LUNGS IN ACTION: Maintaining Exercise Capacity in Clients with COPD Post Completion of Pulmonary Rehabilitation

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1 LUNGS IN ACTION: Maintaining Exercise Capacity in Clients with COPD Post Completion of Pulmonary Rehabilitation Heather Allan Director, COPD National Program The Australian Lung Foundation

2 Objectives Outline the burden of Chronic Obstructive Pulmonary Disease (COPD) in Australia Outline the benefits of pulmonary rehabilitation for those with COPD Highlight the challenges in maintaining the benefits gained in pulmonary rehabilitation Introduce Lungs in Action A community based maintenance program Present our results to date

3 COPD in Australia Leading cause of death and disease burden 1 in 5 people over 40 have COPD 1 Second leading cause of avoidable hospital admissions 2 Every day 1,000 patients occupy a hospital bed 3 Average length of stay 7.2 days 3 1 Buist/Access Economics; 2 Page et al; 3 Crocket et al

4 Deconditioning spiral (They say I gotta go to rehab )

5 Objectives of COPD Management COPD is not curable, but is treatable Relieve symptoms Increase exercise tolerance and ability to perform activities of daily living Improve health status and QoL Slow disease progression Prevent and treat exacerbations Reduce mortality

6 Pulmonary rehabilitation Evidence-based program proven to improve symptoms, functional exercise capacity, quality of life and reduce hospital admissions 6 8 week course Education Exercise and strength training Mostly hospital based 1 ATS/ERS Statement on Pulmonary Rehabilitation

After Rehab Post rehab: Dyspnoea reduced Exercise capacity and QoL increased Benefits decline by 12 months 1 Benefits (exercise capacity and QoL) can be

7 After Rehab Post rehab: Dyspnoea reduced Exercise capacity and QoL increased Benefits decline by 12 months 1 Benefits (exercise capacity and QoL) can be maintained by maintaining regular exercise 2 Limited community exercise programs that cater to breathless client 1 Ries, 2003; Brooks, Spencer, 2009

8 Lungs in Action Lungs in Action Post-rehab Community-based Safe Low-cost to patient Self-sustaining Opportunity for social contact

Method Exercise professionals complete fully accredited training program Training = on-line theory + practical component Full training = 13 CECs from Fitness Australia

9 Method Exercise professionals complete fully accredited training program Training = on-line theory + practical component Full training = 13 CECs from Fitness Australia and in process of applying for ESSA accreditation Fitness Professional establishes local class Pulmonary rehab is source of referrals Clients pay $6-$8 per class to attend

Training Theory component Comprehensive on-line training Respiratory system COPD and other conditions Pulmonary rehabilitation Importance of exercise in

10 Training Theory component Comprehensive on-line training Respiratory system COPD and other conditions Pulmonary rehabilitation Importance of exercise in COPD Limitations of exercise in COPD Recognising breathlessness Managing breathlessness Supplemental oxygen Developing a tailored program Program design

Training - Practical and Mentoring Unique to Lungs in Action Trainees linked with mentor Trainee attends 2 rehab classes Completes checklist of core

11 Training - Practical and Mentoring Unique to Lungs in Action Trainees linked with mentor Trainee attends 2 rehab classes Completes checklist of core competencies Demonstration of exercise modifications Written assignment where trainee develops sample class Delivery of a class for the mentor for assessment

12 Benefits of mentoring model Lungs in Action class complements local PR class ensuring a smooth transition from hospital to community Establishes relationship Ongoing referral stream to ensure sustainability

13 Results 35 LIA programs in NSW, VIC, QLD, TAS and ACT 18 further programs in various stages of development

14 Measuring participant outcomes Functional exercise capacity (6MWT) Quality of Life (SGRQ) Objective is to maintain measures achieved immediately post rehab

15 6 minute walk distance (m) Results Functional Exercise Capacity mean difference (95%CI) = 9m (-35 to 53) NS Immed Post PR 12 months

16 Results Quality of Life

17 Conclusion The unique Lungs in Action model provides an important opportunity for COPD patients to maintain an exercise regime Preliminary data suggest that LIA is able to maintain the gains achieved in pulmonary rehabilitation Further data collection is required

18 Acknowledgements Elizabeth Harper, Lungs in Action Program Manager, The Australian Lung Foundation Corinne French, Physiotherapist, Helensvale Community Health, Gold Coast, Queensland Dr Lissa Spencer, Physiotherapist, Royal Price Alfred Hospital, Sydney A/Prof Jenny Alison, Physiotherapist, Royal Prince Alfred Hospital and Research Leader, Lung and Heart Physiotherapy Research Group, Faculty of Health Sciences, University of Sydney

Improving access to pulmonary rehabilitation through Medicare Benefit Scheme subsidies

Improving access to pulmonary rehabilitation through Medicare Benefit Scheme subsidies FREQUENTLY ASKED QUESTIONS Contents: About Lung Foundation Australia s Medicare Benefit Scheme Application Page 1