Intervention protocols
For the treatment group, each patient received four 45- minute training sessions on HQG led by a trained therapist on the ninth, tenth, eleventh, and twelfth sessions of the PRP, together with a home learning package in form of audiovisual materials. The specific form of HQG chosen in this study was Baduanjin.
It consists of eight distinct movement routines, with each movement routine being repeated six times. The whole protocol usually takes 12–15 minutes to complete at the usual pace. To address the special needs of
patients with COPD, an expert panel review was conducted to assess its potential clinical effectiveness. A field test was also conducted to study the safety in its application to COPD patients prior to the RCT. Five (5) adaptations were ultimately recommended by the experts (Box 1). In order to maximize the potential benefits of the training, the minimal dosage of the training protocol that the experts advised was to keep practice at least 1 time per day and for at least 4 times a week until the 6-month FU. To keep a record of their own practice, each patient was issued a daily log. For the control group, each patient received the same number and duration of additional training sessions reinforcing the breathing (including pursed-lip and coordinated breathing) and walking exercises of the conventional program to make it comparable to the treatment group in terms of additional staff attention given to the participants. In addition, another set of audiovisual training material on the corresponding aspects was issued to each control subject. They were also advised to keep daily walking for not less than 30 minutes until the 6-month FU.