Elsie Hui, Jean Woo Division of Geriatrics, Department of Medicine and Therapeutics,

1. A community model for exercise prescription for patients with chronic obstructive pulmonary disease and congestive heart failure Elsie Hui, Jean Woo Division of Geriatrics, Department of Medicine and Therapeutics, The Chinese University of Hong Kong HSRF 02030711

2. Introduction • Chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) are the leading causes for admissions and bed occupancy in the Hospital Authority. • Exercise prescription improves: • Physical performance • Psychosocial well being • Reduce hospital service utilization and costs Refs: Ferrari M, Vangelista A, Vedovi E et al. Minimally supervised home rehabilitation improves exercise capacity and health status in patients with COPD. Am J Phys Med Rehabil 2004; 83: 337-43. Rees K, Taylor R, Singh S, Coats A, Ebrahim S. Exercise based rehabilitation for heart failure. Cochrane Database Syst Rev 2004; 3: CD003331.

3. Purpose • To test the feasibility of continuing exercise programmes for COPD or CHF patients: • Exercise • Peer support • Health education • Promote self-motivation and compliance • Based at community centres • Led by health professionals or trained non-health professionals

4. Materials & Methods

5. Intervention

7. Subject characteristics

8. COPD Results

9. CHF Results # Significant changes were recorded on both the left and right side. * Significant changes were observed for all domains of the HADS, MOS & CHQ.

10. Programme evaluation

11. Focus group(transcripts) COPD group • The exercise is helpful as it increases my daily activities tolerance. • In the past, I used to go to the hospital whenever I felt breathless, which happens at least once or twice a year, but now I can somehow manage the crisis. • Group learning can facilitate the exchange of ideas. It creates happiness and concern for others. CHF group • Learning in a group makes us more interactive. I seldom exercised in the past, but now I do it everyday. Group exercise is good for lazy people as they perform better and last longer as a group. I believe we have benefit from the programme and will live a healthier life. • The educational talks gave me a lot of information on nutrition. In the past, doctors just told me to avoid high cholesterol foods, but I had no idea what cholesterol was and which foods were suitable for me. They didn't have time to explain things in detail.

12. Conclusions and recommendations • Patients with COPD and CHF have unmet needs in the community, disease-specific rehabilitation programmes being predominantly hospital based and of limited duration. • The group community interventions described above have the advantage of being incorporated as regular programmes in the community or primary care setting. They help patients cope with their diseases through empowerment and mutual support, apart from achieving symptom improvement and other positive physical and psychosocial outcomes. • This model could be an integral part of chronic disease management programmes in the community.

13. References Woo J, Chan W, Yeung F, et al. A Community model of group therapy for the older patients with COPD: a pilot study. J Evaluation in Clin Practice, 2006;12:523-531. Hui E, Yang H, Chan W, et al. A community model of group rehabilitation for older patients with chronic heart failure: a pilot study. Disability and Rehab, 2006 (in press) huie@ha.org.hk