2009 APA Conference Week Abstracts - Australian Physiotherapy ...

Cardiorespiratory Physiotherapy Australia
Acceptability of the aquatic environment for exercise
training in people with chronic obstructive pulmonary
disease with physical co-morbid conditions
McNamara R,J 1,2 Alison JA, 2,3 McKenzie DK, 1
McKeough ZJ 2
1
Prince of Wales Hospital, Sydney, 2 The University of Sydney, Sydney,
3
Royal Prince Alfred Hospital, Sydney
Only recently has the physiological response to exercise
training in water been shown to be safe in people with
chronic obstructive pulmonary disease (COPD). Waterbased
exercise may be an alternative to land-based exercise,
especially for patients with physical co-morbid conditions.
However, no studies have evaluated the acceptability of
warm water and the humid aquatic environment as a medium
for exercise in this population. The aim of this study was to
determine whether the aquatic environment was acceptable
for people with COPD and physical co-morbidities enrolled
in an 8-week water-based exercise program. Acceptability
and adverse events were recorded with a questionnaire at
the completion of the program. Eighteen participants (mean
(SD) age 72 (10) years; FEV 1 % 61 (14) % predicted) were
recruited. All participants completed the questionnaire. One
hundred percent of participants reported acceptability with
the water and air temperature, shower and change-room
facilities, staff assistance and modes of pool entry. Fifteen
participants achieved at least 65% training adherence and
identified 6 factors enabling successful completion of the
program: support from staff (93%), enjoyment (80%), a
sense of achievement (80%), noticeable improvements
(73%), personal motivation (73%) and support from other
participants (53%). Of the 3 participants who withdrew
from training, 1 suffered a lower limb skin tear following
an accident in the water, whilst 2 withdrew due to general
body pain and fatigue unrelated to the water-based training.
Eighty-nine percent of participants indicated they would
continue with water-based exercise. Water-based exercise
was well accepted by people with COPD and physical comorbidities.
Assessment of free-living physical activity using
a multi-sensor armband in people with chronic
obstructive pulmonary disease with physical
co-morbid conditions
McNamara RJ, 1,2 Alison JA, 2,3 McKenzie DK, 1
McKeough ZJ 2
1
Prince of Wales Hospital, Sydney, 2 The University of Sydney, Sydney,
3
Royal Prince Alfred Hospital, Sydney
The impact of physical co-morbid conditions such as obesity,
orthopaedic and musculoskeletal conditions on exercise
capacity and physical activity in people with chronic
obstructive pulmonary disease (COPD) is unknown. The aim
of this study was to compare the amount of physical activity
performed by people with COPD with and without physical
co-morbidities. Twenty-five participants with COPD (mean
(SD) age = 73 (10) years; FEV 1 % 53 (15) % predicted)
referred to pulmonary rehabilitation were recruited.
Participants underwent measurement of respiratory
function, quality of life, functional performance and sixminute
walk distance prior to wearing the SenseWear Pro3
Armband (a multi-sensor monitor that estimates physical
activity) for a period of 7 days. Participants with the
physical co-morbid conditions had a significantly reduced
six-minute walk distance (mean difference 240m, 95% CI
161 to 319m) and reduced quality of life (mean difference =
14 units on St George’s Respiratory Questionnaire, 95% CI
3–25 units) compared to those with no physical co-morbid
condition. There was a significant lower daily average
energy expenditure and daily average number of steps (both
p < 0.001) in the physical co-morbid condition group. The
presence of physical co-morbid conditions in people with
COPD leads to a more sedentary lifestyle, reduced exercise
capacity and poorer quality of life.
Water-based exercise in people with chronic
obstructive pulmonary disease with physical co-morbid
conditions: a randomised controlled trial
McNamara R,J 1,2 Alison JA, 2,3 McKenzie DK, 1
McKeough ZJ 2
1
Prince of Wales Hospital, Sydney, 2 The University of Sydney, Sydney,
3
Royal Prince Alfred Hospital, Sydney
The aim of this randomised controlled study was to determine
whether a water-based exercise program was effective in
improving exercise capacity and quality of life in people with
chronic obstructive pulmonary disease (COPD) and physical
co-morbidities compared to land-based exercise and also to
determine the acceptability of the aquatic environment for
people with COPD. Participants were randomly allocated
to one of three groups: land-based exercise, water-based
exercise or a control group of no exercise. The two exercise
groups trained for 8 weeks, 3 exercise sessions per week
(2 supervised and 1 independent). Participants underwent
measurements of respiratory function, exercise capacity
and quality of life by a blinded investigator at baseline and
following intervention. Acceptability and adverse events
were recorded with a questionnaire at the completion of
the program. Of 53 participants (mean (SD) age 72 (9)
years, mean FEV 1 % 62 (19) % predicted), 85% completed
the study. Compared to control, water-based exercise
significantly increased six-minute walk distance (mean
difference 65m, 95% CI 42–88m), incremental-shuttle
walk distance (mean difference 49m, 95% CI 29–69m) and
endurance-shuttle walk distance (mean difference 371m,
95% CI 124–618m). Only the water-based exercise group
achieved the minimum clinically important difference of 4
units change in the St George’s Respiratory Questionnaire.
One hundred percent of participants reported acceptability
with the water and air temperature, shower and changeroom
facilities, staff assistance and modes of pool entry.
Water-based exercise is an effective alternative to landbased
exercise and is well accepted in people with COPD
and physical co-morbidities.
High and low level pressure support during exercise
in people with severe kyphoscoliosis: a double blind
randomised crossover trial
Menadue C, 1,2 Ellis ER, 2 Piper AJ, 1,3 Hollier C, 1
Alison JA 1,2
1
Department of Respiratory & Sleep Medicine, Royal Prince Alfred
Hospital, Sydney, 2 Discipline of Physiotherapy, The University of
Sydney, Sydney, 3 Woolcock Institute of Medical Research, Sydney
Reports on the effect of non-invasive ventilation during
exercise in people with severe kyphoscoliosis are conflicting.
To determine whether the level of pressure support provided
during exercise influences exercise endurance time, a
randomised crossover study with repeated measures was
performed. We hypothesised that only high level pressure
support would increase exercise endurance time. Thirteen
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