None listed
Conditions
Brief summary
People with chronic disease only have access to structured exercise rehabilitation programs in tertiary health services if they have a diagnosis of chronic respiratory disease, chronic heart failure or have suffered a heart attack/undergone heart surgery. Current exercise rehabilitation programs address these conditions in a single disease assessment and management strategy, although the frequency of people with multiple chronic conditions (or multimorbidity) in Australia is increasing. Research suggests that other people with chronic diseases (such as cancer, diabetes, chronic kidney disease) also benefit from exercise training however these people are unable to access structured exercise rehabilitation currently as funding to run these services is lacking. The aim of this project is to pilot the implementation of a generic rehabilitation program for people with chronic disease in a parallel randomised controlled trial. This trial will randomise people with multimorbidity to receiving either their usual disease-specific rehabilitation or generic chronic disease rehabilitation program. The aim of this pilot trial (one of a pair) is to test the feasibility of implementing a generic chronic disease rehabilitation program (multimorbidity rehabilitation) and to measure effect sizes that will be used to power subsequent large randomised controlled trials to answer the questions of efficacy and cost-effectiveness.
Interventions
Multimorbidity (generic) rehabilitation Will be administered in small group sessions supervised by a physiotherapist and a nurse, twice-weekly for 8 weeks, including aerobic exercise (walking and cycling for 15 minutes each) and resistance exercise (upper and lower limbs). Session duration will be 75 minutes twice weekly, with an education session duration of one hour once weekly. Education sessions will be delivered by health professionals including a physiotherapist, nursing, dietician to the class group of patients. Education topics will include general information on chronic disease and multimorbidity, risk factor management, exercise, dietary management, diabetes education, pharmacological and psychological support. Initial aerobic exercise prescription will be calculated at 80% of peak walking speed or distance (ALF & APA, 2009 and National Heart Foundation of Australia, 2011) and stationary cycling intensity will be calculated at 60-80% of maximum work rate estimated from the 6-minute walk test (Hill et al 2008). Exercise prescription will be progressed using a rating of perceived exertion (RPE) Borg scale (6-20) and dyspnoea modified Borg scale, aiming for a RPE score of 12-14 and a dyspnoea score of 3-4. The aerobic component will include intermittent, incline, treadmill training in patients with peripheral vascular disease as their primary presenting complaint or who have a significant contribution from this as part of their presentation (Gardner et al, 1995). Initial resistance exercise load will correspond to 10-12 RM (repetition maximum). A weight that can be lifted correctly and comfortably at least 10 times, but not more than 12 times (Kraemer et al 2004). Resistance exercise will be progressed using a rating of perceived exertion (RPE) Borg scale (6-20) aiming for a RPE score of 12-14.
Sponsors
Dr Elizabeth Skinner
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Physician diagnosis of a single disease as follows including: - Chronic obstructive pulmonary disease - Bronchiectasis - Chronic asthma - Chronic heart failure - Coronary artery disease - Ischaemic heart disease - AND at least one other chronic condition for which rehabilitation is indicated (as listed in the target conditions published by Barnett et al., 2012: diabetes, chronic kidney disease, depression, anxiety, new diagnosis of cancer in past 5 years, stroke and transient ischaemic attack, peripheral vascular disease, Parkinson's disease, multiple sclerosis, chronic liver disease).
Exclusion criteria
- Unable to walk > 50 metres; - Severe cognitive impairment, psychiatric or intellectual disability which would limit ability to participate in a class with distant supervision or ability to complete outcome measures (defined as MMSE <= 18 points); - Pulmonary hypertension with recent history of dizziness or syncope on exertion (must have medical clearance if mean pulmonary artery pressure > 50 mm Hg); or acute pulmonary embolus; - Interstitial lung disease; - Unstable cardiovascular disease (e.g. unstable angina, uncontrolled arrhythmia, NYH Class 4 CHF; uncontrolled hypertension, diastolic pressure > 95 mm Hg); - Absolute contraindications to exercise (e.g. severe orthopaedic/neurological deficit; severe uncontrolled pain; surgical or medical (including active transmissible infectious disease) restrictions to mobilisation/rehabilitation e.g. diabetic foot; severe ischaemic vascular disease; advanced neuropathy/retinopathy) which would compromise the ability to safely exercise; - People already participating in a structured exercise rehabilitation program from a community or external provider; - Uncontrolled diabetes; - Uncontrolled epilepsy or seizures; - Extensive brain, skeletal or visceral metastases (confirmed cancer diagnosis); - Life expectancy considered to be less than 12 months; - Known thrombocytopaenia (<50×109/l) or severe neutropenia (neutropenia defined as absolute neutrophil count < 500/microL; profound neutropenia defined as ANL < 100 neutrophils/mm3, Freifeld et al., 2010); - Room air desaturation at rest < 85%; - Abnormal and untreated moderate anaemia (80-109 g/L); - Pregnant women.
Outcome results
None listed