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Psychological and cognitive outcomes of a randomized trial of exercise among patients with chronic obstructive pulmonary disease
Abstract
Exercise rehabilitation is recommended increasingly for patients with chronic obstructive pulmonary disease (COPD). This study examined the effect of exercise and education on 79 older adults (M age = 66.6 +/- 6.5 years; 53% female) with COPD, randomly assigned to 10 weeks of (a) exercise, education, and stress management (EXESM; n = 29); (b) education and stress management (ESM; n = 25); or (c) waiting list (WL; n = 25). EXESM included 37 sessions of exercise, 16 educational lectures, and 10 weekly stress management classes. ESM included only the 16 lectures and 10 stress management classes. Before and after the intervention, assessments were conducted of physiological functioning (pulmonary function, exercise endurance), psychological well-being (depression, anxiety, quality of life), and cognitive functioning (attention, motor speed, mental efficiency, verbal processing). Repeated measures multivariate analysis of variance indicated that EXESM participants experienced changes not observed among ESM and WL participants, including improved endurance, reduced anxiety, and improved cognitive performance (verbal fluency).
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In the citing paper
“Emery and colleagues96 found reductions in symptoms of anxiety and depression following a 10-week PR intervention.”
From Anxiety and Depression in COPD (2008) · cites this paper as [96]
In the citing paper
“Subsequent participation in supervised whole-body exercise training has been shown in several randomized controlled trials95–98 to improve symptoms of anxiety and depression as a consequence of training-related gains in functional capacity.”
From Anxiety and Depression in COPD (2008) · cites this paper as [96]
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BackgroundA community-based approach to trials of aerobic exercise in aging and Alzheimer's disease
Vidoni, E. D., Sciver, A. R. V., Johnson, D. K., He, J., Honea, R. A., Haines, B., Goodwin, J., Laubinger, M. P., Anderson, H. S., Kluding, P. M., et al. (2012) · Contemporary Clinical Trials · doi:10.1016/j.cct.2012.08.002 · Cited by 60
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“Psychopharmacology (6) and pulmonary rehabilitation (7, 8) also seem to be promising treatments (9) for depression and anxiety in COPD.”
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“Research also has shown that exercise training improves overall cognitive functioning in healthy older adults (42) and also improves verbal fluency (43) and fluid intelligence (44) in patients with COPD.”
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“Clinicians should encourage all patients to participate in pulmonary rehabilitation, especially the exercise-training component, as this may represent the most effective way to interfere with the anxiety–dyspnea cycle.(34) Education for patients and carers on managing breathlessness(35) and exacerbations may reduce th…”
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“A randomized trial examining the effect of exercise, education and stress management in 79 older adults with COPD found that those assigned to exercise, education and stress management had reduced anxiety compared to those receiving education and stress management without exercise and to a control group [24].”
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“Emery et al. (1998) examined the effect of exercise and education on 79 older adults with COPD, randomly assigned to 10 weeks of (a) exercise, education, and stress management (EXESM); (b) education and stress management (ESM); or (c) waiting list (WL).”
BackgroundFocusing on outcomes: Making the most of COPD interventions
Clark, N. M. (2008) · International Journal of COPD · doi:10.2147/copd.s4093 · Cited by 33
“Emery and colleagues 38 found that in moderate to severe COPD patients comprehensive pulmonary rehabilitation reduced anxiety.”
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“A total of 13 studies (21, 23, 27, 28, 30, 32, 34, 36, 38, 40, 42, 45, 49) provided data on the peak exercise capacity, demonstrating a significant improvement in VO2peak after exercise intervention (MD= 1.”
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“However, numerous studies have reported multiple factors that contribute to this process, including systemic inflammation [37, 38], hypercapnia [8, 39], oxidative stress, hypoperfusion [40, 41], physical activity [8, 42–46], shared risk factors, such as smoking [47], and shared comorbidities, such as hypertension and…”
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“Out of these 42 studies, 23 found a desired effect [34,53–55,”
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“A study found that psychological well-being, including depression, anxiety, and quality of life, changed in COPD patients at a 10-week follow-up after an exercise rehabilitation intervention [49].”
