Physical activity promotion in lung disease

Question 1

what is Pulmonary rehabilitation?

Answer 1

-Multidisciplinary programs consisting of supervised exercise training and self-management education according to individual patients’ requirements.
-Designed to break the cycle on inactivity.
-Improve the physical and psychological condition of people with lung disease.
-Promote the long-term adherence to health-enhancing behaviours- activity/ nutrition.

Question 2

what are the 10 core components of pulmonary rehabilitation ?

Answer 2

• advanced care and planning
  -establish social networks
  -facilitate smoking cessation
  -optimise pharmacotherapy
  -detect and manage acute exacerbations
  -manage acute dyspnea
  -exercise rehabilitation
  -increase physical activity
  -improve body composition
  -promote mental health

Question 3

what are benefits if pa to lung disease ?

Answer 3

-Revers systematic consequence of COPD (skeletal muscle wasting)
-Reduce sensitivity to dyspnoea (breathlessness) ventilation required to overcome specific task.
-Enhance mechanical efficiency of Pa (particularly walking)
-Improve patients self-confidence/ experience of Pa.

Question 4

what are current challenges of pulmonary rehabilitation?

Answer 4

• Increasing awareness and knowledge of pulmonary rehabilitation
• Limited resource/ patient access to pulmonary rehabilitation
• Ensuring quality of pulmonary rehabilitation programmes
• Mismatch between exercise capacity and Pa
• Benefits are short lived (typically diminish within 6-12 months)
• Majority of studies show a poor relationship between improvements in exercise capacity (as a result of pulmonary rehabilitation) and enhanced levels of activity.
• Factors that may contribute to mismatch and lack of long-term improvements?
• Issues with Pa assessment- may underestimate.
• Highlights the Pa is a complex behaviour.
• Effective maintenance strategies.

Question 5

what are some techniques for behaviour change ?

Answer 5

• Barrier identification
• Support with problem solving.
• Relapse prevention management
• Action planning
• Goal setting
• Self-monitoring/ feedback

Question 6

How can counselling following Pulmonary rehabilitation help ?

Answer 6

• The addition of activity counselling to pulmonary rehabilitation showed important effects on Pa levels compared to PR alone, achieving significant increases that exceed the MID for daily steps in COPD>
• MID = >600 steps
• Regardless of the way pedometers are implemented the improvement meets the MID.

Question 7

what are the challenges of counselling ?

Answer 7

• Face-to-face contact is time-consuming.
• Dependent on resources/skill and training of health care professional
• Electronic information and communication technologies offer the possibility of decreasing the burden on clinicians and patients.
• Standardising interventions and making them available to people who live in remote areas or in areas where access to healthcare provides is limited.
• Over the long-term/maintenance

Question 8

using telecoaching as an intervention for Pa

Answer 8

• 12 week semiautomated telecoaching intervention on Pa in patients with COPD in a multicentre European randomised controlled trial.
• 343 patients from six centres, randomly allocated groups
• Step counter providing feedback both directly and via a dedicated smartphone application.
• Pa can be significantly increased in patients with COPD using a 12-week semiautomated telecoaching intervention.
• Evidence growing rapidly.