Effect of balance training enrolled in pulmonary rehabilitation on quality of life, fatigue perception, depression and anxiety in COPD patients.

Patients assigned to the intervention group undergo balance training three times a week for 24 weeks (72 sessions). Training sessions last 30 min and are monitored by health professionals. Participants receive individualized exercises and attention regarding the level of difficulty and approach to training progression. The content of the balance-training program was developed according to previous works , guidelines for fall prevention , and consultation with experts. Balance training consisted of four main types of exercise: (1) stance exercises, (2) transition exercises, (3) gait exercises, and (4) functional strengthening. When a participant was able to complete a task independently and with little instability, the difficulty level was increased progressively by introducing more challenging conditions (eg, eyes closed, addition of a secondary cognitive task, increased speed/repetition, or perturbations). Prior to beginning study, we pilot tested the training program on two patients with COPD to determine (1) equipment needs for safety and (2) feasibility of the balance program with respect to a 30-min session. Balance training occurred concurrently with inpatient PR, which included (1) supervised exercise training bid three times a week, (2) daily breathing exercises, and (3) self-management education and psychologic and social support. Three times a week, patients in the intervention group receive the balance-training program in place of their usual morning or afternoon exercise session. Therefore, the total time spent exercising is matched between groups.