UCSF

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.