None listed
Conditions
Brief summary
Patients with end stage pulmonary disease experience a prolonged functional decline associated with a heavy symptom load, emotional distress and social isolation prior to their death. Community palliative care has been evolving to meet the needs of these patients and is a nascent approach in the care spectrum in Singapore. This study aims to understand the impact of a community based supervised exercise programme on the exercise capacity, physical activity levels as well as patient reported quality of life of palliative patients with end stage Chronic Obstructive Pulmonary Disease (COPD) within a 6-month period. Current Assisi Hospice day care patients who have been diagnosed with Stage 3 or 4, GOLD D COPD and currently undergoing a supervised exercise programme prescribed by a physiotherapist will be recruited into this study. The 5-time sit to stand (STS) , 6-minute walk test (6MWT) and St George Respiratory Questionnaire (SGRQ) will be measured at the start of the study and at the timepoints of 1 month, 3 months and 6 months to evaluate changes in lower limb muscle strength, exercise capacity and self-reported quality of life for each participant, respectively. The participant’s physical activity levels (PAL) based on their active/sedentary times and number of steps taken per day will also be measured at the start of the study, and then remeasured again at 3 months and 6 months to understand the participant’s activity levels as a result of the supervised exercise programme. PAL are measured by the activity monitor, ActivPal, placed on the front of the right thigh. As there is a possibility of a floor effect in these patients, other parameters during the 5 time STS and 6MWT will be also be collected. This includes the time walked to first stop/termination of test, time taken to reach nadir saturation, as well as the time required for the patient’s vital signs to recover will also be recorded. Adverse events and participation rate in exercise programmes will also be tracked. We hypothesise that there is no significant nor clinical important change in 6MWT distance, but significant improvements in time to first rest, time taken to reach nadir saturation and time required for vitals recovery will be observed at 3-month and 6-month timepoints. Significant improvements may be seen in quality of life and sit-to-stand time at 6-month. There will be significant reductions in sitting time at 6-month.
Interventions
Study participants are recruited from Assisi Hospice Day Care Centre. A routine activity at the Day Care Centre daily is an individualised exercise session. Study participants will have received exercise sessions regardless of their participation in the study. The additional activities imposed by the study and outside of routine care are a 6-minute walk test, a 5-times Sit-to-Stand Test, a St.George's Respiratory questionnaire and collection of physical activity and sitting time data through a p
Study participants are recruited from Assisi Hospice Day Care Centre. A routine activity at the Day Care Centre daily is an individualised exercise session. Study participants will have received exercise sessions regardless of their participation in the study. The additional activities imposed by the study and outside of routine care are a 6-minute walk test, a 5-times Sit-to-Stand Test, a St.George's Respiratory questionnaire and collection of physical activity and sitting time data through a physical activity monitor, ActivPal. These tests will take 1 hour at every observation session and performed at recruitment, and 1,3 and 6 months post-recruitment. Assisi Hospice physiotherapist (who is part of the research team) and other research team members will perform these physical tests, questionnaire and ActivPal application on the participants. The individualised exercises are prescribed and supervised by the physiotherapists and conducted by therapy assistants face-to-face at Assisi Hospice Day Care Centre. These exercise sessions run in tandem with other activities at the day care centre. Participants can attend the day care centre for up to five days based on their attendance at the day care. The exercise session is performed only once daily and the time of exercise is dependent of every patient's day care routine. The duration of each exercise session is between 45-60 minutes with rest breaks in between modalities. Exercise intensity is tailored to each participant’s tolerance at moderate intensity level equivalent to a Borg dyspnoea scale of 3-4/10 and comprise primarily of strengthening and cardiovascular exercises. Exercise prescribed can include pneumatic weights strength training, upper limb, lower limb ergometry or lower limb stepper exercises and group exercises using resistance bands or free weights. The exercises are delivered in a group setting of 4 patients. Whilst in the study, their participation rate of exercise session at day care center is measured monthly by audit of session attendance. Adverse events will be defined as counts of hospitalisation or death as a result of exercise and severe acute desaturation requiring high level of oxygenation to reverse the hypoxia. Medical follow up with the covering daycare physician will also be arranged if patient is still unwell despite initial measures and falls during exercise.
Sponsors
Singapore Institute of Technology
Eligibility
Sex/Gender
All
Age
55 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Stage 3 and 4, Group D patients with chronic obstructive pulmonary disease (COPD) 2. Currently undergoing supervised exercise program in the center
Exclusion criteria
1. Cognitively impaired (Abbreviated Mental Test less than 7/10) 2. Orthopedic condition that does not allow exercise testing 3. Any absolute contraindications to exercise testing 4. Cannot comprehend English/Mandarin
Outcome results
None listed