Adherence to Physical Activity Following Virtual Pulmonary Rehabilitation

Title: Adherence to Physical Activity Following Virtual Pulmonary Rehabilitation
Author(s): S. Conaty and S. Cunneen
Institution: Tallaght University Hospital
Poster: Click to view poster
Category: COPD/Asthma
Abstract: Pulmonary Rehabilitation (PR) incorporates behavior change interventions, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote long-term adherence to health-enhancing behaviours (Bolton et al., 2013). However, research shows that traditional PR does not have an effect on long-term behavior change and doesn’t result in an increase in daily physical activity (PA)(Egan et al., 2012). Virtual Pulmonary Rehabilitation (VPR) was implemented due to Covid-19 restrictions. The aim of this project was to evaluate the VPR service in Tallaght University Hospital (TUH) by monitoring behaviour change and adherence to PA following VPR. It was thought that PA behaviors may improve after VPR due to the home-based nature of the programme, with patients completing classes using equipment that is readily available in their homes. Easy access to this equipment may improve carryover to independent exercise after the programme. The objectives were to measure daily PA levels and sedentary behavior in patients following VPR and to assess the barriers to PA in this population.

Ethical approval was not required for this service evaluation as per National Official of Clinical Audit guidance and the joint SJH/TUH research ethics committee. The first 12 patients who completed VPR in TUH were contacted via telephone. A physiotherapist not involved in the running of the VPR classes conducted the telephone surveys. The International Physical Activity Questionnaire (IPAQ) Short Form was administered over the phone. The IPAQ Short Form is a self-report survey that assesses PA across a number of domains. In addition patients were asked to give examples of PA performed and barriers that limited their PA.

The IPAQ was conducted with 10 patients due to one patient not answering the phone and one patient had died. The patients had a diagnosis of COPD (n=5), Pulmonary Fibrosis (n=2), Asthma (n=2) and Sarcoidosis (n=1). Telephone surveys were completed an average 19 weeks after completion of VPR. No patients performed vigorous PA and eight patients performed moderate PA. The main type of PA reported was housework and only two patients reported completing formal exercise. Eight patients walked for more than 10 minutes with the average time of 24 minutes. The average daily time reported to be spent sitting was 8 hours. The reported barriers to physical activity were reduced motivation when exercising alone compared to in a group, Covid-19 restrictions, dyspnea, fatigue and oxygen dependency.

Poor adherence to PA was observed following VPR. PA levels were anecdotally similar to those observed following face-to-face PR. Patients who performed PA generally performed it at a low intensity. Patients were more likely to continue with PA in the form of housework and walking than formal aerobic or strengthening exercise. The results of this service evaluation highlight the need for interventions to promote long-term adherence to PA following PR.