Individually targeted exercise training in pulmonary rehabilitation
This thesis examines the effect of an individually targeted exercise programme when compared to a general exercise programme in patients with Chronic Obstructive Pulmonary Disease (COPD). The effect of these programmes upon domestic function and daily activity is also examined.;Initially, the test-retest reliability of the primary measure of domestic function, the Canadian Occupational Performance Measure (COPM) was examined. The COPM was completed in 15 patients with stable COPD. The intra class correlation coefficients were high indicating that the COPM is a reliable measure in patients with COPD.;A large randomised prospective trial was then completed. 185 patients with stable COPD referred for seven-week hospital based, outpatient pulmonary rehabilitation programme, were recruited. A third of these patients (n=61) were initially assigned to a pre treatment group in order to establish the variability of all outcome measures.;Patients were randomly assigned to either a general exercise programme (GEP) (n=90) or an individually targeted exercise programme (ITEP) (n=90). Functional targets for patients in the ITEP were identified using the COPM. Activity monitors measured daily activity. Exercise performance was measured using the Incremental Shuttle Walking Test and the Endurance Shuttle Walk Test and measures of health status were also employed. Both treatment groups made statistically significant improvements in domestic function, exercise performance and health status. However there were no statistically significant differences between the GEP and the ITEP. This study demonstrated that general exercise training is as effective as more complex individually targeted training.;ITEP is no more effective at prolonging the benefits of pulmonary rehabilitation when compared the GEP.