Tele-based Resisted Exercise for COPD

Six Weeks Tele-based Resistance Exercise Improves the Respiratory Muscle Strength and Biceps Strength Among Patients With Chronic Obstructive Pulmonary Disease

The present study aims to investigate the effect of six weeks tele-based resisted exercises on cardiopulmonary function, quality of life, muscle strength and functioanl performance among patients with chronic obstructive pulmonary disease. In addition, the effect of different forms of exercise instruction (i.e., booklet and video) was also investigated.

Study Overview

• Status: Completed
• Conditions: Telerehabilitation; Pulmonary Rehabilitation; Compliance, Patient; COPD; Cardiopulmonary Exercise Test
• Intervention / Treatment: Other: Education; Other: Video-based pulmonary rehabilitation; Other: Booklet-based pulmonary rehabilitation

Detailed Description

Background and Purpose: Chronic obstructive pulmonary disease (COPD) is the 3rd global cause of deaths. Pulmonary rehabilitation (PR) is the standard treatment for this disease. However, the dropout rate remains high (33-50%) because of traffic issues and patients' low mobility. Therefore, telerehabilitation seems to be a better way to deliver PR. Using videos to deliver PR is not only easy to manipulate on the cellphone or ipad, but also improve patients' attention and compliance. Thus, the aim of this study is to assess whether tailor-made PR video rehabilitation program improves patients' quality of life (QoL), muscle strengths, cardiopulmonary functions, and compliance.

Methods: This is a quasi-experimental study. Participants were medically stable COPD patients and able to use LINE and YOUTUBE in cellphone. They voluntarily choose to participate in control group, booklet group or video groups to conduct 6-week tele-based resisted exercise program. Patients in control group received conventional intervention and exercise instruction booklet. Participants in booklet and video groups additionally received a COPD exercise package with 2 elastic bands in different weight (4 ponds and 8 ponds). Participants in booklet group received the exercise instructed in education booklet with words and pictures. Patients in video group received exercise instructed using YouTube videos. Both participants in booklet and video groups were asked to record their rating of perceived exertion (RPE) scores. A physical therapist would weekly contact them to monitor and modify the exercise intensity using their RPE scores. The videos included 5-minute breathing reeducation, 20-minute interval strengthening exercise and 5-minute education animation. All patients were assessed the performance of spirometry, cardiopulmonary exercise test (CPET), questionnaires about symptoms, QoL, muscle strengths and distances of 6-minute walk test (6MWT) before intervention, after intervention and after 6-week follow-up.

• Study Type: Interventional
• Enrollment (Actual): 40
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Taiwan
  • Tainan, Taiwan, 704
    • National Cheng Kung University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 40 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• COPD
• Be medically stable
• Ability to use a smartphone and applications (LINE and Youtube)
• Access to the internet
• Have visual and auditory impairments corrected with assistive devices

Exclusion Criteria:

• Other respiratory disease as main complaint other than COPD
• Exacerbations within 4 weeks
• Had enrolled PR programs within the last 6 months
• Unable to follow verbal instructions, suffer from cognitive impairment, or have language difficulties
• Unstable medical conditions
• Any comorbidities which precluded exercise training

