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There is more to supervised exercise than exercise itself : a mixed methods study of supervised exercise with the chronic disease self-management program for people with COPD

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Cameron-Tucker, Helen Laura (2009) There is more to supervised exercise than exercise itself : a mixed methods study of supervised exercise with the chronic disease self-management program for people with COPD. PhD thesis, University of Tasmania.

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Abstract

'THERE IS MORE TO SUPERVISED EXERCISE THAN EXERCISE ITSELF'
A Mixed Methods Study of Supervised Exercise with the Chronic Disease SelfManagement
Program for People with COPD
Chronic obstructive pulmonary disease (COPD), a progressive respiratory condition,
significantly affects the lives of those managing its daily impact. Exercise is
recognised as an important management strategy. This thesis investigates the
addition of supervised exercise to the Stanford Chronic Disease Self-Management
Program (CDSMP) in people with COPD. The CDSMP is a group-based program
designed to facilitate the acquisition of self-management skills, and does not have an
exercise component.
This thesis provides opportunity to consider theories of health behaviour change and
the role of self-efficacy in the self-regulation of behaviours, such as exercise. The
effect of the CDSMP on self-reported exercise was reviewed, finding a lack of
published research concerning supervised exercise with the CDSMP.
To investigate the effect of supervised exercise with the CDSMP older adults were
allocated to the CDSMP, with or without supervised exercise, in a parallel group
randomised controlled clinical trial with a pre/post test design over two years. A
mixed methods approach was used to provide a more detailed analysis of the effect
of supervised exercise than one method alone, giving quantitative evidence enriched
by the lived experience of participants. Objective outcomes included physical
capacity (primary outcome), self-reported exercise, stage of change for exercise,
exercise self-efficacy, shortness of breath, heath-related quality of life and self management
behaviours. Change in outcomes between groups and within group was
measured by appropriate statistical tests. Qualitative methods of enquiry using semistructured
interviews and thematic analysis uncovered the lived experience of the
people who participated in the CDSMP with or without supervised exercise. Eighty-four participants were randomised. There were 15 withdrawals, due to ill health
and other commitments. This thesis demonstrated a small statistically significant increase in physical capacity for the intervention and control groups, but
no significant difference between them. However, the clinical significance of the
within-group change was not reached. Further research is required in this area. There
were no significant differences between groups for any secondary outcome, although
analysis of effect sizes indicated that supervised exercise confers a benefit to those
who participate: they exercised more frequently, for longer duration, had less
breathlessness and improved quality of life physical component summary compared
with those who did not have supervised exercise. However, neither one hour of
weekly supervised exercise, in the absence of a structured home programme, nor the
CDSMP alone, was sufficient to produce more than small improvements in
outcomes.
Qualitative findings revealed participants bring to healthcare interactions a personal
meaning of self-management defined by their lived experiences and strategies
developed in response to living with COPD. Similar sources of motivation act across
the CDSMP and supervised exercise, thereby supporting the construct of selfefficacy
and signifying the pivotal role of perceived personal control as a mediator of
behaviour change. However, the experience was not viewed positively by all,
indicating the need to be alert to possible adverse psychological effects of
interventions and to identify at-risk individuals. Participants endorsed supervised
exercise, emphasising the importance of respecting their preferences. This study suggests that the process of facilitating behaviour is not concerned with
'who knows best', but rather with how the interaction between health professional
and participant facilitates a consideration of self and the best possible behaviours to
manage life with long-term health conditions, pointing to a framework for
participant-centred engagement in healthcare.
In conclusion, supervised exercise of one hour per week does not need to be an
integral component of the CDSMP, but offered as an optional adjunct, underpinned
by a participant-centred approach. Methods of increasing the clinical significance of
the small increase in distance walked need to be explored.

Item Type: Thesis (PhD)
Keywords: Lungs, Lungs, Exercise therapy
Copyright Holders: The Author
Copyright Information:

Copyright 2009 the Author - The University is continuing to endeavour to trace the copyright
owner(s) and in the meantime this item has been reproduced here in good faith. We
would be pleased to hear from the copyright owner(s).

Additional Information:

Available for use in the Library and copying in accordance with the Copyright Act 1968, as amended. Thesis (PhD)--University of Tasmania, 2009. Includes bibliographical references

Date Deposited: 25 Nov 2014 00:57
Last Modified: 11 Mar 2016 05:53
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