Minimal-Resource Home Exercise Program Improves Activities of Daily Living, Perceived Health Status, and Shortness of Breath in Individuals with COPD Stages GOLD II to IV

Figures & data

Figure 1. CONSORT diagram of patient enrollment into the study.

Table 1. Demographic data of the sample at the time of the initial assessment.

	General group – Baseline	GOLD 2	GOLD 3	GOLD 4
No, groups	28	11	9	8
Age, years	62.3 ± 5.4	58.0 ± 3.2	60.2 ± 4.6^a	64.4 ± 4.6^b,c
Male, %(n)	57.1(16)	45.4(5)	44.4(4)	87.5(7)^c
BMI, kg/m^2	22.9 ± 5.4*	24.9 ± 6.4	22.3 ± 4.4	20.9 ± 4.7^b,c
Smoking load, packs/year	51.9 ± 20.2	36.4 ± 11.8	51.9 ± 20.2^a	58.0 ± 12.8^b,c
FEV1, L	1.23 ± 0.06	1.77 ± 0.08	1.06 ± 0.05^a	0.68 ± 0.04^b,c
FEV1, %	44.7 ± 2.25*	65.1 ± 2.0	39.6 ± 1.0^a	24.2 ± 4.0^b,c
FVC, L	2.92 ± 0.21	3.36 ± 0.19	2.62 ± 0.18^a	2.35 ± 0.24^b,c
FVC, %	75.8 ± 4.1	93.2 ± 4.3	77.2 ± 4.4^a	56.3 ± 3.6^b,c
FEV1/FVC, %	59.8 ± 6.9*	55.2 ± 1.9	42.8 ± 2.2^a	28.4 ± 2.6^b,c
CAT	25.4 ± 3.7	20.6 ± 4.3	25.2 ± 3.6^a	30.6 ± 2.2^b,c
mMRC	2.8 ± 1.1	2.2 ± 0,6	2.9 ± 0,4^a	3.3 ± 0,3^b,c
Exacerbations/year	0.8 ± 1.1	0.3 ± 1.2	0.6 ± 0.5^a	1.7 ± 0.9^b,c
Hospitalizations/year	0.4 ± 0.39	0	0.32 ± 0,28	0.8 ± 0.5^b,c

Results expressed as mean ± SD or number. GOLD: Global Initiative for Chronic Obstructive Lung Disease; BMI: body mass index; FEV _1: forced expiratory volume in the first second; FVC: forced vital capacity. *Significant difference at baseline between individuals with COPD GOLD II, III and IV. Adjusted p- value for the false discovery rate (FDR method). ^aSignificant difference compared with patients with COPD stage II (adjusted pvalue = 0.001); ^bSignificant difference compared with patients with COPD stage II (adjusted pvalue = 0.001); ^cSignificant difference compared with patients with COPD stage III (adjusted pvalue = 0.001).

Table 2. The difference in ADL- Glittre time, CAT, and mMRC pre and post-intervention.

		Mean ± SD	Difference between means ± standard error	95%CI	Adjusted p value #	Cohen’s D
ADL –Glittre time, min	Pre- Intervention	4.9 ± 1.4
	Post - Intervention	3.9 ± 1.1	−0.9 ± 0.2	(-1.3; −0.2)	0.013*	0.74
CAT	Pre- Intervention	25.6 ± 7.76
	Post - Intervention	18.9 ± 9.1	−6.6 ± 3.4	(-10.6; −1.6)	0.040*	0.63
mMRC	Pre- Intervention	2.8 ± 1.1
	Post - Intervention	2.07 ± 0.81	−0.7 ± 0.3	(-1.2; −0.2)	0.013*	0.72

Results expressed as mean ± SD or number. CI: confidence interval. Cohen’s d: effect size measure for comparing differences between means. CAT: COPD assessment test; mMRC: Medical Resource Council modified dyspnea scale.* Statistically significant compared to pre-intervention. # Adjusted p-value for the false discovery rate (FDR method).

Table 3. Comparative analysis between the means of variation of time after intervention (min) of the ADL- Glittre time and the score of the COPD Assessment test (CAT) among COPD individuals with different severity profiles.

	GOLD	Difference between means ± standard error	Adjusted p value*	Cohen’s D	95% CI
Δ ADL –Glittre time, min	2-3^#	0.2 ± 0.3	0.809	0.18	(−0.6; 1.1)
	2-4^#	−1.3 ± 0.4	0.002	−1.01	(−2.2; −0.4)
	3-4^#	−1.5 ± 0.4	0.002	−1.45	(−2.4; −0.6)
Δ CAT	2-3	−9.9 ± 1.7	0.002	−1.05	(−14.0; −5.7)
	2-4	−18.9 ± 1.8	0.002	−1.55	(−23.2; −14.5)
	3-4	−11.1 ± 1.7	0.002	−1.26	(−13.1; −5.0)

Results expressed as mean ± standard error. CI: confidence interval. Cohen’s d: effect size measure for comparing differences between means; GOLD: Global Initiative for Chronic Obstructive Lung Disease CAT: COPD Assessment Test. ^#Statistically significant relative to baseline. *Adjusted p-value for the false discovery rate (FDR method).

Table 4. Quality of life analysis by the SGRQ and its subdomains before and after the intervention.

		Mean ± SD	Difference between means ± standard deviation	Adjusted p value*	Cohen’s D	95% CI
SGRQ - Symptoms	Pre- Intervention	65.5 ± 12.5
	Post - Intervention	60. 5 ± 10.5	15.0 ± 7.2	0.06	0.67	−29.5; −0.6;
SGRQ - Activities	Pre- Intervention	53.5 ± 11.0
	Post - Intervention	49.5 ± 9.1	14.1 ± 6.4	0.06	0.69	−27.1; −1.2;
SGRQ- Psychosocial Impacts	Pre- Intervention	37.4 ± 17.5
	Post - Intervention	33.8 ± 16.4	11.4 ± 7.3	0.06	0.12	−1.2; 25.0
Total SGRQ	Pre- Intervention	50.6 ± 17.7
	Post - Intervention	46.2 ± 12.8	12.6 ± 6.7	0.06	0.68	−26.1; −1.9;

Results expressed as mean ± standard deviation. CI: confidence interval. Cohen’s d: effect size measure for comparing differences between means; SGRQ: Saint George’s Hospital questionnaire on respiratory disease. *Adjusted p- value for the false discovery rate (FDR method).

Figure 2. Comparative analysis of the intervention in the duration of the ADL-Glittre in COPD individuals with different GOLD classification criteria. *Statistically significant compared to baseline (adjusted p – value = 0.012) Adjusted p- value for the false discovery rate (FDR method. **Statistically significant compared to baseline (adjusted p – value = 0.002) Adjusted p- value for the false discovery rate (FDR method).

Figure 3. Correlation matrix (pearson’s correlation) between the mean variation (pre and post-intervention) in the time to perform the ADL-Glittre test, min, in the COPD assessment test (CAT), in the Medical resource Council modified dyspnea scale (mMRC), and the Saint George’s Hospital questionnaire on respiratory disease (SGRQ). r = Pearson’s correlation coefficient, CI: 95% confidence interval. * statistically significant correlation. Adjusted p- value for the false discovery rate (FDR method