The results of our investigation show that a sensitizing
intervention that combined 8 exercise sessions with a selfmanagement
education program is suitable for improving
patient skills over a 1-year period. It provides clinically
significant improvements in patient’s exercise tolerance
and HRQoL, and reductions in cost of COPD medications,
compared to usual care. The education component within
a self-management program should not be considered as an
isolated intervention. Clinicians should consider adding
supervised exercise to change patients’ habits and enable
them to learn ways to get desensitized to the sensation of
dyspnea and to the fear of physical exertion (also called
kinesiophobia).24
The absence of relevant results concerning hospital
admissions suggest that a self-management programhas to be
part of an integrated care system which consists of multiple
interventions at different levels (i.e. the patient, professionals
and/or the organizational level).25,29,38 Achieving
behavioral changes inpatients aswell as professionals appears
essential for substantially changing the partnership dynamic
between patients and care providers, and patient selfmanagement
behaviour. To this end, organizational structure
should also be modified to include case management, followup
systems and/or multidisciplinary care provision.