Managing Chronic Obstructive Pulmonary Disease (COPD)Together: Participant-CENTREd Continuum of Care (PCCC). A comparison of telephone health-mentoring, home-based walking and rehabilitation with rehabilitation only.

The intervention (Rehab-plus) comprises telephone health-mentoring with a home-based walking action plan plus pulmonary rehabilitation. 1. Rehab-Plus participants will establish a 'SNAPPS' (Smoking, Nutrition, Alcohol, Physical activity, Psychosocial wellbeing, Symptom management) Health Behaviours Summary and Profile and set a home-based walking plan with the Research Assistant. They will receive a ‘Participant Pack’ containing: -A copy of their walking plan and additional blank forms -A copy of their 'SNAPPS' Health Behaviours Summary and Profile -‘ SNAPPS’ Health Behaviours Choices and Guidelines table -Exercise, Nutrition, Living with COPD pamphlets -Dealing with your concerns flowchart. 2. Rehab-Plus participants will be contacted via telephone by a community nurse health-mentor over 6 to 12 weeks, to support the walking plan, and other health-behaviour plans. They will be notified when pulmonary rehabilitation is to commence. We suggest the initial two calls be weekly: the first call is to establish contact, review and reset the home-walking action plan and agree on any other actions. The second call one week later is to reinforce the commitment to working together and to support the home-walking plan and other agreed actions. We have found in clinical practice that most prefer a call a week after the initial contact. Our clinical experience and our pilot research that investigated telephone-delivered mentoring found that nurses and participants did not strictly adhere to an ongoing prescribed regime of telephone calls. Rather, the frequency and duration of calls was negotiated between the nurse and participant, according to individual needs. Therefore, we also suggest as a guide a minimum of four calls be made over the 6 to 12 week health-mentoring period to support the walking plan and other health-behaviour changes. NOTE: 1. Community Nurses will be trained in self-management support under the 'CENTREd' Model (Commitment to partnership, Engagement and establishihg and agreed agenda, Negotiation of mutally identified goals, Taking action to achieve the goals, Repeating back key information to ensure mutual understanding, Establishing planned follow-up to develop a proactive approach to care). 2. Pulmonary rehabilitation consists of individual management of issues such as airway clearance techniques; six-week group-based Stanford Chronic Disease Self-Management Program; two sessions specifically addressing (a) exercise and home-based walking action plan, (b) medication use and other group-identified issues; and optional weekly group-based supervised exercise. 3. Supervised exercise: - Frequency - 1 session per week - Intensity - the intensity of exercise is determined by using the modified Borg Rating of Perceived Exertion (RPE) Scale, aiming for a minimum of moderate intensity (RPE = 3) and not exceeding a strong intensity (RPE = 5). - Time (duration of exercise session) - 1 hour - Type - This general guideline is adjusted according to individual needs: 5 minutes of warm-up exercises, 30 minutes of aerobic exercise (bicycle , treadmill, corridor walking, bicycle arm pedals), 5 minutes of stretching exercise (upper limb, lower limb, and trunk), 10 minutes of strengthening exercise (upper limb, lower limb, trunk with free weights, pulleys, steps, elastic bands, or fit ball), 5 minutes of cool-down exercises. - Mode - Participants attend in a group, with each individual progressing according to their response to exercise. Exercise sessions are supervised by a trained physiotherapy assistant, with the physiotherapist readily available for consultation if needed. 4. The Chronic Disease Self-Management Program is a highly structured group-based 6-week workshop with sessions of 2 and a 1/2 hours duration offered once per week and facilitated by pairs of trained leaders.The leaders may be peers (others with a chronic condition) or health professionals who have undertaken 24 hours of training. It offers generic education about health-related behaviours: symptom management (anger, fear, frustration, depression, shortness of breath, fatigue, pain); breathing exercises; muscle relaxation; endurance exercise; cognitive symptom management; communication skills; advance directives for health care; working with and informing the healthcare team; medication usage and healthy eating. The CDSMP aims to facilitate the development of self-management self-efficacy (akin to confidence) through guided feedback sessions, problem-solving and completing action plans to achieve participant-defined goals. There is no supervised exercise component.