Long-term self-reported attendance in exercise training or lung choir and status of quality of life following initial pulmonary rehabilitation for COPD

Mette Kaasgaard; Uffe Bodtger; Søren T Skou; Stephen Clift; Ole Hilberg; Daniel Bech Rasmussen; Anders Løkke

doi:10.3389/fresc.2024.1447765

Long-term self-reported attendance in exercise training or lung choir and status of quality of life following initial pulmonary rehabilitation for COPD

Front Rehabil Sci. 2024 Sep 19:5:1447765. doi: 10.3389/fresc.2024.1447765. eCollection 2024.

Authors

Mette Kaasgaard^{1

2}, Uffe Bodtger^{1

2}, Søren T Skou^{3

4}, Stephen Clift^{5

6}, Ole Hilberg^{2

7}, Daniel Bech Rasmussen^{1

2}, Anders Løkke^{2

7}

Affiliations

¹ Pulmonary Research Unit (PLUZ), Department of Medicine, Zealand University Hospital, Naestved, Denmark.
² Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
³ The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark.
⁴ Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark.
⁵ Sidney De Haan Research Centre for Arts and Health, Canterbury Christ Church University, Canterbury, United Kingdom.
⁶ International Centre for Community Music, York St John University, York, United Kingdom.
⁷ Department of Medicine, Lillebaelt Hospital, Vejle, Denmark.

Abstract

Background: Both adherence rates to pulmonary rehabilitation (PR) programmes and long-term attendance in exercise training after PR remain a challenge. In our previous randomised controlled trial (RCT), effects were positively associated with a dose-response pattern, regardless of whether PR contained conventional physical exercise training (PExT) or Singing for Lung Health (SLH) as a training modality within a 10 weeks' PR programme for chronic obstructive pulmonary disease (COPD). However, long-term status of this RCT cohort remains unknown. In this study, we investigated whether current status (=attendance in supervised exercise training or a lung choir and scoring in quality of life (QoL)) was related to initial PR completion, randomisation, or adherence.

Methods: We collected data via telephone, using a researcher-developed questionnaire on current self-reported attendance in supervised exercise training or a lung choir and on perceived benefits of the initial RCT intervention. Additionally, we used COPD-validated questionnaires (primarily: QoL (measure: St George's Respiratory Questionnaire; SGRQ).

Results: In 2023 (i.e., mean/median 4.7 years after initial PR), surviving participants were contacted (n = 196; 73% of 270), and 160 (82% of 196) were included. Out of the included participants, 30 (19%) had not completed initial PR. Compared to the initial PR-completers, non-completers reported less current attendance in exercise training or lung choir (24% vs. 46%, p = 0.03) but SGRQ scores were comparable. Yet, those who attended exercise training or lung choir at present (n = 66/160; 41% out of 160) reported better QoL score than those with no current attendance (SGRQ; Attending: 39.9 ± 15.4; Not attending: 43.1 ± 16.7; p = 0.02). Neither having had SLH instead of PExT, nor adherence level during initial PR, was related to current attendance or to QoL scores.

Conclusion: This study indicates that long-term self-reported attendance and current QoL scores are positively related to initial completion of a PR programme. Surprisingly, neither initial PR content (PExT or SLH) nor initial PR adherence was related to long-term outcomes. We suggest that future PR programmes include special attention to those who do not complete PR to support long-term attendance and QoL status.

Keywords: chronic obstructive pulmonary disease; completion rate; group singing; long-term attendance; lung choir; physical exercise training; pulmonary rehabilitation; quality of life.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. Funding for the study was obtained from the following funding bodies: The Danish Health Foundation (DKK 500,000), The Danish Lung Foundation (DKK 100,000), Region Zealand (DKK 342,857), and Chiesi Pharma AB (DKK 85,000). All research grants were used for salaries for principal investigator (MK) and research assistant, running costs, and equipment. Participants did not receive any economic compensation for study participation.