Exercise and Maintaining the Quality of Life - Research Proposal Example

Relationship between exercise and maintaining quality of life in patients with COPD Research motivation Chronic obstructive pulmonary disease (COPD) damages the patients’ ability to carry out excessive physical exercise, especially in patients suffering from severe lung disease. However, different perceptions and meaning about the importance of exercise in rehabilitating patients with COPD might cause miscommunication between a patient and the physician, which would further impact the treatment of the patient. Further, research has found that lack of exercise in patients with COPD also results in the diminishing of their quality of life and their actual performance of daily activity also witnesses a downfall. Although, there are many differing views about the rehabilitation of patients with COPD, most experts acknowledge that a moderated exercise regime helps in improving the day-to-day activities of the patient and enhances his or her quality of life (Toru, 2002). However, due to the lack of reliable data that can establish the relationship between exercise and improvement in the quality of life in COPD patients, many are not sure about the efficacy of this approach. Therefore, in order to find out the impact of exercise in patients with COPD, I have undertaken this research. The outcome of this research would be based on the measurement of patient-centered and physiologic results. Through this research, I hope to provide the best possible approach to evaluate reactions to therapeutic involvement and suggest ways to manage the disease through a comprehensive exercise regime. Research Background Some of the common complaints that patients with COPD stresses on are weakened exercise tolerance, dyspnoea and diminished quality of life. However, research indicates that these problems arise not just because of the loss of pulmonary function. The decrease in exercise tolerance is mainly because of weak lung function (Arnold, 2005). Further, although medication might improve the pulmonary function in COPD, it might not necessarily have the same effect on the capacity of the patient to exercise without fatigue (Caroci, 2004). Also, there are other factors like weakness of peripheral muscle and damaged gas exchange which contribute towards the reduction in exercise tolerance (Ramsey, 2006; Rector, 2006). Research reveals that for COPD patients, it is important to analyse the consequences of exercise intolerance. This is necessary as diminished exercise tolerance among COPD patients would render them disabled and their utilisation of healthcare would also be very high (Pauwels, 2007; Borg, 1982). These patients would not be able to undertake any physical labour and often become social outcasts. Further, exercise intolerance may result into the death of the patient as well (American Thorasic Society, 1995). In order to resolve this problem, most countries have adopted well-monitored pulmonary rehabilitation programmes. These programmes aim to build exercise capability in COPD patients and help in integrating the patients in the society by enhancing their daily activities and quality of life. However, such programmes should be very comprehensive and should be flexible enough to be customised according to each patient’s needs. The programme should also include modules such as exercise training, smoking cessation sessions, breathing exercises, nutritional guidance, psychological help, medical treatment and health education (Schiller, 1989). Research Problems The current medical treatment for COPD aims to remove contact with causative agents, reduce or remove inflammation, develop gas exchange, deal with associated comorbidities and decrease the imposed airflow constraint and air trapped in the lung. Based on the presence of the degree of airway and lung disease, it is imperative to maintain therapies focused on ensuring optimal lung function on an ongoing basis. Further, patients should undergo pulmonary rehabilitation after the disease stabilises and ensures that medical therapies would be optimised. Such a rehabilitation programme would help the patient in improving his or her understanding about the disease, medication for the disease, nutritional requirements and action plans to be undertaken to improve the quality of life. Although, pulmonary rehabilitation has attained varied levels of success, most physicians are still skeptic about the potential results of such a programme conducted for COPD patients (Carter, 2007). However, it has been seen that the objectives to improve the function and enhance the medical delivery for COPD patients can be attainted through a multi-dimensional delivery process. Although, there are many delivery models that have been used by various physicians, most believe that exercise training is the most important delivery process that improves the functions of the patients and thus, enhances his or her quality of life (Carter, 2007). Therefore, in this paper, I would review the current understanding about exercise tolerance in COPD patients. I would also study how enhancing exercise tolerance can help in managing the disease in better manner and thereby, increasing the quality of life of the patient. Research Objectives Most experts believe that pulmonary rehabilitation for COPD patients is beneficial for managing the disease. However, there is a lack of data to support this view. Therefore, through this research I would attempt to understand the correlation between exercise tolerance in COPD patients and quality of life. However, undertaking such a huge research would mean careful planning and developing clear research objectives. Some of my research objectives are discussed below: Creating customised programme: Even before commencing the rehabilitation programme, I would conduct not just a detailed medical and physiological assessment, but would also turn quality of life tests on my patients to understand their individual needs and preferences. This would help me in tailor making the programme according to their needs. Further, I would proactively seek inputs from the patient as well as the family members to establish individual goals for the patients. Conducting random exercise studies: I would also conduct some random but controlled exercise regimes with my patients to understand their endurance for exercising. I would conduct these tests by measuring their capability for walking small as well as long distances. This would help me in analysing whether my programme would become successful or not. Understanding the impact on quality of life: This would be the most important aspect of this research, wherein, I would attempt to study the impact of the exercise training on the quality of life of my patients. I would not just examine the patients’ physical well being, but would also analyse their social lives by interviewing their friends and family members. This would help me in understanding whether