How nutrition supplements may improve exercise capacity in people with Chronic Obstructive Pulmonary Disease attending outpatient pulmonary rehabilitation program.

Participants in intervention group: Participants who agree to consume a nutritional supplement will be provided with the nutritional supplement Fortisip compact protein for the duration of their program. Fortisip compact protein is a ready-to-drink, high energy, high protein, vitamin and mineral rich oral nutritional supplement containing 300 kcal and 18 g protein per 125 ml bottle. Fortisip compact protein is a liquid formulation produced by Nutricia Advanced Medical Nutrition and is a common nutritional supplement recommended and provided in some NSW hospitals as well as outpatient and community health settings as a standard process for nutrition intervention. Participants of this study will be required to consume one 125ml Fortisip compact protein daily orally for the duration of the program (16 sessions/8weeks). Participants will be encouraged to consume the nutritional supplement at time of physical activity however compliance of this will not be monitored. To monitor adherence, participants will be provided with a compliance log sheet and they will be requested to sign off daily once they have consumed their nutritional supplement. Participants will be requested to bring their compliance log sheet in weekly at their scheduled exercise session. Participants in non- randomised control group: Intervention and control participants will need to attend twice weekly pulmonary rehabilitation group exercise sessions for eight weeks facilitated by the physiotherapists. Each exercise session runs for 1.5hours. Participant’s level of intensity whilst completing exercise session is monitored using the Borg Scale of Perceived Exertion. Intensity is moderate, set at Borg/ RPE of 3-4. The exercise session includes: a walking track, stationary cycling, treadmill, upper limb exercises with dumbbells and therabands, lower limb exercises mostly using the patient’s body weight (e.g: sit-to-stand, stepping, lunges). Participants also complete one half hour nutrition group education session facilitated by a dietitian. As this is a ‘rolling’ program the nutrition session occurs at different stages of the 8 week program for each participant. Participants will be attending outpatient pulmonary rehabilitation program running at Royal North Shore Community Health Centre, Mona Vale Community Health Centre, Brookvale Community Health Centre, Ryde Hospital or Hornsby Ku-ring-gai Hospital. All participants will have the following measurements taken: Baseline measurements: Completed by physiotherapist: • 6MWT • Body weight, BMI • 5STS • St George’s respiratory questionnaire Completed by dietitian • Hand grip strength • MNA Discharge measurements: Completed by physiotherapist: • 6MWT • 5STS • St George’s respiratory questionnaire Completed by dietitian • Body weight, BMI • Hand grip strength • MNA