Combining COPD exercise and self-management in Wales

Claire talks about starting a 'COPD+' course, combining exercise and self-management components.

COPD is one of the biggest reasons people are admitted to A&E in Wales. A recent national audit found that people with COPD in Wales stay in hospital longer than elsewhere, and sadly more people die here too.

I used to be a respiratory nurse, so I've worked with these people every day and know how important it is to get it right.

Now I'm on the health board as the chronic conditions lead, and we need to give people the skills to manage the condition themselves on a day-to-day basis, so they can stay as well as possible.

Pulmonary rehabilitation

Several years ago, we started offering courses of pulmonary rehabilitation, an exercise programme that helps with people breathe more easily by improving muscle strength and lung fitness – but there are a number of stumbling blocks that prevent people with COPD getting access to this crucial help.

Pulmonary rehabilitation is the most important thing people with COPD can do to slow the progression of their condition and improve their quality of life - but to qualify they need to fit a set criteria, including an MRC breathlessness score of 3 or above on optimal medication.

Launching the programme

Then, the opportunity came about to launch a ‘self-management for life’ programme in the community for anyone living with COPD, however it didn't have a physical activity or exercise component. Both elements are really important for the care and wellbeing of people with COPD, and too many people were missing out on one, or both.

One of our GP leads approached me about this problem and we both felt there was a gap we needed to fill. And so COPD+ was born. We agreed to trial the programme locally and invite everyone in the area who had COPD but didn’t qualify for pulmonary rehabilitation. I was thrilled to get the go-ahead.

It was a really positive step forward that would help us support the people we care for earlier, so that they didn't get to the stage where we’d need to see them in hospital as emergency patients.

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Writing the programme

I've written the 7-week course based on a number of other programmes that I've been a part of over the years, and we're going to trial the next programme with a different course outline. It involves an hour of exercise – walking, step-ups, sit-to-stand and arm exercises – followed by a well-earned cup of coffee.

Next, a health care professional and lay tutor talk to the group about how they can look after themselves, including things like breathing exercises, planning, pacing, mindfulness, being positive and medications.

We've made it as interactive as possible and there’s lots of time for free-thinking and discussion, which means the group can find the answers themselves.

We’re evaluating the programme by using the shuttle walk test – where a person walks between 2 cones 10 metres apart with a timer which increases in speed – as well as measuring their anxiety and depression and their COPD assessment scores.

After every session, we've asked everybody to fill out feedback forms and so far it’s been overwhelmingly positive. People in the group have told me they've enjoyed it and found it helpful to the day-to-day management of their condition.

A great start

I'm so pleased at how well the programme has been received and can't wait to see the results of the full evaluation.

Hopefully, this can help us reduce the number of people with COPD coming into the emergency department here in Wales, and when they do come in they can spend less time with us. Read more about the importance of exercise. 

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