Construction Of Exercise Guidance Program For Patients With Stable Chronic Obstructive Pulmonary Disease

ObjectivesThrough semi-structured interviews to understand the status of cognition and demand for exercise in patients with stable COPD,and then analyze the main problems and needs of patients in exercise,to provide reference for the development of the content framework of exercise program;complete the retrieval,screening,content analysis and quality evaluation of the clinical practice guide,systematic evaluation / meta analysis literature and RCT literature related to exercise in stable COPD patients;through the expert meeting,according to the expert's suggests,the "Guidelines for exercise for patients with stable COPD" was established,to provide reference tools of patients with stable COPD and clinical staff,to improve the patient's awareness of exercise and the behavior of exercise,thus promoting the patient's rehabilitation.Methods1.Semi-structured interview: One-on-one interviews were conducted among 11 patients with stable COPD to understand the patients' awareness and needs of exercise.Combined with literature review to analyze the main problems and demands of patients in exercise;2.Literature research: comprehensively search and screen the clinical practice guidelines,systematic review/Meta analysis and RCT related to the exercise of patients with stable COPD,and then analyze the content of the literature that meets our criteria,and use AGREE II,AMSTAR 2 evaluation tool,GRADE system and Risk Of Bias(ROB)for the evaluation of the quality of clinical practice guidelines,systematic reviews/meta analysis and RCT;3.Expert meeting : Through the content analysis of clinical practice guidelines,systematic review/Meta analysis and RCT related to exercise for stable COPD patients,and then the program was modified by expert meeting method.Results1.Cognition and demand for exercise in patients with stable COPD: The interview results of 11 patients with stable COPD showed that patients with stable COPD have a one-sided effect on the exercise and methods of exercise.Controversy and misunderstanding,but patients urgently need professional guidance and education and continuous rehabilitationtraining guidance on exercise methods,time and frequency,intensity and safety and precautions.2.Clinical practice guidelines,systematic evaluation/meta analysis and RCT retrieval,screening,content analysis and quality evaluation of patients with stable COPD related to exercise: One clinical practice guideline was included,which was issued by British thoracic society in 2013,called?BTS Guideline on Pulmonary Rehabilitation in Adults?,there are also13 systematic reviews/Meta analysis and 62 RCT included.The recommended level of the included guideline is Grade B.The standardized scores in the six areas of scope and purpose,participants,rigor,clarity,applicability and independence are 77.8%,38.9%,61.1%,76.0%,59.2%,55.6%,respectively.The ICC value of the consistency test results of the guide is 0.802,and 8 recommendations related to exercise training were included;13 systematic reviews/Meta analysis included 8 Chinese,5 English.Among them,8 Chinese literature are“low quality”,5 English literature are “high quality”,the quality of evidence is from very low to medium,and the effectiveness of exercise training for patients with stable COPD is clarified;62 RCT including 47 Chinese and 15 English,the quality is relatively good,and the included literature can provide rich and reliable content reference for the construction of the program.3.Construction of the “ Exercise Guidance Program for Patients with Stable COPD”:Based on the program content framework,the clinical practice guide,systematic evaluation/Meta analysis and RCT combined with stable COPD patients for retrieval,screening,literature content analysis and quality on the basis of the evaluation and the expert meeting method,the final draft of the“ Exercise Guidance Program for Patients with Stable COPD” is constructed.The final draft of the program includes the role of exercise,evaluation before exercise,indications and contraindications for exercise,The precautions of exercise,the way of exercise,the time of exercise,the frequency of exercise,the intensity of exercise.Conclusions1.Patients with stable COPD have a one-sided understanding of exercise,and there are some misunderstandings in the role and methods of exercise.However,patients strongly need professional medical staff to provide professional guidance on exercise methods,time andfrequency,intensity and monitoring methods and exercise precautions.Therefore,a scientific and standardized exercise training instruction plan should be formulated to provide reference tools for patients and clinical medical staff to exercise guidance for patients;2.According to the literature review results and patient' s problems and needs,developing the content framework of the program,combined with a clinical practice guide,13 systematic reviews/Meta analysis and 62 RCT and expert opinions,the “Exercise Guidance Program for Patients with Stable COPD” is scientific and applicable.It can provide reference for patients with stable COPD and clinical staff to exercise guidance.