Quali-quantitative analysis of adherence and perceived satisfaction of individuals with COPD after high-intensity training on land and in water: additional analysis from a randomized clinical trial

ABSTRACT Although patients with chronic obstructive pulmonary disease (COPD) benefit in many ways after participating in pulmonary rehabilitation programs, high dropout rates are still observed among participants. This study aims to analyze the adherence rate and perceived satisfaction in individuals with chronic obstructive pulmonary disease who underwent high-intensity physical training on land (LG) and in water (WG). This study is an additional analysis from a randomized controlled trial. In total, 36 subjects (51%) completed the intervention. All participants underwent six months of high-intensity endurance and strength training. Adherence was assessed by the proportion of patients who completed the training program. Perceived satisfaction was evaluated using a questionnaire composed of structured and semi-structured questions. The interviews were recorded, transcribed, and analyzed according to the criteria of our thematic analysis. The Shapiro-Wilk test was used to assess data normality, and dropout rates were compared using the chi-square test. Statistical significance was set at 5%. Regarding adherence, 59% of WG participants and 44% of LG participants completed the program, with no difference between the groups (p>0.05). Individuals from both groups were equally satisfied after six months of physical training (<90%); the therapist-patient relationship and treatment effectiveness being important factors for this perception. Qualitative analysis also showed that WG participants reported a more prominent improvement in their respiratory symptoms, leisure, sensation of pain, and sleep. In conclusion, patients with COPD were satisfied after six months of high-intensity physical training in water and on land, noting that water exercising promoted additional benefits compared to land exercising. There seems to be no superiority to any of the regimens (water or land) regarding the adherence to the training programs.

摘要：尽管慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）患者参与肺康复计划后可获得多方面获益，但参与者仍存在较高的脱落率。本研究旨在分析接受陆地高强度体能训练组（land, LG）与水中高强度体能训练组（water, WG）的慢性阻塞性肺疾病患者的依从率与感知满意度。本研究为一项随机对照试验（randomized controlled trial）的补充分析。最终共有36名受试者（占比51%）完成了干预措施。所有参与者均接受了为期6个月的高强度耐力与力量训练。依从性通过完成全部训练计划的患者占比进行评估。感知满意度采用由结构化与半结构化问题组成的问卷进行评价。对访谈内容进行录音、转录，并依据本研究的主题分析法标准开展分析。采用夏皮罗-威尔克检验（Shapiro-Wilk test）评估数据正态性，采用卡方检验（chi-square test）比较脱落率，设定统计学显著性阈值为5%。就依从性而言，水中训练组59%的参与者与陆地训练组44%的参与者完成了训练计划，两组间未观察到显著差异（p＞0.05）。两组受试者在接受6个月体能训练后满意度均高于90%，医患关系与治疗有效性是影响该感知的重要因素。定性分析还显示，水中训练组参与者报告其呼吸道症状、休闲活动、疼痛感知与睡眠状况获得了更为显著的改善。综上，慢性阻塞性肺疾病患者在接受为期6个月的陆地或水中高强度体能训练后均表现出较高的满意度，且相较于陆地训练，水中训练可带来额外获益。就训练计划的依从性而言，两种训练方案未表现出显著优劣性。