International Journal of Physical Medicine & Rehabilitation
Open Access

Abstract

Adherence to Exercise Training in COPD Patients: Factors that Predict Patient Adherence and Non-Adherence: A Report

Renukadevi Mahadevan

Objectives: To know the percentage of adherence to 12 weeks of exercise training program and to know the reason for non-adherence and the factors enhanced them to adhere to the exercise rehabilitation program.

Methodology: One hundred and thirty four patients with COPD who were referred for rehabilitation participated in this study. Qualitative study using semi-structured interviews was conducted for COPD patients aged 45-70 years, referred for pulmonary rehabilitation over a 2-year period. There were two method of intervention carried for two different groups, conventional constant load training group and another was high intensity interval training group. The intervention was for 12 weeks. The mode of training was treadmill aerobic training. The frequency was 3 days in a week. Attendance of more than 75% is considered as adherent to the exercise training. The interview conducted to the subjects dropped from the training and to subjects adhered to the intervention. Wide range of open ended questions as well as probing questions, such as why they had decided to attend or not attend the exercise training program, and why they had decided to continue or drop out were asked. Interviews were carried out and audiotaped with the consent of the participant.

Results: One hundred and thirty four patients included in the study. The adherence to exercise by both conventional constant load training and HITT was 44.7% and drop out was 55.22%. The adherence to conventional constant exercise training was (30) 41.6% and the drop out was 58.3%. The adherence to high intensity interval training was 48.3% and the drop out was 51.6%. The reason for non-adherence for both the type of intervention was not affordable (29.72%), no attender (family support) to accompany (13.51%), LTOT use (9.45%), breathless and leg fatigue (10.81%), absent of therapist (6.75%), travelling distance (6.75%), hospitalizations (18.91%), felt that they can do at home (2.70%), shifting/migration (1.35%). The adherence to the programme was positively influenced by other patients attending the exercise rehabilitation, and increased self-confidence Twenty five percent were accountable to factors beyond patient’s control having medical reasons like exacerbations/hospitalizations and absent therapists. The adherence of COPD patients to exercise rehabilitation program for twelve weeks is moderate. The factors predominantly led to non-adherence was unaffordability, less family support, breathless and leg fatigue and less predominantly was travelling distance, migration/shifting and can manage to do exercise at home. Hospital admission/exacerbation, absent of therapist or change in the schedule. The factors led to adherence were, influenced by other patients attending the exercise rehabilitation, self-confidence, understanding the benefits of training and influence of the referred doctor.