Investigation of Square Step Exercise Applied by Telerehabilitation in Chronic Obstructive Pulmonary Disease Patients
Condition: COPD; Cognitive Impairment; Balance; Distorted
MeSH terms: Cognitive Dysfunction
Study type: Interventional

Summary: 
      COPD is a progressive disease associated with systemic inflammation, with many extrapulmonary
      outcomes such as cognitive impairment. Most of the daily activities involve doing several
      tasks at the same time, such as walking while talking or avoiding obstacles.
    

Detailed description: 
      The most prominent independent risk factor for cognitive impairment in COPD patients is
      reduced oxygen availability as a result of lung dysfunction. The prevalence of cognitive
      impairment in COPD patients ranges from 10% to 61%. A wide variety of tools have been
      developed for screening cognitive functions. The most widely used tests covering multiple
      cognitive domains are the Mini Mental State Examination (MMSE) and the Montreal Cognitive
      Assessment (MoCA).

      When two tasks are performed at the same time, they compete for sources of attention,
      resulting in decreased performance on one or two tasks. Balance or postural control is a
      complex skill required for independent mobility and preventing falls. Balance performance
      naturally decreases with age; however, certain conditions are associated with more pronounced
      and rapid declines. Balance problems and fall risk are increased in COPD patients.From this
      perspective aim of this study is to assess the effect of square-step exercise and
      strengthening exercise applied with telerehabilitation on cognitive status and balance in
      patients with COPD.
    

Intervention name(s): The Square-Step Exercise Training; Strengthening Exercise Training
Intervention type(s): Other; Other
Intervention description(s): The Square-Step Exercise is instructed to walk according to the step pattern shown on a 100 * 250 cm mat, divided into 40 squares of 25 cm each. It includes forward, backward, lateral and diagonal steps, and step patterns are progressively made more complex. Each pattern consists of two to 16 steps; Individuals are asked to repeat the step pattern until they reach the end of the mat. Each step pattern is repeated 4-10 times to ensure that individuals can complete the pattern. The individuals included in the study will exercise in easy-difficulty patterns for the first 2 weeks, medium-difficulty patterns in the 3rd and 4th weeks, medium and advanced patterns in the 5th and 6th weeks, and advanced patterns in the 7th and 8th weeks. The square-step exercise group will perform 15 minutes of warm-up exercise, 30 minutes of progressive square-step exercise, and 10 minutes of cool-down exercise accompanied by a physiotherapist, 3 days a week.; Thera-Band brand elastic bands will be used to apply resistance in strengthening training. To determine the intensity of the exercise, the perceived difficulty level after 15 repetitions with the elastic band will be evaluated with the Borg scale. If the perceived difficulty level is at the level of 12-14 (slightly difficult), it will be considered as the starting difficulty level.In the strengthening exercise group will perform, shoulder abduction, shoulder press after elbow flexion, horizontal abduction, punching with an elastic band, triceps strengthening, external rotation of the shoulder, hip abduction with external rotation and sit-to-stand exercises for 8 weeks, 3 days / week , 3 sets / sessions, 8-12 repetitions. For each exercise, it will be applied as 8 repetitions in the initial workload. In the next exercise sessions, the number of repetitions will be increased until the patient can comfortably perform 12 repetitions with the same load.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Exercises will be applied with the telerehabilitation method to the individuals included in the study. Video and audio communication will be provided by free and widely used programs such as Whatsapp or Telegram. Pulse oximetry, tripod and exercise material will be given to each individual included in the study by the researcher. Individuals included in the study will be randomly divided into two groups. Exercises in both groups will be done 3 days a week for 8 weeks. Before and after each exercise session, the heart rate and oxygen saturation values of the patients will be measured by pulse oximetry, and their perception of dyspnea and leg fatigue according to the Borg scale will be recorded. The first and last evaluation of individuals will be done face to face.
Masking: Double (Participant, Care Provider)
Primary purpose: Treatment