A Beginning Look at the Effect of Age on Dyspnea, Physical Functioning and Self-Efficacy for Home Walking and Managing Shortness of Breath in Adults with Chronic Obstructive Pulmonary Disease (COPD)

Abstract

Chronic illness is common in older adults and is associated with functional impairments. Older adults with chronic obstructive pulmonary disease (COPD) face both age-related and disease-related decline in pulmonary function. Dyspnea, also referred to as shortness of breath, is a major symptom in COPD and progressive dyspnea is associated with decline in physical function. Aging, chronic illness and a decline in physical function can compromise the individual's confidence, also known as self-efficacy, for performing physical activities. Chronic disease self-management programs for COPD that include an exercise program have been reported to improve functional status, decrease dyspnea and improve self-efficacy for specific tasks. It is not known if advancing age moderates the effect of a dyspnea self-management program (DSMP) on functional performance, dyspnea and self-efficacy outcomes. Purposes: 1) Determine if advancing age is a moderator of functional performance, dyspnea, or self-efficacy outcomes following three different DSMP interventions; 2) Determine if predictors of self-efficacy for home walking and self-efficacy for managing shortness of breath are similar; and 3) Determine if self-efficacy for home walking and self-efficacy for managing shortness of breath change following three different DSMP interventions. Methods: This is a secondary analysis of a longitudinal, randomized-controlled DSMP trial. One hundred and three (103) participants with COPD (57 women; mean age 66 ± 8; mean FEV-1% predicted: 44.8 ± 14%) were randomized to: 1) a dyspnea self-management program (DM group); 2) a DSMP and four supervised treadmill exercise session (DM-Exposure group) or 3) DM plus 24 supervised treadmill exercise sessions (DM-Training) group. Functional performance outcomes, including self-reported measures and exercise tests, dyspnea intensity measures and self-efficacy for home walking and self-efficacy for managing shortness of breath ratings were measured at specific intervals over the 12 month study period. Results: Age was found to be a significant moderator of self-reported physical function, exercise test performance, and dyspnea intensity both during and after exercise. Additionally, self-efficacy for home walking and self-efficacy for managing shortness of breath improved in all groups following the DSMP intervention. Age was not a significant moderator of self-efficacy outcomes. The predictors of baseline self-efficacy domains evaluated in this study were not similar. Conclusions: Advancing age moderates the effect of three different DSMP interventions on self-reported and exercise test functional performance measures, and dyspnea intensity ratings during and after exercise. Self-efficacy for home walking and self-efficacy for managing shortness of breath ratings improved after the DSMP interventions. While not a completely consistent pattern, it does appear that a more intense exercise intervention may be favorable for the older adult