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ResultAddressing Risk Factors of Cognitive Impairment in Adults Aging with HIV
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Stress Axis Response to Aerobic Exercise in Chronic Obstructive Pulmonary Disease Patients
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“The addition of a 10-week exercise training to a stress management program in COPD patients produced more favorable responses in endurance, cognitive performance, and anxiety [15].”
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BackgroundResultBehavioral medicine and aging.
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“…are combined with and compared with pulmonary rehabilitation/exercise training for people living with COPD (controlled clinical trial [53]; RCTs [54–58]), very few significant between-group differences favoring the CBT intervention have been reported for: anxiety (Becks Anxiety Index (BAI) pre-post…”
BackgroundDoes Exercise Improve Cognitive Performance? A Conservative Message from Lord's Paradox
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“Up to now, disease education has been implemented as part of pulmonary rehabilitation, and most studies reported that education alone did not impact on the quality of life.(9) The purpose of this study was to develop an education program and evaluate the effectiveness of an organized education program in improving dis…”
BackgroundAnxiety and depression following pulmonary rehabilitation
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Self-citationByrd, R., Smith, P. J., Mohamedaly, O. H., Snyder, L. D., & Pastva, A. M. (2018) · Cardiopulmonary Physical Therapy Journal · doi:10.1097/cpt.0000000000000087 · Cited by 15
Impact of physiotherapy on patients with advanced lung cancer
Özalevli, S. (2013) · Chronic Respiratory Disease · doi:10.1177/1479972313508965 · Cited by 15
“Exercising reduces anxiety and depression, perceived dyspnea severities and fatigue, and increases quality of life, especially in older COPD patients.(12,89,90) The effect of exercise on depression and anxiety is, on the other hand, unknown in advanced lung cancer patients.”
BackgroundCremen, I. A., & Carson, R. G. (2017) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2017.00276 · Cited by 14
“…reported a positive impact of motor training or PA have treated the TMT-A and TMT-B separately (or singly), or reported a single additive measure (Emery et al., 1998; Scherder et al., 2005; Baker et al., 2010; Nguyen and Kruse, 2012; Vaughan et al., 2014; Eggenberger et al., 2015; Tazkari, 2016;…”
BackgroundParreira, V. F., Kirkwood, R. N., Towns, M., Aganon, I., Barrett, L., Darling, C., Lee, M., Hill, K., Goldstein, R. S., & Brooks, D. (2015) · Canadian Respiratory Journal · doi:10.1155/2015/478528 · Cited by 14
Carmeli, E., Orbach, I., Zinger‐Vaknin, T., Morad, M., & Merrick, J. (2008) · Journal of Applied Research in Intellectual Disabilities · doi:10.1111/j.1468-3148.2007.00416.x · Cited by 16
Computerized screening for cognitive impairment in patients with COPD
Campman, C. A. M., van Ranst, D., Meijer, J. W., & Sitskoorn, M. M. (2017) · International Journal of COPD · doi:10.2147/copd.s142871 · Cited by 13
Chronic Obstructive Pulmonary Disease and Depression—The Vicious Mental Cycle
Corlăteanu, A., Covanţev, S., Iasabash, O., Lupu, L., Avadanii, M., & Siafakas, N. (2025) · Healthcare · doi:10.3390/healthcare13141699 · Cited by 15
Pulmonary Rehabilitation in COPD: Current Practice and Future Directions
Casey, M., Mulkerns, A., O’Donnell, C., & McDonnell, T. (2018) · InTech eBooks · doi:10.5772/intechopen.71218 · Cited by 14
“Typically, underweight status and weight loss are more prevalent in advanced disease and emphysematous phenotype [54], while obesity is more prevalent in mild disease [53].”
BackgroundPulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease
Girdhar, A., Agarwal, P., & Singh, A. (2019) · IntechOpen eBooks · doi:10.5772/intechopen.81742 · Cited by 12
“While obesity predominates in the milder stages of the disease, patients with advanced disease and emphysema tend to be underweight and have generalized muscle wasting [114, 115].”
