Development and feasibility of an exercise training program in primary care for patients with COPD experiencing an acute exacerbation

Abstract

Background: Starting rehabilitation soon after an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is crucial to diminish the detrimental effects of this acute event on muscle function. However, uptake in outpatient pulmonary rehabilitation is low.

Objectives: To design and test a feasible, acceptable and accessible exercise training program (ETP) in primary care for patients experiencing an AECOPD.

Design: (1) A literature review and qualitative study to develop an ETP and (2) A feasibility study of the ETP implemented in primary care.

Methods: (1) The development of the ETP proceeded in several phases with input from different stakeholders through focus group discussions. (2) Patients experiencing a moderate or severe AECOPD were included and followed the ETP for two weeks with a physiotherapist in primary care. Interviews with the participants took place and patients were given the choice to complete the eight-week program.

Results: (1) Six discussion sessions took place. The ETP contained a flexible set of progressively more difficult exercises applicable in a primary care practice. (2) Eight patients experiencing a moderate (n = 1) or severe (n = 7) AECOPD were included. Patients started the first physiotherapy session 5 (2-6) days after the start of their symptoms or hospital discharge. Seven patients wanted to complete the ETP.

Conclusions: An ETP in primary care is feasible, acceptable and accessible for patients experiencing a moderate or severe AECOPD, and for physiotherapists. The effectiveness of this ETP on muscle function and physical activity is currently under investigation in a RCT. CONTRIBUTION OF THE PAPER.

Keywords: Chronic obstructive; Focus groups; Primary health care; Pulmonary disease; Rehabilitation; Resistance training; Symptom flare up.