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Sham Comparator: Control group; Patients in control group received the education booklet with words and pictures.	Other: Education; COPD patients conduct pulmonary rehabilitation for 6 weeks by read an education booklet with words and pictures which is made by the physiotherapist.
Experimental: Video group; Patients in intervention group watched YOUTUBE videos to rehab and recorded the intensity after the exercise by RPE scores. During the intervention, a physical therapist would have weekly telephone calls or LINE calls for 6 times to monitor and modify the intensity of exercise.	Other: Video-based pulmonary rehabilitation; COPD patients conduct pulmonary rehabilitation for 6 weeks by watching Youtube videos which were made by the physiotherapist.The patients are monitored by the physiotherapist by weekly phone call and asked to record RPE scores at the RPE form.
Experimental: Booklet group; Patients in intervention group read education booklet with words and pictures to rehab and recorded the intensity after the exercise by RPE scores. During the intervention, a physical therapist would have weekly telephone calls or LINE calls for 6 times to monitor and modify the intensity of exercise.	Other: Booklet-based pulmonary rehabilitation; COPD patients conduct pulmonary rehabilitation for 6 weeks by read an education booklet with words and pictures which is made by the physiotherapist.The patients are monitored by the physiotherapist by weekly phone call and asked to record RPE scores at the RPE form.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time point difference of AT from 1st week to 6th week	Use cardiopulmonary exercise test (CPET) to get the change of time point difference of AT from 1st week(intervention starts) to 6th week(intervention ends)	From 1st week to 6th week
Time point difference of AT from 1st week to 12th week	Use cardiopulmonary exercise test (CPET) to get the change of time point difference of AT from 1st week(intervention starts) to 12th week(follow up ends)	From 1st week to 12th week
Time point difference of AT from 6th week to 12th week	Use cardiopulmonary exercise test (CPET) to get the change of time point of AT from 6th week(intervention ends) to 12th week(follow up ends)	From 6th week to 12th week
Change of maximal exercise work from 1st week to 6th week	Use cardiopulmonary exercise test (CPET) to get the change of values of the pateint's total work (watt) from 1st week(intervention starts) to 6th week(intervention ends)	From 1st week to 6th week
Change of maximal exercise work from 1st week to 12th week	Use cardiopulmonary exercise test (CPET) to get the change of values of the pateint's total work (watt) from 1st week(intervention starts) to to 12th week(follow up ends)	From 1st week to 12th week
Change of maximal exercise work from 6th week to 12th week	Use cardiopulmonary exercise test (CPET) to get the change of values of the pateint's total work (watt) from 6th week(intervention ends) to 12th week(follow up ends)	From 6th week to 12th week
Change of VO2max from 1st week to 6th week	Use cardiopulmonary exercise test (CPET) to get the change of values of VO2max (mL/min/kg) from 1st week(intervention starts) to 6th week(intervention ends)	From 1st week to 6th week
Change of VO2max from 1st week to 12th week	Use cardiopulmonary exercise test (CPET) to get the change of values of VO2max (mL/min/kg) from 1st week(intervention starts) to 12th week(follow up ends)	From 1st week to 12th week
Change of VO2max from 6th week to 12th week	Use cardiopulmonary exercise test (CPET) to get the change of values of VO2max (mL/min/kg) from 6th week(intervention ends) to 12th week(follow up ends)	From 6th week to 12th week
Change of VE/VCO2 from 1st week to 6th week	Use cardiopulmonary exercise test (CPET) to get the change of values of VE/VCO2 from 1st week(intervention starts) to 6th week(intervention ends)	From 1st week to 6th week
Change of VE/VCO2 from 1st week to 12th week	Use cardiopulmonary exercise test (CPET) to get the change of values of VE/VCO2 from 1st week(intervention starts) to 12th week(follow up ends)	From 1st week to 12th week
Change of VE/VCO2 from 6th week to 12th week	Use cardiopulmonary exercise test (CPET) to get the change of values of VE/VCO2 from 6th week(intervention ends) to 12th week(follow up ends)	From 6th week to 12th week
Change of muscle strength from 1st week to 6th week	Use dynamometer to measure the changes of muscle strength(kg) from 1st week(intervention starts) to 6th week(intervention ends), including bilateral handgrip, elbow flexors (biceps) and knee extensors (quadriceps) for 3 times separately.The patient need to increase the strength to the highest level in 6 seconds and rest for 30 seconds.The highest value will be divided by the patient's body weight (kg/kg)	From 1st week to 6th week
Change of muscle strength from 1st week to 12th week	Use dynamometer to measure the changes of muscle strength(kg) from 1st week(intervention starts) to 12th week(follow up ends), including bilateral handgrip, elbow flexors (biceps) and knee extensors (quadriceps) for 3 times separately.The patient need to increase the strength to the highest level in 6 seconds and rest for 30 seconds.The highest value will be divided by the patient's body weight (kg/kg)	From 1st week to 12th week
Change of muscle strength from 6th week to 12th week	Use dynamometer to measure the changes of muscle strength(kg) from 6th week(intervention ends) to 12th week(follow up ends), including bilateral handgrip, elbow flexors (biceps) and knee extensors (quadriceps) for 3 times separately.The patient need to increase the strength to the highest level in 6 seconds and rest for 30 seconds.The highest value will be divided by the patient's body weight (kg/kg)	From 6th week to 12th week
Change of 6-minute walk test from 1st week to 6th week	Measure the change of 6-minute walk test from 1st(intervention starts) week to 6th week(intervention ends).The patient walks in his/her own pace, as far as he/she can in 6 minutes at the 20-meter long straight path and the we will record the distance in meter.Stop when time's up or patient develops clinical symptoms.	From 1st week to 6th week
Change of 6-minute walk test from 1st week to 12th week	Measure the change of 6-minute walk test from 1st(intervention starts) week to 12th week(follow up ends).The patient walks in his/her own pace, as far as he/she can in 6 minutes at the 20-meter long straight path and the we will record the distance in meter.Stop when time's up or patient develops clinical symptoms.	From 1st week to 12th week
Change of 6-minute walk test from 6th week to 12th week	Measure the change of 6-minute walk test from 6th(intervention ends) week to 12th week(follow up ends).The patient walks in his/her own pace, as far as he/she can in 6 minutes at the 20-meter long straight path and the we will record the distance in meter.Stop when time's up or patient develops clinical symptoms.	From 6th week to 12th week
Attendance rate in video group or booklet group	If the patient completes 70% or more of the intervention program by being analyzed from the record of RPE form, he/she will be recognize as being completed the intervention.Finally, we will count the number of the patients who completed the intervention to be divided by the number of totally patients in video/booklet group at 6th week.	From 1st week to 6th week

