Optimizing physical activity and work participation in individuals with chronic obstructive pulmonary disease
Bibliographic record
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a systemic disease associated with disabling dyspnea, reduced exercise capacity,and increased mortality. As symptoms get worse, individuals with COPD become less physically active and therefore, more deconditioned. The loss of physical function entails a corresponding loss in lifestyle and social roles, leading to a decrease in quality of life. Effective management of the disease includes rehabilitation aiming at increasing exercise and physical activity (PA), maximizing function to the highest level possible within the limitations inherent to the disease in order to improve quality of life. The overall objectives of this thesis were: i) to maximize by new management approaches exercise training and long-term adherence to PA behaviour in individual with COPD by contributing to evidence of new models of exercise and self-management (SM) support tailored to patients' needs and capacities, and ii) to improve our understanding of COPD with respect to work participation and to better identify individuals at risk.The first study consists of a randomized controlled trial comparing the effects of eccentric and concentric cycle training on quadriceps muscle strength and functional outcomes in advanced COPD. Eccentric cycle was associated with greater relative improvements in quadriceps strength and similar gains in exercise capacity, but with lower sensations of dyspnea when compared with concentric cycling. The second study demonstrates the systematic development of a theory-informed web-based intervention to support SM of PA in COPD. We developed an interactive and theory-informed intervention. The third study tested the acceptability and usability of a web-based PA intervention from the perspective of COPD patients. The web-based intervention was acceptable and usable by COPD patients, resulting in short-term improvements in daily step counts. In addition, opportunities to refine the intervention and solve usability issues were identified.The fourth study evaluated work productivity loss in COPD subjects categorized according to the GOLD ABCD classification in comparison to non-COPD subjects, and it estimated the predictive value of clinical measures such as symptom burden and exacerbations. This study was embedded in a population-based, longitudinal study, the Canadian Cohort Obstructive Lung Disease (CanCOLD) study. Our results showed that work productivity loss is higher in COPD subjects with high symptom burden in comparison to those with low symptom burden and non-COPD subjects, emphasizing the validity of the ABCD GOLD classification and the validity of the CAT questionnaire. The findings of the studies presented in this thesis suggest that ECC could be an alternate and/or adjunct exercise training modality for pulmonary rehabilitation in patients with advanced COPD. In addition, by employing a user-centered design approach, a theory-informed web-based physical activity intervention including activity monitoring, feedback and education was found to be easy to use and to have the potential to promote daily PA behavior in subjects with COPD. Future work will be required to test the effectiveness of these treatment strategies in a larger controlled clinical trial. Finally, the societal burden of COPD individuals with high burden calls for further awareness of the relevance of early recognition and optimal treatment of individuals with mild to moderate COPD. Challenges to the implementation of these interventions are presented.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".