P141 An evaluation of the acceptability of supervised ward-based exercise for patients admitted to hospital for acute exacerbation of COPD

Abstract

Introduction Patients with COPD demonstrate peripheral muscle dysfunction and reduced physical activity. Both are compounded by admission for acute exacerbation (AECOPD). Supervised exercise during AECOPD has been shown to be safe and may ameliorate these deleterious physical effects. Debate remains as to the acceptability of exercise for patients admitted with AECOPD. Objective To evaluate the acceptability of supervised exercise for patients admitted with AECOPD. Methods Patients admitted with AECOPD between December 2013 and August 2014 were included if medically stable, had no other limiting factor to exercise and consented to participate. Physiotherapists prescribed a standardised progressive exercise programme comprising daily upper/lower limb strengthening exercises and walking, supervised by a physiotherapy assistant. Patients completed a self-reported Likert scale questionnaire on discharge. Data collection included MRC Dyspnoea score, COPD Assessment Test (CAT), Timed Up and Go (TUAG) and 4-metre gait speed (4MGS). Results 150 patients were screened, 78 (52%) participated. Mean (SD) age 70(10) years, 50% female, median (IQR) length of stay 7(5 -12) days, median number of exercise sessions 2(1- 3). Median MRC 4(4-5) (n = 60); mean CAT at baseline 26 with a mean change of -3.7 (n = 50). 71 patients completed the questionnaire. 89% felt happy to participate in exercise when approached by a physiotherapist. 93% reported being able to undertake the exercises taught, 80% felt very or fairly confident to continue at home. 82% felt the exercise improved their ability to carry out functional tasks. 34% recalled previously completing Pulmonary Rehabilitation. Analysis of those who completed TUAG and 4MGS pre and post intervention (n = 15) showed mean baseline values of 23.7 (10.7) secs and 0.44(0.21) mps respectively; mean changes of - 6.8(9.45) secs and +0.08(0.16) mps respectively. Conclusions Supervised exercise is acceptable to patients admitted with AECOPD, even in those demonstrating significant frailty. However, the non-participation rate was high, reasons for which are unknown. It is unclear whether the improvement in health status and functional mobility during admission was due to exercise participation or natural recovery. Further work is required exploring the impact of initiating exercise during admission on physical activity behaviours post discharge as well as reasons for non-participation during admission.