Cognitive impairment in people with COPD - effect of pulmonary rehabilitation

Participants with COPD who enrol in pulmonary rehabilitation at RPAH will be asked to complete the Montreal Cognitive Assessment (MoCa) as well as the usual initial assessment (six-minute walk test plus measures of spirometry, quality of life and anxiety and depression), (T1) They will attend pulmonary rehabilitation twice a week for 8 weeks and perform exercise training (20 minutes cycling, walking and upper and lower limb strength training). Strength training will involve weight machines and theraband exercises and be based on the maximal weight a participant can perform for three sets of ten lifts. This will be progressed weekly as tolerated by the patient. Target intensity for cycling and walking training is determined from the initial six-minute walk test. Walking training is set at 80% of the 6MWD and cycle training is set at 60% Wmax as calculated by the equation for cycle intensity developed by Hill et al 2008 All interventions will be set and supervised by the experienced pulmonary rehabilitation physiotherapists. Participants are closely supervised and monitored for pain, oxygen saturation, heart rate and level of both dyspnoea and exertion. Weekly exercise diaries will be kept to encourage participants to progress the exercise both at rehabilitation and at home On completion of the 8 week rehabilitation program they will perform all assessments again including the MoCa (T3). Participants will be followed up 6 months following the completion of the 8 week pulmonary rehabilitation program (T4). Between T3 and T4 participants will be encouraged to follow a home exercise program and complete an exercise diary (given to them in a booklet at the completion of the program). They will be invited to call at any time if they have an questions about the exercise training. The MoCA has been used as a screening instrument for moderate cognitive impairment by assessing memory, language, executive functions, visuospatial skills, calculation, abstraction, attention, concentration and orientation.