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
FEV1	Use spirometry to measure the values of FEV1 (%) for 3 times.The highest result will be recored.	Baseline, 6 weeks later, and 12 weeks later
FEV1/FVC	Use spirometry to measure the values of FEV1/FVC for 3 times.The highest result will be recored.	Baseline, 6 weeks later, and 12 weeks later
Modified Medical Research Council (mMRC)	Level of Modified Medical Research Council (mMRC)	Baseline, 6 weeks later, and 12 weeks later
COPD Assessment Test (CAT)	Total score of COPD Assessment Test (CAT)	Baseline, 6 weeks later, and 12 weeks later
EuroQol-5 Dimensions-5 Levels (EQ-5D-5L)	Score of EuroQol-5 Dimensions-5 Levels (EQ-5D-5L)	Baseline, 6 weeks later, and 12 weeks later
Clinical COPD Questionnaires (CCQ)	Score of Clinical COPD Questionnaires (CCQ)	Baseline, 6 weeks later, and 12 weeks later

Collaborators and Investigators

• Sponsor: National Cheng-Kung University Hospital
• Investigators: Study Chair: Ching-Hsia Hung, Ph.D, National Cheng-Kung University Hospital

Study record dates

Study Major Dates

• Study Start (Actual): March 2, 2020
• Primary Completion (Actual): May 31, 2021
• Study Completion (Actual): July 10, 2021

Study Registration Dates

• First Submitted: April 14, 2021
• First Submitted That Met QC Criteria: April 28, 2021
• First Posted (Actual): May 3, 2021

Study Record Updates

• Last Update Posted (Actual): July 22, 2024
• Last Update Submitted That Met QC Criteria: July 18, 2024
• Last Verified: July 1, 2024

More Information

Terms related to this study

• Keywords: COPD; Cellphone; Telerehabilitation; Pulmonary Rehabilitation; Cardiopulmonary exercise test; LINE; Video-based telerehabilitation; Youtube; Booklet-based telerehabilitation; Interval strengthening exercises
• Other Study ID Numbers: B-BR-108-038-2

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No