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Research Title Objectives



Outcome & Main Findings

Water-based Exercise in COPD with Physical Comorbidities: a randomisedcontrolled trial The objectives of this study was to test the efficacy of water based exercise versus land based exercises or no exercises on COPD patients with physical comorbidities in terms of exercise capacity, health-related quality of life and respiratory muscle strength. Subjects included were COPD patients with one or more physical comorbidities that were outpatients and had a confirmed diagnosis of FEV1/FVC of <70% based on Gold Classification. Even those patients who use supplemental oxygen were included. On the other hand, patients who have physical commodities that could impact on exercise performance or those with cardiac disease, conditions contraindicated to water-based therapy, completed pulmonary rehabilitation in the past 12 months or were currently undergoing an exercise program, had cognitive decline, or were unable to understand oral and written English were excluded. The 45 participants were divided into three groups: the water-based exercise group, land-based exercise group and the control group without exercise. Both exercise groups attended a 60-min/week exercise session supervised by the same trained physiotherapist for a total of 8 weeks. The duration, intensity and muscle groups trained were closely monitored to ensure an equalised study. To ensure that they were exercising the right amount of intensity, the participants were encouraged to reach the modified Borg scale rating of 3-5. The training intensity was measured three times every exercise session and the mean value was recorded. For the control group, they received the usual medical care and no exercise training over the duration of the study. The main factor assessed in this study is the endurance exercise capacity which was measure using the endurance shuttle walk test (ESWT). Participants were measured twice, once during the baseline period and the other one post-intervention. Several tests were conducted to measure the pulmonary function of the patient namely: spirometry, diffusing capacity of the lung for carbon monoxide, static lung volumes by body plethysmography,and maximum inspiratory and expiratory mouthpressure (MIP and MEP, respectively). These tests followed the specific guidelines following the administration of inhaled salbutamol through a spacer device. For the exercise capacity of the patient, a self-paced 6-min walk test (6MWT), the ESWT and the incremental shuttle walk test (ISWT). Dyspnea and exertion rate were measured using the modified Borg 0-10-category ratio scale. Lastly, the participants answered the self-reported Chronic RespiratoryDisease Questionnaire (CRDQ) and the Hospital Anxietyand Depression questionnaire to assess their status and mental health. The results regarding the first group (Water-based training groups) were better compared to the 2nd (Land-based training group) and the 3rd (no exercise group) as manifested by an increase in distance in 6-minute walk test, Endurance shuttle walk test and incremental shuttle walk test. The hydrostatic pressure added load to the inspiratory muscles resulting in an increase in maximum inspiratory pressure (MIP), they also present an improved peak and endurance exercise capacity. The difference in the

Practical/Clinic al Implications


results of group 1 and 2 showed a reduction in CRDQ dyspnea and fatigue domain scores. In the experiment conducted, it is evident that water-based exercises had a better outcome compared to those on land and those who didnt h ave exercise at all. It proves that exercises done in water can be an alternative way, and is proved better, in providing treatment for COPD patients. This implies that pulmonary rehabilitation in the Philippines is recommended to includewater-based exercises that can improve their function and quality of life. This article is good in terms of the randomization where subjects were objectively randomized and proved that water-based therapy had significant results in improving a patients exercise capacity and quality of life and can serve as an alternative intervention. There was a limitation only that the majority of the subjects were that of Stage 2 so further investigation of the effect for those with severe COPD is warranted.