BackgroundBlumenthal, J. A., Smith, P. J., Sherwood, A., Mabe, S., Snyder, L. D., Frankel, C. W., McKee, D. C., Hamilton, N., Keefe, F. J., Shearer, S., et al. (2020) · Transplantation Direct · doi:10.1097/txd.0000000000000979 · Cited by 11
Ding, K., Song, F., Sun, W., Sun, M., & Xia, R. (2025) · European Respiratory Review · doi:10.1183/16000617.0170-2024 · Cited by 10
“Two studies [22, 25] utilised sessions, and in one study [22] educational lectures covered topics relevant to COPD patients ( e.g. lung anatomy and physiology, chronic lung disease medications, pulmonary function test interpretation, COPD pathophysiology, and understanding arterial blood gases).”
InfluentialErfani, A., Moezy, A., Mazaherinezhad, A., & Mousavi, S. A. (2015) · Asian Journal of Sports Medicine · doi:10.5812/asjsm.25821 · Cited by 10
“Numerous pieces of evidence suggest beneficial effects of exercise therapy for COPD patients in improving their function and decreasing musculoskeletal complications (9-13).”
BackgroundCognitieve beperkingen bij patiënten met COPD: een overzicht
Cleutjens, F. A. H. M., Janssen, D. J. A., Gijsen, C., Dijkstra, J. B., Ponds, R., & Wouters, E. F. �. (2013) · Tijdschrift voor Gerontologie en Geriatrie · doi:10.1007/s12439-013-0053-1 · Cited by 10
“Een verbetering in cognitief functioneren na lichamelijke activiteit werd gemeten met behulp van een cognitieve test die de verbale vloeiendheid ( fluency) detecteert.(34) Mogelijk is er bij COPD sprake van een vicieuze cirkel van deconditionering waarbij cognitieve beperkingen leiden tot een daling van lichamelijke a…”
BackgroundGaalema, D. E., Mahoney, K., & Ballon, J. S. (2021) · Journal of Cardiopulmonary Rehabilitation and Prevention · doi:10.1097/hcr.0000000000000644 · Cited by 10
Impairment of Cognitive Function in Different Domains Early After Lung Transplantation
Tomasi, R., Klemm, M., Hinske, L. C., Hulde, N., Schramm, R., Zwißler, B., & von Dossow, V. (2021) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-021-09787-z · Cited by 8
Collins, R. E., & Marrone, D. F. (2015) · SAGE Open · doi:10.1177/2158244015602516 · Cited by 13
Metadata
- Authors
- Emery, C. F., Schein, R. L., Hauck, E. R., & MacIntyre, N. R.
- Affiliations
- The Ohio State University (US)
- Venue
- Health Psychology
- Published
- 1998
- Volume
- 17
- Issue
- 3
- Pages
- 232-240
- ISSN
- 0278-6133 (ISSN-L)
- 1930-7810
- OpenAlex
- W2090976943
- Cited by
- 353
- References
- 0
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 5 · 2023: 4 · 2022: 5 · 2021: 9 · 2020: 15 · 2019: 11 · 2018: 8 · 2017: 12 · 2016: 8 · 2015: 18 · 2014: 24 · 2013: 17 · 2012: 15
- FWCI
- 5.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Psychology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (7r29hl045290-05)
- National Institute on Aging (AG 00029)
- National Heart, Lung, and Blood Institute (HL 45290)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Keywords
- chronic obstructive pulmonary disease, exercise rehabilitation, stress management, patient education, older adults, lung function, exercise endurance, depression, anxiety, quality of life, cognitive performance, verbal fluency, attention, motor speed
- MeSH terms
- Aged, Analysis of Variance, Anxiety, Cognition Disorders, Combined Modality Therapy, Depression, Exercise Therapy, Female, Humans, Health Knowledge, Attitudes, Practice, Lung Diseases, Obstructive, Male, Middle Aged, Neuropsychological Tests, Patient Education as Topic, Physical Fitness, Quality of Life, Regression Analysis, Relaxation Therapy, Respiratory Function Tests, Stress, Psychological, Causality, Treatment Outcome
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