Chronic Disease Self-Management Program with or without supervised exercise for people with chronic obstructive pulmonary disease

INTERVENTION: (1) The intervention was supervised exercise added to the Chronic Disease Self‐Management Program (CDSMP‐Ex). See point two below for a description of the CDSMP. Frequency ‐ 1 session per week, held in the same week as the Chronic Disease Self‐Management Program . Intensity ‐ the intensity of exercise was determined by using the modified Borg Rating of Perceived Exertion (RPE) Scale, aiming for a minimum of moderate intensity (RPE = 3) and not exceeding a strong intensity (RPE = 5). Time (duration of exercise session) ‐ 1 hour Type ‐ This general guideline was adjusted according to individual needs: 5 minutes of warm‐up exercises 30 minutes of aerobic exercise (bicycle , treadmill, corridor walking, bicycle arm pedals) 5 minutes of stretching exercise (upper limb, lower limb, and trunk) 10 minutes of strengthening exercise (upper limb, lower limb, trunk with free weights, pulleys, steps, elastic bands, or fit ball) 5 minutes of cool‐down exercises. Mode ‐ Participants attended in a group, with each individual progressing according to their response to exercise. Exercise sessions were supervised by a trained physiotherapy assistant, with the physiotherapist readily available for consultation if needed. (2) The Chronic Disease Self‐Management Program is a highly structured group‐based 6‐week workshop with sessions of 2½ hours duration offered once per week and facilitated by pairs of trained leaders.The leaders may be peers (others with a chronic condition) or health professionals who have undertaken 24 hours of training. It offers generic education about health‐related behaviours: symptom management (anger, fear, frustration, depression, shortness of breath, fatigue, pain); breathing exercises; muscle relaxation; endurance exercise; cognitive symptom management; communication skills; advance directives for health care; working with and informing the healthcare team; medication usage and healthy eating. The CDSMP aims to facilitate the development of self‐management self‐efficacy (akin to confidence) through guided feedback sessions, problem‐solving and completing action plans to achieve participant‐defined goals. There is no supervised exercise component. CONDITION: Chronic Obstructive Pulmonary Disease (COPD) PRIMARY OUTCOME: Physical capacity measured by the 6 minute walk test SECONDARY OUTCOME: Exercise participation (achieving minimum reccommended levels of exercise) measured by a dichotomous question : ; Do you exercise regularly according to the definition below? Y/N INCLUSION CRITERIA: Participants were required to meet the following criteria: be over 18 years; willing to attend a supervised exercise component; willing and able to commit to 8 weeks of attendance; have a diagnosis of chronic obstructive pulmonary disease (COPD) based on airflow limitation measured by spirometry (McKenzie, Frith & Burdon 2003) or a physician diagnosis and be at least 2 months post exacerbation. An exacerbation was defined as increased shortness of breath, increased mucus production, and purulent mucus (Bellamy, Booker & Fardy 2003; MacNee & Rennard 2004) ; Regular Exercise is any planned physical activity (e.g., brisk walking, aerobics, bicycling, swimming, line‐dancing, tennis, doing formal exercises etc.) performed to increase or maintain health and physical fitness. Such exercise should be performed on all or at least 5 days of the week to accumulate 30 minutes or more per day. Exercise does not have to be painful to be effective but should be done at a moderate level that increases your breathing rate and makes you feel warmer. Health‐related quality of life was measured with the Short Form‐ 36 version 2 Generic Health Survey (SF‐36v2) (Ware, Kosinski & Dewey 2000) Self‐efficacy for exercise was measured with the Exercise: Self‐Efficacy scale (Cancer Prevention Research Center 1991) Self‐management behaviours were measured with the Flinders University Partners in Health (PIH) Scale (Battersby et al. 2003) Self‐reported exercise was measured with the Community Healthy Activities Model Program for Seniors (CHAMPS) Physical Activity Questionnaire (Stewart et al. 2001) Shortness of breath was measured with a Visual Analogue Scale (VAS) (American Thoracic Society 1999; Gift 1989; Nici et al. 2007) Stage of change for exercise was measured with the Exercise: Stages of Change Short Form questionnaire (Cancer Prevention Research Center 1991)