Physical activity, health status and hospital admission in chronic obstructive pulmonary disease following pulmonary rehabilitation

Background: Despite the several benefits of post-rehabilitation Community-based Exercise Programmes (CEPs) to people with COPD, it is unclear whether these patients objectively improve their levels of daily physical activity (PA) and whether this is associated with improvement in other clinical outcomes. Methods: A mixed-methods sequential explanatory study design was applied. Daily PA (accelerometers, model AM300), health status (Saint George’s Respiratory Questionnaire, SGRQ), exercise capacity (6MWD testing), pulmonary functional, FEV1 (spirometry) and number of hospital admission (self-reporting) were measured at time points 1 (start of study) and 2 (after 3 months) of a CEP in 26 participants with COPD (mean [±SD] age, 73±7 years; FEV1, 64±19% predicted). Participants’ views of the benefits, barriers and enablers of participation were also explored. Results: Levels of daily PA improved moderately (42 minutes/day on moderate-intensity PA) but not significantly. Health status, 6MWD and FEV1 improved while hospital admission reduced significantly after 3 months (all p< 0.05). Daily PA correlated positively with 6MWD (r = 0.40, p=0.046) and negatively with health status (r= -0.52, p=0.006) and number of hospital admission (r= -0.394, p<0.05). Changes in levels of daily PA correlated positively with changes in 6MWD (r= 0.31, p= 0.048) and negatively with changes in health status (r= -0.65, p= 0.0001). Only health status significantly predicted levels of daily PA (Beta= -0.47, t= -2.85, p=0.009, R2adjusted= 0.38). These results were enabled by six factors; ease of access to PA intervention, convenient programme components, being retired, feeling safe, social support and seasons. Four barriers to activity participation were identified; poor physical health, family commitments, transport difficulties and other commitments. Conclusion: Moderate improvement in levels of daily PA produced by a CEP is associated with improvements in clinical outcomes in people with COPD. Strengthening enablers of adherence to the programme is important to achieving the goals of COPD management.