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      Home-based neuromuscular electrical stimulation improves exercise tolerance and health-related quality of life in patients with COPD

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          This retrospective, observational study of a routine clinical practice reports the feasibility and efficiency of home-based pulmonary rehabilitation (PR), including transcutaneous neuromuscular electrical stimulation (NMES) or usual endurance physical exercise (UEPE), on exercise tolerance, anxiety/depression, and health-related quality of life (HRQoL) in patients with COPD.


          Seventy-one patients with COPD participated in home-based PR with NMES (Group NMES [G NMES]), while 117 patients participated in home-based PR with the UEPEs (Group UEPE [G UEPE]). NMES was applied for 30 minutes twice a day, every day. The endurance exercises in G UEPE began with a minimum 10-minute session at least 5 days a week, with the goal being 30–45 minutes per session. Three upper and lower limb muscle strengthening exercises lasting 10–15 minutes were also proposed to both the groups for daily practice. Moreover, PR in both the groups included a weekly 90-minute session based on an educational needs assessment. The sessions comprised endurance physical exercise for G UEPE, NMES for G NMES, resumption of physical daily living activities, therapeutic patient education, and psychosocial support to facilitate health behavior changes. Before and after PR, functional mobility and physical exercise capacity, anxiety, depression, and HRQoL were evaluated at home.


          The study revealed that NMES significantly improved functional mobility (−18.8% in GNMES and −20.6% in G UEPE), exercise capacity (+20.8% in G NMES and +21.8% in G UEPE), depression (−15.8% in G NMES and −30.1% in G UEPE), and overall HRQoL (−7.0% in G NMES and −18.5% in G UEPE) in the patients with COPD, regardless of the group (G NMES or G UEPE) or severity of airflow obstruction. Moreover, no significant difference was observed between the groups with respect to these data ( P>0.05).


          Home-based PR including self-monitored NMES seems feasible and effective for severely disabled COPD patients with severe exercise intolerance.

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          Most cited references 25

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          Self management for patients with chronic obstructive pulmonary disease.

          Self management interventions help patients with chronic obstructive pulmonary disease (COPD) acquire and practise the skills they need to carry out disease-specific medical regimens, guide changes in health behaviour and provide emotional support to enable patients to control their disease. Since the first update of this review in 2007, several studies have been published. The results of the second update are reported here.
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            The effectiveness and applicability of motivational interviewing: a practice-friendly review of four meta-analyses.

            This article reviews the research support for Motivational interviewing (MI) so that practitioners can make informed decisions about the value and applicability of MI in their clinical work. We highlight the evidence from the three published meta-analyses of MI and a recent meta-analysis that we completed. MI is significantly (10%-20%) more effective than no treatment and generally equal to other viable treatments for a wide variety of problems ranging from substance use (alcohol, marijuana, tobacco, and other drugs) to reducing risky behaviors and increasing client engagement in treatment. Although most client-related variables are unrelated to outcomes (e.g., age, gender, severity), some decisions about treatment format (e.g., individual vs. group) are important. For example, relying solely on group-delivered MI appears to be less effective than one-on-one MI, whereas delivering MI with problem feedback is likely to generate better outcomes for some problems than MI alone.
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              Self-management and behaviour modification in COPD .

              There is new evidence from recent studies that disease-specific self-management improves health status and reduces hospital admissions in COPD patients. It is critical to implement health education programs in the continuum of care aimed at behaviour modification. Studies in COPD have shown that self-management increases knowledge and skills the patients require to treat their own illness. It is also essential to be more effective in improving patients' confidence in their ability to follow a self-care regimen, for example, by augmenting self-efficacy. Self-efficacy plays a part in determining which activities or situations an individual will perform or avoid. Results from a recent qualitative study suggested that a continuum self-management program helps COPD patients to perform given self-health behaviours. COPD patients have perceived barriers and factors (disease-related skills), which will hinder or facilitate lifestyle modification. To be successful, self-management does require a multifaceted approach that incorporates not only teaching various disease contents but also implementing strategies to change behaviour in patients. Further research is needed to develop strategies on how to intervene and facilitate behaviour modification in chronic disease and as such the relevance for the implementation of self-management programs in COPD.

                Author and article information

                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                03 June 2016
                : 11
                : 1189-1197
                [1 ]Faculté des Sciences du Sport, Université de Rouen, CETAPS, EA 3832, Mont Saint Aignan, Beuvry, France
                [2 ]Service de Pneumologie, Centre Hospitalier de Béthune, Beuvry, France
                [3 ]Formaction Santé, Perenchies, France
                [4 ]Service de Pneumologie et Immunoallergologie, Centre Hospitalier Universitaire de Lille, Hôpital Calmette, Université de Lille 2, France
                Author notes
                Correspondence: Jérémy B Coquart, Faculté des Sciences du Sport et de l’Education Physique, CETAPS, Boulevard Siegfried, 76821 Mont Saint Aignan Cedex, France, Tel +33 235 146 775, Email jeremy.coquart@
                © 2016 Coquart et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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