Exercise training in COPD: walking tests and walking training

Abstract

Pulmonary Rehabilitation (PR) has been shownto improve health-related quality of life (HRQoL) and exercise capacity in people with Chronic Obstructive Pulmonary Disease (COPD). The studies contained in this thesis explored three key components of PR, being assessment of exercise capacity, short-term exercise training and ongoing maintenance exercise. The literature review provides an overview of COPD, as well as discussing the literature on the use of field based walking tests, the use of short-term supervised ground-based walking training and the effects of unsupervised maintenance exercise programs. Chapter 2 contains details of the study designs and methods. Chapter 3 contains a prospective study that derived and validated an equation to estimate the speed for the endurance shuttle walk test (ESWT) using results from the six-minute walk test (6MWT) with the results demonstrating that the 6MWT can be used to accurately determine the speed for the ESWT in people with COPD. The study in Chapter 4 was a prospective, multi-centre, randomised controlled trial (RCT) that compared the effects of supervised, ground-based walking to usual care with results indicating that ground-based walking was an effective training modality that improved HRQoL and exercise capacity in people with COPD. In Chapter 5, a long-term follow-on study from the study in Chapter 4 is presented. This was a prospective, multi-centre, RCT which evaluated the effect of a 2-month, supervised, walking training program combined with a 12-month unsupervised maintenance walking program during which participants received either ongoing feedback (telephone calls, biofeedback and goal setting) or no feedback. This study demonstrated that there were no differences in HRQoL when comparing ongoing feedback to no feedback during the maintenance program in people with COPD. The main findings of this thesis, limitations, clinical implications and suggestions for future research are presented in Chapter 6.