Objectives: Pulmonary rehabilitation (PR) is a potent intervention for the management of COPD, a core component of which is supervised exercise training. To obtain maximal health benefits, guidance is provided around exercise assessments and prescription. This study aimed to identify 1) whether real-life clinical practice is consistent with guidance; and 2) if and how availability of resources influence real-life practices.
Methods: An online survey of health professionals (HPs) who prescribe exercise, or have knowledge of how exercise is prescribed, for people with COPD attending PR in Australia.
Results: Sixty-two HPs participated (physiotherapist n=43; nurse n=13; exercise physiologist n=6). Rural to metropolitan centres were represented, offering inpatient (3%), outpatient (55%), community (34%) and home or telehealth (7%) services. Aerobic exercise of varied modes was prescribed at all but two programmes. To prescribe exercise intensity, 81% of HPs used exercise testing; all used 6MWT, except a telehealth programme, which used 30-s sit-to-stand. Around one third (36%) of HPs prescribed exercise based on recommendations (33%=80% 6MWT speed; 2% Borg 3-5 [0-10 scale]). Resource limitations, predominantly time, personnel and equipment, impacted the ability to perform exercise assessments and/or optimally prescribe exercise for 61% of HPs.
Conclusion: While supervised exercise training is recommended for all people with COPD, exercise prescription is not usually based on guideline recommendations. HPs express a need for greater support to be able to provide best-practice exercise care for people with COPD who attend Australian PR.