Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review
Lisa Jane Brighton,1 Catherine J Evans,1,2 William DC Man,3,4 Matthew Maddocks1 1Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK; 2Brighton General Hospital, Sussex Community NHS Foundation Trust, Brighton, UK; 3National Heart and...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2020-04-01
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| Series: | International Journal of COPD |
| Subjects: | |
| Online Access: | https://www.dovepress.com/improving-exercise-based-interventions-for-people-living-with-both-cop-peer-reviewed-article-COPD |
| _version_ | 1811292983842045952 |
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| author | Brighton LJ Evans CJ Man WDC Maddocks M |
| author_facet | Brighton LJ Evans CJ Man WDC Maddocks M |
| author_sort | Brighton LJ |
| collection | DOAJ |
| description | Lisa Jane Brighton,1 Catherine J Evans,1,2 William DC Man,3,4 Matthew Maddocks1 1Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK; 2Brighton General Hospital, Sussex Community NHS Foundation Trust, Brighton, UK; 3National Heart and Lung Institute, Imperial College, London, UK; 4Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, London, UKCorrespondence: Lisa Jane BrightonKing’s College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UKTel +44 20 7848 5041Email lisa.brighton@kcl.ac.ukBackground: People living with both chronic obstructive pulmonary disease (COPD) and frailty have high potential to benefit from exercise-based interventions, including pulmonary rehabilitation, but face challenges completing them. Research to understand ways to optimise exercise-based interventions in this group is lacking. We aimed to understand how exercise-based interventions might improve outcomes for people living with both COPD and frailty.Methods: This realist review used database searches and handsearching until October 2019 to identify articles of relevance to exercise-based interventions for people living with COPD and frailty. A scoping search explored what is important about the context of living with COPD and frailty, and what mechanisms might be important in how exercise-based interventions result in their intended outcomes. Through discussion with stakeholders, the review scope was refined to areas deemed pertinent to improving care. We retained articles within this refined scope and identified additional articles through targeted handsearching. Data were extracted and synthesised in a narrative, prioritised by relevance and rigour.Results: Of 344 records identified, 35 were included in the review and 20 informed the final synthesis. Important contextual factors to consider included: negative beliefs about themselves and exercise-based interventions; heterogenous presentation and comorbidities; decreased reserves and multidimensional loss; and experiencing unpredictable health and disruptions. In these circumstances, mechanisms that may help maximise outcomes from exercise-based interventions included: trusting relationships; creating a shared understanding of needs; having the capacity to address multidimensional concerns; being able to individualise approaches to needs and priorities; and flexible approaches to intervention delivery. Mixed-methods research and explicit theorising were often absent.Conclusion: Building trusting relationships, understanding priorities, using individualised and multidisciplinary approaches, and flexible service delivery can improve the value of exercise-based interventions for people living with both COPD and frailty. Development and evaluation of new and adapted interventions should consider these principles.Keywords: chronic obstructive pulmonary disease, frailty, rehabilitation, exercise, review |
| first_indexed | 2024-04-13T04:54:37Z |
| format | Article |
| id | doaj.art-a3c8a4d303334b439656cd23b73a2f17 |
| institution | Directory Open Access Journal |
| issn | 1178-2005 |
| language | English |
| last_indexed | 2024-04-13T04:54:37Z |
| publishDate | 2020-04-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | International Journal of COPD |
| spelling | doaj.art-a3c8a4d303334b439656cd23b73a2f172022-12-22T03:01:33ZengDove Medical PressInternational Journal of COPD1178-20052020-04-01Volume 1584185553169Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist ReviewBrighton LJEvans CJMan WDCMaddocks MLisa Jane Brighton,1 Catherine J Evans,1,2 William DC Man,3,4 Matthew Maddocks1 1Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK; 2Brighton General Hospital, Sussex Community NHS Foundation Trust, Brighton, UK; 3National Heart and Lung Institute, Imperial College, London, UK; 4Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, London, UKCorrespondence: Lisa Jane BrightonKing’s College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UKTel +44 20 7848 5041Email lisa.brighton@kcl.ac.ukBackground: People living with both chronic obstructive pulmonary disease (COPD) and frailty have high potential to benefit from exercise-based interventions, including pulmonary rehabilitation, but face challenges completing them. Research to understand ways to optimise exercise-based interventions in this group is lacking. We aimed to understand how exercise-based interventions might improve outcomes for people living with both COPD and frailty.Methods: This realist review used database searches and handsearching until October 2019 to identify articles of relevance to exercise-based interventions for people living with COPD and frailty. A scoping search explored what is important about the context of living with COPD and frailty, and what mechanisms might be important in how exercise-based interventions result in their intended outcomes. Through discussion with stakeholders, the review scope was refined to areas deemed pertinent to improving care. We retained articles within this refined scope and identified additional articles through targeted handsearching. Data were extracted and synthesised in a narrative, prioritised by relevance and rigour.Results: Of 344 records identified, 35 were included in the review and 20 informed the final synthesis. Important contextual factors to consider included: negative beliefs about themselves and exercise-based interventions; heterogenous presentation and comorbidities; decreased reserves and multidimensional loss; and experiencing unpredictable health and disruptions. In these circumstances, mechanisms that may help maximise outcomes from exercise-based interventions included: trusting relationships; creating a shared understanding of needs; having the capacity to address multidimensional concerns; being able to individualise approaches to needs and priorities; and flexible approaches to intervention delivery. Mixed-methods research and explicit theorising were often absent.Conclusion: Building trusting relationships, understanding priorities, using individualised and multidisciplinary approaches, and flexible service delivery can improve the value of exercise-based interventions for people living with both COPD and frailty. Development and evaluation of new and adapted interventions should consider these principles.Keywords: chronic obstructive pulmonary disease, frailty, rehabilitation, exercise, reviewhttps://www.dovepress.com/improving-exercise-based-interventions-for-people-living-with-both-cop-peer-reviewed-article-COPDchronic obstructive pulmonary diseasefrailtyrehabilitationexercisereview |
| spellingShingle | Brighton LJ Evans CJ Man WDC Maddocks M Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review International Journal of COPD chronic obstructive pulmonary disease frailty rehabilitation exercise review |
| title | Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review |
| title_full | Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review |
| title_fullStr | Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review |
| title_full_unstemmed | Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review |
| title_short | Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review |
| title_sort | improving exercise based interventions for people living with both copd and frailty a realist review |
| topic | chronic obstructive pulmonary disease frailty rehabilitation exercise review |
| url | https://www.dovepress.com/improving-exercise-based-interventions-for-people-living-with-both-cop-peer-reviewed-article-COPD |
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