Self-management is a term applied to any formalized
patient education program aimed at teaching skills needed to
carry out disease-specific medical regimens, guide health
behavior change, and provide emotional support to enable
patients to control their disease and live functional lives. The
influence of self-management education in patients with
COPD is not clear since previous studies that have addressed
the issue have used a variety of programs. Some investigations, for example, added action plans and/or exercise interventions to the self-management education program. The type and intensity of the education component also varies across studies from group education to individual
education to written education only. The effectiveness of
pulmonary rehabilitation and, more specifically, of exercise
training, has been extensively documented using both inpatient and outpatient approaches. However, the effects of
exercise interventions administered within self-management
programs remain unclear and have been the focus of only four
studies.5e8 The exercise programs included in these investigations did not systematically meet rehabilitation standards (e.g., frequency and intensity of supervised training sessions) and non-participation was not a criterion for study withdrawal, thus affecting the uniformity of interventions
offered. Moreover, only two studies have evaluated the
cost-effectiveness of such self-management program, i.e.
comprising education and exercise components, with only
the Quebec study of Bourbeau et al. which showed significant
benefits. Given the current context of financial uncertainty,
there is a need for more randomized controlled trial to
achieve more evidence about the cost-saving effect of
exercise interventions incorporated within self-management
education programs, compared to usual care.