Cameron-Tucker Helen Laura, Wood-Baker Richard, Joseph Lyn, Walters Julia A, Schüz Natalie, Walters E Haydn
Centre of Research Excellence for Chronic Respiratory Disease and Lung Aging, School of Medicine.
School of Health Sciences, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia.
Int J Chron Obstruct Pulmon Dis. 2016 Aug 25;11:1991-2000. doi: 10.2147/COPD.S109820. eCollection 2016.
With the limited reach of pulmonary rehabilitation (PR) and low levels of daily physical activity in chronic obstructive pulmonary disease (COPD), a need exists to increase daily exercise. This study evaluated telephone health-mentoring targeting home-based walking (tele-rehab) compared to usual waiting time (usual care) followed by group PR.
People with COPD were randomized to tele-rehab (intervention) or usual care (controls). Tele-rehab delivered by trained nurse health-mentors supported participants' home-based walking over 8-12 weeks. PR, delivered to both groups simultaneously, included 8 weeks of once-weekly education and self-management skills, with separate supervised exercise. Data were collected at three time-points: baseline (TP1), before (TP2), and after (TP3) PR. The primary outcome was change in physical capacity measured by 6-minute walk distance (6MWD) with two tests performed at each time-point. Secondary outcomes included changes in self-reported home-based walking, health-related quality of life, and health behaviors.
Of 65 recruits, 25 withdrew before completing PR. Forty attended a median of 6 (4) education sessions. Seventeen attended supervised exercise (5±2 sessions). Between TP1 and TP2, there was a statistically significant increase in the median 6MWD of 12 (39.1) m in controls, but no change in the tele-rehab group. There were no significant changes in 6MWD between other time-points or groups, or significant change in any secondary outcomes. Participants attending supervised exercise showed a nonsignificant improvement in 6MWD, 12.3 (71) m, while others showed no change, 0 (33) m. The mean 6MWD was significantly greater, but not clinically meaningful, for the second test compared to the first at all time-points.
Telephone-mentoring for home-based walking demonstrated no benefit to exercise capacity. Two 6-minute walking tests at each time-point may not be necessary. Supervised exercise seems essential in PR. The challenge of incorporating exercise into daily life in COPD is substantial.
鉴于慢性阻塞性肺疾病（COPD）患者的肺康复（PR）覆盖范围有限且日常身体活动水平较低，增加日常锻炼很有必要。本研究评估了以家庭步行锻炼为目标的电话健康指导（远程康复）与常规等待时间（常规护理）后进行的团体PR相比的效果。
COPD患者被随机分为远程康复组（干预组）或常规护理组（对照组）。由经过培训的护士健康指导人员提供的远程康复在8至12周内支持参与者进行家庭步行锻炼。两组同时接受PR，包括为期8周的每周一次的教育和自我管理技能培训，以及单独的监督锻炼。在三个时间点收集数据：基线（TP1）、PR前（TP2）和PR后（TP3）。主要结局是通过6分钟步行距离（6MWD）测量的身体能力变化，每个时间点进行两次测试。次要结局包括自我报告的家庭步行锻炼变化、健康相关生活质量和健康行为。
65名招募者中，25人在完成PR前退出。40人参加了中位数为6（4）次的教育课程。17人参加了监督锻炼（5±2次）。在TP1和TP2之间，对照组的6MWD中位数有统计学意义地增加了12（39.1）米，而远程康复组没有变化。其他时间点或组之间的6MWD没有显著变化，任何次要结局也没有显著变化。参加监督锻炼的参与者的6MWD有不显著的改善，为12.3（71）米，而其他参与者没有变化，为0（33）米。在所有时间点，第二次测试的平均6MWD均显著大于第一次，但在临床上没有意义。
针对家庭步行锻炼的电话指导对运动能力没有益处。每个时间点进行两次6分钟步行测试可能没有必要。监督锻炼在PR中似乎至关重要。将锻炼纳入COPD患者日常生活的挑战很大。
