Exercise maintenance following pulmonary rehabilitation: effect of distractive stimuli

Chest. 2002 Sep;122(3):948-54. doi: 10.1378/chest.122.3.948.


Study objective: To determine if distractive auditory stimuli (DAS) in the form of music would promote adherence to a walking regimen following completion of a pulmonary rehabilitation program (PRP) and, thereby, maintenance of gains achieved during the program.

Design: Experimental, randomized, two-group design with testing at baseline, 4 weeks, and 8 weeks.

Setting: Outpatient.

Patients: Twenty-four patients (4 men and 20 women) with moderate-to-severe COPD (FEV(1) 41.3 +/- 13% predicted [mean +/- SD]).

Intervention: Experimental group subjects (n = 12) were instructed to walk at their own pace for 20 to 45 min, two to five times a week, using DAS with a portable audiocassette player. The control group (n = 12) received the same instructions, but no DAS.

Measurements and results: Primary outcome measures were perceived dyspnea during activities of daily living (ADL) and 6-min walk (6MW) distance. Secondary outcome measures were anxiety, depressive symptoms, health-related quality of life (QoL), global QoL, and breathlessness and fatigue at completion of the 6MW. In addition, all subjects recorded the distance and time walked using self-report (pedometers and daily logs). There was a significant decrease in perceived dyspnea during ADL (p = 0.0004) and a significant increase in 6MW distance (p = 0.0004) over time in the DAS group compared to the control group. DAS subjects increased 6MW distance 445 +/- 264 feet (mean +/- SD) from baseline to 8 weeks, whereas control subjects decreased 6MW distance to 169 +/- 154 feet. No significant differences were noted for the remaining variables. The cumulative distance walked by the DAS group was 19.1 +/- 16.7 miles compared to 15.4 +/- 8.0 miles for the control group, a 24% difference (p = 0.49). Despite this difference, self-report exercise log data were similar for the two groups.

Conclusion: Subjects who used DAS while walking had improved functional performance and decreased perceptions of dyspnea, whereas control subjects could not maintain post-PRP gains. DAS is a simple, cost-effective strategy that may have the potential to augment the effectiveness of post-PRP maintenance training.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Attention*
  • Exercise / psychology*
  • Female
  • Forced Expiratory Volume
  • Humans
  • Male
  • Middle Aged
  • Music*
  • Patient Compliance / psychology*
  • Pulmonary Disease, Chronic Obstructive / psychology
  • Pulmonary Disease, Chronic Obstructive / rehabilitation*
  • Walking / psychology