Effects of a Progressive Walking Program on Physical Activity, Exercise Tolerance, Recovery, and Post-Operative Complications in Patients with a Lung Resection

Inah Kim; Haejung Lee

doi:10.4040/jkan.2014.44.4.381

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Kim and Lee: Effects of a Progressive Walking Program on Physical Activity, Exercise Tolerance, Recovery, and Post-Operative Complications in Patients with a Lung Resection

Original Article

J Korean Acad Nurs 2014;44(4):381-390.

Published online: 15 August 2014

DOI: https://doi.org/10.4040/jkan.2014.44.4.381

Effects of a Progressive Walking Program on Physical Activity, Exercise Tolerance, Recovery, and Post-Operative Complications in Patients with a Lung Resection

Inah Kim, Haejung Lee

College of Nursing, Pusan National University, Yangsan, Korea

Address reprint requests to : Lee, Haejung College of Nursing, Pusan National University, Beomeo-ri, Mulgeum-eup, Yangsan 626-870, Korea Tel: +82-51-510-8344 Fax: +82-51-510-8308 E-mail: haejung@pusan.ac.kr

Received 10 January 2014 Revised 7 February 2014 Accepted 26 June 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

The purpose of this study was to identify the effects of a Progressive Walking program (PW) on physical activity, exercise tolerance, recovery, and post-operative complications for patients with a lung resection.

Methods

A nonequivalent control group non-synchronized design was utilized and 37 participants with a lung resection (22 for control group, 15 for experimental group) were recruited at A university hospital from December 2012 to August 2013. The PW consisted of preoperative education, goal setting, and feedback, provided to the experimental group, and usual care to the control group. Data were analyzed using the SPSS WIN 18.0.

Results

A higher proportion of patients in the experimental group showed adequate levels of physical activity (p= .001), shorter period of chest tube retention (≤ 7 days; p= .011), and shorter stay in the hospital (≤ 10 days; p= .036) than patients in the control group. Patients in the experimental group reported longer 6-minute walking distance (p= .032) and lower levels of dyspnea (p= .049) than patients in the control group. The PW did not influence the occurrence of pulmonary complications.

Conclusion

The findings of this study suggest that the PW could be a useful strategy for improving patients’ post-operative health and reducing cost after lung resection.

Keywords: Pneumonectomy, Lung neoplasms, Walking, Exercise tolerance

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Figure 1.

Effects of progressive walking program on patterns of physical activity and 6 minute walking distance.

Table 1.

Contents of Progressive Walking Program

Categories	Contents
Pre operation education	1) Preview=Exercise, manual for Pedometer.
	2) Video=Anatomy of lung, kind of operation, importance of exercise & nutrition.
	→ Provided to patients and their family caregivers
Goal setting	1) Walking=Using the pedometer.
	Start from 1000 steps and increase 8 % everyday. (POD 10=1999 steps/POD 20=4315 steps/POD 30=10062 steps)
	2) Shoulder=Elevation through flexion & abduction, external & internal rotation (OP day=1 set).
	Once 1 set achieved, ↑the numbers of sets (Max 8 sets). 3) Respiration=Deep breathing & coughing (OP day=1 set).
	Once 1 set achieved, ↑the numbers of sets (Max 8 sets).
Feedback	1) Identify the amount of exercise & difficulties during exercise.
	2) Encouraging message=Address barriers to exercise for increasing amounts of exercise. POD 1-5=Provided daily feedback.
	POD 6-30=Provided feedback once every 3 days (Feedback by telephone call after discharge).

POD=Post operative day; OP=Operation.

Table 2.

Homogeneity Test for Characteristics between Experimental and Control Group Participants (N=37)

