University Exercise Science: COPD Pulmonary Rehab Article Review

This report is a comprehensive review of a journal article by Mesquita et al. (2017), focusing on changes in physical activity and sedentary behavior following pulmonary rehabilitation in patients with COPD. The review examines the study's methodology, which involved a retrospective observational design with 90 COPD patients undergoing a pulmonary rehabilitation program. The results highlighted improvements in exercise capacity, quality of life, and reduced anxiety and depression after the program. The study also explored correlations between changes in sedentary behavior and physical activity with airflow obstruction and BMI. The discussion section analyzed the heterogeneity of patient responses and the importance of moderate-intensity activities. The conclusion reinforces the benefits of pulmonary rehabilitation in improving patient outcomes, emphasizing the need for further research to address the study's limitations, such as the limited patient sample and under-representation of certain activities. The review underscores the significance of exercise in managing cardiopulmonary disorders and improving the well-being of COPD patients.

Running head: EXERCISE SCIENCE
EXERCISE SCIENCE
Name of the student
Name of the university
Author note:

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Background (Section One: Reason for article choice AND Importance)
1. Reason for Selection of Article :
The purpose of the paper was to characterize the group of the patient with conges
Chronic Obstructive Pulmonary Disease (COPD) according to sedentary behavior and
change of physical activity after pulmonary rehabilitation Program (Mesquita et al., 2017).
Cardiopulmonary disorders are defined as the range of disease associated with heart and
lungs dysfunction (Sabatine et al., 2017). Chronic Obstructive Pulmonary Disease (COPD) is
one of the cardiopulmonary disorders that have the ability to disrupt the normal function of
healthy individuals and disrupt the quality of life. In the United States, approximately 17
million people diagnosed with COPD (Wilkins et al., 2017). The association between
Cardiopulmonary Disorders and Clinical Exercise Physiology is that exercise physiology
helps to analyses the fitness of individuals in order to assist them for improving their health
(Corra et al., 2018). The paper has been chosen because this is a peer-reviewed article which
showed how the change in sedentary behavior and change in the pattern of physical activity
can promote the wellbeing of the individuals. In the field of clinical exercise physiology,
very little evidence which investigated the relationship of physical exercise and Chronic
Obstructive Pulmonary Disease (COPD) (Cormie et al., 2018). This paper helped to reduce
the gap in the literature and in the domain of Clinical Exercise Physiology. In this study, the
authors have conducted a retrospective observational study for assessing the change in the
pattern of exercise and sedentary behavior of 90 patients with Chronic Obstructive
Pulmonary Disease (COPD)( Mesquita et al., 2017). This peer-reviewed journal contributed
to the field of clinical exercise physiology by providing a direction to the health
professionals, physiologist and physiotherapist to recommend the physical exercise as an
effective intervention for supporting the wellbeing of the patients with chronic pulmonary

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disease and encourage them to maintain an active life. It also provided the direction to the
policymakers to amend the policies associated with the intervention of cardiopulmonary
disorder. To gain an in-depth understanding of the associations between physical activity and
cardiopulmonary disorders, this peer-reviewed journal is the most suitable journal.
Introduction:
In the introduction section, researchers have represented the scrutiny of scholar work
of other authors in the same field. The article suggested pulmonary rehabilitation reduces the
dysphonia, increase the capacity of physical activity and improve the wellbeing of the
patients. The authors represent the work of other workers which suggested that sedentary
behavior have negative consequences on the patients with Chronic Obstructive Pulmonary
Disease (COPD.). The researchers highlighted that while Pulmonary rehabilitation program
shows a drastic change in sedentary behavior and time spent in sedentary behavior in patients
with COPD, changing physical activity pattern and sedentary behavior with the assistance of
pulmonary rehabilitation may have a positive impact in improving the well-being of the
patient (Mesquita et al., 2017). However, the improvement rate highly relied on the broad
range of changes in the pattern of physical exercise and sedentary behavior. This difference
in the pattern of physical exercise and sedentary behavior showed the difference in the rate of
reduction of dysphonia in patients, which in turn provide healthcare professionals an
opportunity to determine which group of patients can be benefited from the implementation
of this intervention in the clinical setting (Mesquita et al., 2017). Moreover, it will also
provide the opportunity to the health professionals and professionals from other disciplines to
determine which group of patients require additional interventions along with this
intervention such as behavioral interventions (Lavie et al., 2015).

