Exercise training decreases dyspnea and the distress and anxiety associated with it. Monitoring alone may be as effective as coaching.

Abstract

STUDY OBJECTIVE: To determine whether exercise training with coaching is more effective than exercise training alone in reducing dyspnea and the anxiety and distress associated with it and improving exercise performance, self-efficacy for walking, and dyspnea with activities of daily living. DESIGN: Randomized clinical trial of 51 dyspnea-limited patients with COPD assigned to monitored (n = 27) or coached (n = 24) exercise groups. SETTING: Outpatient area of university teaching hospital. INTERVENTION: Both groups completed 12 supervised treadmill training sessions (phase 1) over 4 weeks followed by 8 weeks of home walking (phase 2). The CE group also received coaching during training. MEASUREMENTS: Perceived work of breathing, dyspnea intensity, distress associated with dyspnea, and anxiety associated with dyspnea were rated on a visual analog scale during incremental treadmill testing and after 6-min walks before and after phase 1. Dyspnea with activities of daily living, self-efficacy for walking, state anxiety, and 6-min walks were measured before and after both phases. RESULTS: Dyspnea and the associated distress and anxiety improved significantly for both groups relative to work performed and in relation to ventilation (p < 0.05). There were no significant differences between groups in any outcomes. The phase 1 improvement in laboratory dyspnea was accompanied by improvements in dyspnea with activities of daily living (p < 0.01) and self-efficacy for home walking (p < 0.01) that were sustained during the home phase. CONCLUSIONS: Coaching with exercise training was no more effective than exercise training alone in improving exercise performance, dyspnea, and the anxiety and distress associated with it, dyspnea with activities, and self-efficacy for walking.