None listed
Conditions
Brief summary
Pulmonary rehabilitation (PR) is effective in reducing exacerbations and hospital admissions, improving health-related quality of life, exercise tolerance, and symptoms of breathlessness and fatigue in people with chronic obstructive pulmonary disease (COPD) and other chronic lung diseases such as interstitial lung disease, Bronchiectasis. However, despite the robust evidence for the benefits of PR, uptake is low, with 8-50% of those referred to PR never attend and 10-32% of those who commence not completing the program. Studies from the United Kingdom report that low PR program uptake, high non-attendance and non-completion rate are particularly evident in people who have physical frailty or high levels of anxiety and/or depression. In the elderly population with chronic lung disease, frailty is characterised by multisystem decline encompassing physical, cognitive, social and psychological aspects. Frailty is prevalent in people with COPD when compared to healthy age-matched community living individuals as young as 50 years old and is strongly associated with a higher risk of mortality. One in five people who are frail and living with COPD suffer from adverse outcomes such as increased risk of acute exacerbations and hospitalisations. A recent systematic review reported that frailty is associated with respiratory impairment and poorer health-related quality of life in people with COPD, idiopathic pulmonary fibrosis (IPF) (a subcategory of ILD) and asthma. There are no studies in people with other chronic lung diseases, such as ILD other than IPF or bronchiectasis, who are commonly referred to PR. Thus, frailty is now highlighted as an important condition that needs to be recognised and managed to improve patient outcomes and reduce healthcare costs. However, in Australia, there are no data on the proportion of people with chronic respiratory diseases referred to PR who have physical frailty, anxiety and/or depression, and the relationship between physical frailty, anxiety and/or depression and the uptake, attendance and completion of PR in people with chronic lung disease is unknown. The hypothesis of the study is people who have chronic lung disease and is physically frail, anxious and/or depressed have poor uptake, attendance and completion of a PR program.
Interventions
Participants will attend a pulmonary rehabilitation program of exercises twice a week for eight weeks, groups of 1:6 ration - staff to participant ratio, supervised by experienced pulmonary rehabilitation physiotherapists (i.e., 16 sessions). Participants will be invited to attend the exercise sessions face-to-face, however, with adaptations put in place during the global pandemic, participants will be given the option to attend exercise session supervised by experienced pulmonary rehabilitation
Participants will attend a pulmonary rehabilitation program of exercises twice a week for eight weeks, groups of 1:6 ration - staff to participant ratio, supervised by experienced pulmonary rehabilitation physiotherapists (i.e., 16 sessions). Participants will be invited to attend the exercise sessions face-to-face, however, with adaptations put in place during the global pandemic, participants will be given the option to attend exercise session supervised by experienced pulmonary rehabilitation physiotherapists virtually via zoom. The exercise program will include upper limb and lower limb endurance training, strength training and balance exercises. Exercise sessions will be between 40 to 60 minutes including rest periods. Participants will perform upper limb endurance exercises using either an arm ergometer or light weights with high repetitions; lower limb endurance training using either a cycle ergometer, treadmill, ground walking or marching on the spot; strength training for upper limbs using fixed weight machines or hand weights or resistance bands and for lower limb using fixed weight machines or body weight exercises (e.g. squats, sit-to-stand, step-ups). Session attendance checklist will be completed by the physiotherapist. During endurance exercise sessions participants will be asked to exercise at an intensity that elicits a breathlessness or fatigue score of 3 (moderate) to 4 (somewhat severe) on the 0-10 category ratio scale (Borg 1998). For weight training, Rate of Perceived Exertion (RPE) scale will be aimed between 15 (Vigorous/Very Hard) to 18 (Very heavy, can perform no more than 10 repetitions). Before commencing exercise, participants will be asked to inform the supervising physiotherapist if they have any change in how they feel or any new symptoms. Participants will be advised to stop exercise if they have any concerns. A pulmonary rehabilitation physiotherapist will discuss with you the needs on lung disease specific education sessions at the initial assessment. Education sessions will be referred to the “Better Living with Chronic Obstructive Pulmonary Diseases” Lung Foundation Australia online resources Better living with Chronic Obstructive Pulmonary Diseases - Lung Foundation Australia. The online resources contain short videos and written resources that participant can print off. Education topics include strategies to manage breathlessness; importance of physical activity and exercise; medications and inhaler techniques; healthy eating; managing daily activities; managing anxiety and depression. If any of the topics is required after their discussion with the pulmonary rehabilitation physiotherapist, the physiotherapist will ask the participant to attend the pulmonary rehabilitation exercise program 15 minutes prior or after the exercise session starts or finish respectively to go through the topic that is required. Participants will be asked by the physiotherapist to book in a one-on-one session with the physiotherapist if any topic is required to be discussed privately.
Sponsors
Sydney Local Health District
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
40 Years to No maximum
Healthy volunteers
No
Inclusion criteria
• People diagnosed with chronic respiratory disease/s including Chronic Obstructive Pulmonary Disease, chronic asthma, Interstitial lung disease, bronchiectasis, lung cancer, referred to a pulmonary rehabilitation program in Sydney Local Health District. • Age range greater and equal to 40 years old • Sex: All genders • Willing to provide informed consent and willing to participate and comply with the study requirements.
Exclusion criteria
• People with acute symptoms of any illness where exercise is not recommended • People who have difficulty understanding English or are unable to have access to an interpreter • People with severe cognitive impairment or other comorbidities which would make exercise unsafe
Outcome results
None listed