relative to work performed and in relation to ventilation (p<0.05). There were no significant differences between groups in any outcomes. The phase 1 improvement in laboratory dyspnea was accompanied by improvements in dyspnea with activities of daily living (p<0.01) and self-efficacy for home walking (p<0.01) that were sustained during the home phase.

Conclusions

Coaching with exercise training was no more effective than exercise training alone in improving exercise performance, dyspnea, and the anxiety and distress associated with it, dyspnea with activities, and self-efficacy for walking.

Section snippets

Patients

The protocol was approved by the University of California, San Francisco Committee on Human Research. Patients were eligible for the study if they had moderate to severe COPD (FEV1 <60% of predicted and FEV1/FVC ratio <0.6 after inhaling 3 puffs of albuterol) resulting in dyspnea that limited their ADL, did not require continuous oxygen, were in medically stable condition, and could walk on the treadmill. Patients who had been enrolled in formal pulmonary rehabilitation (including maintenance

Sample

A total of 313 volunteers were interviewed for participation in this study. Of these, 223 were excluded before exercise testing because they either did not meet the inclusion criteria, lived too far from the medical center, or were not interested in participating. Of the 90 patients who completed screening tests, 32 failed to meet the inclusion criteria. Eight of the remaining 58 patients failed to complete the study: 4 because of hospitalization, 2 because of failure to keep appointments, 1

Discussion

The major finding of this study was that dyspnea intensity, and the distress and anxiety associated with it, decreased significantly in relationship to work performed on the treadmill after 12 supervised treadmill exercise training sessions. In addition, improvement in dyspnea with the 6-min walk test was sustained during an 8-week home walking phase and was accompanied by significant improvement in dyspnea with ADL and in self-efficacy for walking at home. These improvements in dyspnea were no

Acknowledgments

The authors express their appreciation of Richard Casaburi, MD, for help with analysis of the V-slopes.

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    This research study was funded by NIH-NCNR grant RO1 NR02131.

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