or not a successful exercise regime can help in improving the quality of life of a patient with COPD. Studying mortality rate: I would also attempt to understand whether this exercise programme helped in reducing the mortality rate in COPD patients. Therefore, even after finishing the programme, I would be in constant touch with my subjects and analyse their progress for the next couple of years. Research Questions Exercise training is a very important part of treating COPD patients as such patients often complains about exercise tolerance. However, experts are still divided in their views about the best exercise method that can help such patients (Borg, 1982). Thus, in order to understand how exercise can help COPD patients to improve their quality of life, it is necessary to comprehend and come up with a good training regime first. For this research, I have formulated the following questions that would help me in developing a good exercise training program and would also aid in analysing the impact of the program on the patient. Is it important to incorporate exercise training program in the rehabilitation programme for COPD patients? What should be the intensity of this training program? Should medical support, nutrition guidance and oxygen interventions be a part of the exercise training regime? How should the patient maintain the exercise regime after he or she finishes the programme? How would the physician monitor the change in quality of life of the patient? Should he or she involve the patient’s family and friends in the programme? Should the physician maintain contact with the patient even after the conclusion of the programme? Research Methodology For this research, I would study 120 patients with COPD in Jhon Hospital in London. My research would take at lest 2-3 years to complete. During my research, my patients would undergo baseline pulmonary function testing. I would assess dyspnea in patients while conducting daily activities through the Oxygen Cost Diagram (OCD). Further, to examine quality of life and psychologic status, I have used the St George's Respiratory Questionnaire, the Depression Scale and the Hospital Anxiety. Additionally, for the endurance test, all the patients would have to undergo a six-minute walking exercise and a cycling test. I would also assess fatigue in my patients through the use of the Multidimensional Fatigue Inventory, wherein the five subscales of fatigue would be measured. These subscales include physical, general and mental fatigue, as well as decrease in motivation and activity. Study Population Around 120 patients with COPD were recruited from Jhon Hospital in London for this rehabilitation program for the period of two years. I have also included some outpatients for this research. I would collect the data by studying carefully the condition of the patients before the rehabilitation program as well as after the successful completion of the program. I have included the COPD patients who are diagnosed with COPD by a pulmonologist. I have taken only those patients who have FEV1 between 30 to 80 per cent, have stable clinical condition and do not have any other infections. However, I have excluded patients who have severe COPD. The patients who are eligible for this research are given written information about this study and are asked to sign a well-documented consent form. Data Collection The demographic data of the COPD patients would be taken from the patient files from the hospital. Even before conducting the test, the patients would be made familiarised with the evaluation protocol and test tools. The COPD patients will be examined based on the functional capability of the patients. The functional capability of the patients is examined through the six-minute walk test. Through this test, the patient will be asked to walk with increasing speed between two marked points kept at 10 meters apart. The walking speed would increase every minute and the increase in speed would be announced through bleeps. This test would be conducted in 12 stages, and the test would be concluded once the patient complains of breathlessness. Data Analysis In order to access the quality of life in patients with COPD, I would use the St George's Respiratory Questionnaire. The questionnaire would help in evaluating the physical performance, emotional functioning, social well-being, mental health, general health, body pain and vital statistics of the patients. The results will be analysed through the Statistical Package for Social Sciences (SPSS). In order to evaluate the socio-demographic features, I would use descriptive statistical means. I would further test the normality of the variable through Kolmograf Smiroff test. The variables would be examined through covariance analysis. Further, I would assess the linear correlation between variables through the use of Pearson's linear corelation coefficient. Research The research attempts to establish that pulmonary rehabilitation that includes exercise training helps in contributing towards creating a comprehensive disease management process for COPD patients. Such disease management programmes are already in place for patients with other chronic diseases such as diabetes, hypertension, asthma and congestive heart failure and have gained success over time. Therefore, it has become imperative to now focus on a disase management programme that would help COPD patients to achieve enhanced quality of life. Such a rehabilitation programme would help in monitoring the overall progress of the patient and would include most of the stakeholders such as the patient, the patient’s family and friends, physician, therapists, dietician, and caregiver. This would help in formulating a comprehensive programme that can be easily integrated with disease management. Further, with the use of a successful disease management process, the patient would be able to enhance his or her quality of life, contain the medical care costs as well as gain understanding about the disease and its management process. References Carter, Rick, Anna Tacon, Jim Williams, Brian Tiep (2007). "Managing COPD: pulmonary rehabilitation coupled with exercise and disease management can lead to lower medical costs and higher quality of life for patients with COPD.(Trends in the Treatment of Lung DISEASES)(chronic obstructive pulmonary disease)." RT. Ascend Media. 2007. Retrieved January 31, 2010 from HighBeam Research: http://www.highbeam.com/doc/1G1-170730388.html Toru, OGA et al. (2002). Relationship between different indices of exercise capacity and clinical measures in patients with chronic obstructive pulmonary disease. Heart & lung, 31(5), 374-381. Arnold R, Ranchor AV, Koeter GH, Jongste MJ, Sanderman R (2005). Consequences of chronic obstructive pulmonary disease and chronic heart failure: the relationship between objective and subjective health. Soc Sci Med 2005; 61: 2144-2154. Caroci Ade S, Lareau SC (2004). 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