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2. Methods:
The researchers conducted a retrospective observational study where they recruited
90 patients with COPD to participate in a pulmonary rehabilitation program at CIRO,
Netherlands. The inclusion criteria for the study were the patients with primary COPD
according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and
complete pulmonary rehabilitation program. As discussed by Hung et al., (2015)
retrospective observational study is a type of the cohort study which looks backward of the
hypothesis and examines exposures to suspected factors which were established at the
beginning of the study. McDonnell et al., (2015) stated that it is level three of evidence
which helps to investigate the hypothesis and hence it is one of the most reliable
experimental study which provides the opportunity to obtain accurate data. The advantage of
undertaking this study design is that it clearly indicates the temporal sequence between
exposure and outcome (Lewis, 2015). Other advantages of retrospective cohort study include
a comparison of individuals who are not similar in many ways but have few characteristics
similar which were undertaken in that study, provides an opportunity to assess the multiple
outcomes, resources are mainly devoted to data collection and require a very short period of
time to conduct the experiment (Nilsson et al., 2016). Hence, it is the most suitable study
design for investigation without bias. However, the research has an array of disadvantages.
The first disadvantages are that researchers cannot measure some of the key statistics and
significant biases may affect the selections of the participants or control (Nilsson et al.,
2016). The researchers are not able to control the exposure or sometimes the outcome
assessment. It may introduce the selection bias in the study and cannot be applicable to rare
diseases.

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The patients were assessed according to demographics, lung function, and clinical
data as well as body composition. Initially, they were assessed according to their exercise
capacity (6-minute walk test (6MWT), depression (Hospital Anxiety and Depression Scale
(HADS), constant work rate test (CWRT) and activity of quality of life (COPD-version of
the St. George's Respiratory Questionnaire (SGRQ-C). in order to assess the physical activity
of the patients and sedentary behavior, CIRO activity monitor (Mesquita et al., 2017).
Lastly, they were enrolled in a pulmonary rehabilitation program as previously described.
40session program which encompasses high-intensity progressive exercise training,
psychological counseling and occupational therapy align with 20 1 hour educational training
(Mesquita et al., 2017). The interdisciplinary teams such as chest physicians, respiratory
nurse, physiotherapist, occupational therapist, social workers are involved in this case.
The collected data was analyzed by adopting ANOVA t-test with hesitance of SPSS.
As discussed by Khowaja et al. (2016), SPSS is a statistical software which is created for
assessing the data of management and editor type. The advantage of using this software is
that provide the opportunity to assess a large number of data. Hence, this software is accurate
in assessing the data and obtaining the current result.
B) Summary (Section Two: Significance)
1. Results:
In the result section, the researchers represent the result into four sections. The
authors presented result using tabular format along with a written explanation. As discussed
by Akcay et al. (2017). Representing results with the tabular format along with written
information is considered as valid evidence which provides the readers with a clear idea of

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the results sections. Considering the baseline characteristics of the participants, most of the
participants who participated in the study were male, former smokers\ and they had at least 2
exacerbation last year (Mesquita et al., 2017). The result suggested that less than one-third of
the patients were on long term oxygen therapy, had hyperglycemia and most prevalent
comorbidities were dyslipidemia and low muscle mass. Considering the pre-rehabilitation
assessment of physical activity as well as physical behavior, the results suggested that the
vast majority of the patients spent their time in exhibiting sedentary behavior. Furthermore,
they are impaired in showing capacity of physical activity, have poor health and mood status.
Considering the Impact of pulmonary rehabilitation, the improvement in exercise after the
program was demonstrated by walk distance of 6 minutes. In this parameter, 46% to 50% of
the patients showed improvement (Mesquita et al., 2017). The quality of life also improved
for the patients and 67% of the patient exhibited clinically relevant improvement which was
measured by the SGRQ-C total score. Approximately 60 % of patients exhibited a reduced
level of anxiety and depression. However, considering the average of all patients, no
significant difference has been observed. Considering the Correlation of changes in sedentary
behavior and physical activity, The result suggested there is a fair correlation observed
between changes in sedentary behavior and airflow obstruction, updated body mass index,
dyspnea (Mesquita et al., 2017). Little to fair correlation was observed between baseline
body mass index and light physical activity. A interferes correlation was observed between
light physical activity and sedentary behavior. While considering the average of the
correlation, more frequent decrease in sedentary lifestyle observed (Mesquita et al., 2017).
Considering changes in physical activity and sedentary behavior, the good responders who