Characteristics	Categories	Total	Exp. (n=15)	Cont. (n=22)	χ²	p
Characteristics	Categories	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD	χ²	p
Age (year)	<65	25 (67.6)	12 (80.0)	13 (59.1)		.286*
	≥65	12 (32.4)	3 (20.0)	9 (40.9)
		59.51±11.06	59.46±8.89	59.50±12.54
Gender	Male	28 (75.7)	11 (73.3)	17 (77.3)		1.000*
	Female	9 (24.3)	4 (26.7)	5 (22.7)
Spouse	Yes No	34 (91.9) 3 (8.1)	14 (93.3) 1 (6.7)	20 (90.9) 2 (9.1)		1.000*
Education	≤Middle school	19 (51.4)	8 (53.3)	11 (50.0)	0.04	1.000
	≥High school	18 (48.6)	7 (46.7)	11 (50.0)
Regular exercise	Yes No	14 (37.8) 23 (62.2)	7 (46.7) 8 (53.3)	7 (31.8) 15 (68.2)	0.84	.361
Operation history	Yes	20 (54.1)	8 (53.3)	13 (59.1)	0.55	.457
	No	17 (45.9)	7 (46.7)	9 (40.9)
BMI	<18.5	1 (2.7)	0 (0.0)	1 (4.6)		.891*
	18.5 to<25.0	30 (81.1)	12 (80.0)	18 (81.8)
	≥25.0	6 (16.2)	3 (20.0)	3 (13.6)
		23.01±2.73	23.08±2.96	22.96±2.63
Comorbidity	Yes	25 (67.6)	9 (60.0)^†	16 (27.3)^‡	0.66	.202
	No	12 (32.4)	6 (40.0)	6 (72.7)
Smoking state	Never smoked	22 (59.5)	8 (53.3)	14 (63.6)		.177*
	Quit smoking Current smoker	9 (24.3) 6 (16.2)	1 (6.7) 6 (40.0)	3 (13.7) 5 (22.7)
FEV1 % predicted	<80	27 (73.0)	10 (66.7)	17 (77.3)	0.51	.708
	≥80	10 (27.0)	5 (33.3)	5 (22.7)
		72.70±9.97	73.00±9.97	72.50±10.19

Exp.=Experimental group; Cont.=Control group; FEV1=Forced Expiratory Volume in 1 second; BMI=Body Mass Index. *Fisher’s exact test;

^† Hypertension, diabetes;

^‡ Hypertension, diabetes, arthritis, osteoporosis, gastritis.

Table 3.

Homogeneity Test for Levels of Physical Activity, 6 Minute Walk Distance, and Dyspnea at Pre-test between Experimental and Control Groups (N=37)

Characteristics	Total	Exp. (n=15)	Cont. (n=22)	χ² or t or U	p
Characteristics	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD	χ² or t or U	p
Physical activity				0.54	.207
Adequate	22 (59.5)	10 (66.7)	12 (54.5)
Inadequate	15 (40.5)	5 (33.3)	10 (45.5)
6 minute walk distance (m)	472.35±83.91	457.35±78.45	482.85±87.95	−0.89	.382
Dyspnea	12.01±13.45	10.37±9.82	13.13±15.58	160	.870

Exp.=Experimental group; Cont.=Control group; Adequate=Meet physical activity guidelines (≥900 MET-min/wk); Inadequate=Do not meet physical activity guidelines (<900 MET-min/wk).

Table 4.

Effects of Progressive-walking Program on Daily Steps, Pulmonary Complications, and Recovery (N=37)

Outcome variables	Exp. (n=15)	Cont. (n=22)	t	p
Outcome variables	n (%) or M±SD	n (%) or M±SD	t	p
Total steps at POD 30 days	9,933.33±6,485.85	−
<10,000	8 (53.3)	−
≥10,000	7 (46.7)	−
Recovery
Number of days with chest tube retention (days)	5.93±2.93	8.45±6.20		.016*
≤7	13 (86.7)	10 (45.5)
>7^†	2 (13.3)	12 (54.5)
Hospital stay (days)	8.80±3.73	11.68±6.46		.047*
≤10	12 (80.0)	10 (45.5)
>10^‡	3 (20.0)	12 (54.5)
Dyspnea	12.59±11.00	21.71±16.25	2.03	.049
Occurrence of pulmonary complication (OP day-POD 30)	0 (0.0)	3 (13.6)		.233*

Exp.=Experimental group; Cont.=Control group; OP=Operation; POD=Post operative Day; *Fisher’s exact test;

^† Reasons=Persistent air leakage (43.0%), chest tube drainage>100 ml for last 24 hours (28.5%), both persistent air leak and chest tube drainage>100 ml for last 24 hours (28.5%);

^‡ Reasons=Further evaluation (40.0%), delayed removal of chest tube (33.3%), refuse to be discharged (20.0%), pneumonia (6.7%).

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