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responded to the intervention exhibited improved health status, reduced symptoms of
anxiety, and reduced sedentary behavior.
Discussion:
In the discussion section, researchers provided an in-depth analysis of the discussion
as well as support it with the scholarly work of other authors (McNie, Parris & Sarewitz,
2016). The researchers presented collaborated study of previous researches by exhibited that
while on average the sedentary behavior and physical activity do not change after
participating in the pulmonary rehabilitation program, few of the patients showed excellent
clinically relevant improvement, indicating heterogeneity of the result. The strength of the
discussion part which was presented by the authors is that researchers focused on the
activities with moderate intensity in order to support the wellbeing of the patients with COPD
(McNie, Parris & Sarewitz, 2016). The discussion section also highlighted that the
improvement after the specific intervention may vary from different patients. While one
patient showed improvement in particular one intervention after participating in pulmonary
rehabilitation, that patients showed negative results in other interventions. With the
assistance of other scholarly works, the researchers suggested pulmonary rehabilitation may
show modest improvement in patients with COPD since only a few subgroups showed the
excellent result of changing physical behavior after implementation of pulmonary
rehabilitation. While other groups showed little to changes in health status since the majority
of them waste the maximum of their waking time in sedentary behavior, approximately 13
hours (Mesquita et al., 2017). However, moderate to vigorous physical activities are not only
protective factors that can reduce the potential consequences of physical behavior. On a

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different note, a potential way of reducing sedentary behavior is to increase the time of light
activities. These light activities include leisure time activities, household activities and use
of active transportation such as bicycling or walking up to a certain distance. More activities
living by involving in household activities may improve the health status of patients
(Mesquita et al., 2017).
However, in the discussion section, researchers also consider the limitation and
strength of the study. The researchers highlighted that a limited amount of patients was found
in group who responded to this intervention, the majority of the patients were poor
responders. The activity was restricted to leg; upper arms and these are under-represented.
Moreover, self-efficacy was not assessed in the current study (Mesquita et al., 2017). The
researchers failed to consider the other outcomes of change in physical activity pattern such
as the reduction in utilization of health care services, induces the behavior of active living
and reduce the behavior of sedentary lifestyle. Moreover, researchers did not consider the
constant follow up of the improvement which further affected the result of the study. Hence,
in order to provide more accurate result and more concise discussion, in-depth research
considering the above limitation factors are required to conduct.
Conclusion:
In conclusion, it can be concluded that pulmonary rehabilitation reduces the
dysphonia, increase the capacity of physical activity and improve the wellbeing of the
patients. The purpose of the paper to characterize the group of the patient with conges
Chronic Obstructive Pulmonary Disease (COPD) according to sedentary behavior and
change of physical activity after pulmonary rehabilitation Program with the assistance of

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retrospective observational study. In conclusion, researchers suggested that while changes in
the pattern of physical exercise and sedentary behavior are not applicable for every group of
patients, this intervention is an effective intervention for certain group of patients with
COPD. These groups are the good responders of the study with specific characteristics. In
conclusion, it can be said that in order to make patients less sedentary and living active life,
the potential strategy is to implement light physical activities such as household activities,
active transportation and pleasure time activities rather than implementing vigorous or
moderate activities. However, before implementing light activities it is crucial to consider the
physical capacity of patients.

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