Investigation of the Effect of Structured Energy Conservation Techniques Training on COPD Patients

Investigation of the Effects of Structured Energy Conservation Techniques Training on Activities of Daily Living, Fatigue, and Exercise Capacity in COPD Patients

Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung disease characterized by chronic respiratory symptoms (dyspnea, cough, sputum production, and/or exacerbations) due to persistent, often progressive airflow obstruction resulting from abnormalities in the airways (bronchiolitis, bronchitis) and/or alveoli (emphysema). COPD is a multifaceted disease that is not limited to respiratory symptoms but also negatively affects individuals' functional capacity, physical endurance, and participation in daily living activities. Common symptoms include shortness of breath (dyspnea) and a significant feeling of fatigue; this can lead to decreased exercise capacity, limitations in daily living activities, and ultimately dependence over time. Therefore, in the treatment of COPD, not only drug therapy but also interventions aimed at symptom control and improving functional capacity are becoming increasingly important. Energy conservation techniques, included in pulmonary rehabilitation programs, are based on the view that dyspnea occurs most intensely during daily living activities, and that performing these activities in an energy-conserving manner will result in less dyspnea. Energy conservation techniques are one of the trainings given to improve symptom management in COPD patients. Disease symptoms can increase in COPD patients during tasks such as washing hair, drying hair, shaving, reaching, bending, lifting, carrying, pushing, and pulling weights. When appropriate body mechanics and tools that facilitate tasks are used, the amount of energy required during these tasks decreases. In this way, it is thought that patients will be more active in their daily living activities. Breathing exercises are also a component of pulmonary rehabilitation and support the increase of respiratory muscle function and exercise tolerance. Accordingly, it is thought that structured energy conservation techniques training can improve daily living activities, fatigue, and exercise capacity in COPD patients. This research will be conducted as a pre-test-post-test, single-blind, randomized controlled trial to examine the effect of structured energy conservation techniques training on daily living activities, fatigue, and exercise capacity in COPD patients.

In chronic diseases, education is the most important tool for enabling self-treatment, lifestyle modifications, and the development of methods to prevent disease progression. The goals of patient education in COPD are to reduce disease symptoms and acute exacerbations. Another goal is to prevent COPD-related complications and to educate patients or their families. Energy conservation techniques are one type of education given to improve symptom management in COPD patients. Energy conservation techniques consist of personal energy conservation methods when performing physical activities. With these approaches, the energy requirements of activities are reduced. Thanks to energy conservation techniques during physical activity, it is possible to complete the activity with less dyspnea. Some energy conservation techniques include performing daily activities while sitting, placing frequently used objects between waist and shoulder level, using long-handled tools that make tasks easier, and using a wheeled carrier to facilitate carrying items. Breathing exercises, on the other hand, improve the exercise tolerance of patients by effectively using the diaphragm. Pursed-lip breathing and diaphragmatic breathing are frequently used in COPD patients. Pursed-lip breathing is defined as active and prolonged exhalation performed with slightly parted lips. After taking a deep breath through the nose, exhalation is performed by pursing the lips in a whistling manner, increasing pressure in the bronchi. This breathing exercise prevents premature closure of the bronchi by increasing the pressure during exhalation, extending the expiration time and allowing more air to be expelled. In diaphragmatic breathing, the patient lies on their back or in a semi-sitting position, placing one hand on the front of their chest and the other on their abdomen. As they slowly inhale as much air as possible through their nose, they feel their abdomen slowly rise. While slowly exhaling the air taken in with pursed-lip breathing, they gently apply pressure with the hand on their abdomen. When both breathing exercises are performed regularly, they help reduce the patient's respiratory distress. In conclusion, structured energy conservation techniques training can be effective in increasing functional capacity and improving symptoms in COPD patients. Therefore; This study aimed to investigate the effects of structured energy conservation techniques training on daily living activities, fatigue, and exercise capacity in patients with COPD.

Inclusion Criteria:

• Patients who have been admitted to the pulmonary diseases ward or have applied to the pulmonary diseases outpatient clinic,
• Patients diagnosed with COPD,
• Patients in category E of the GOLD A, B, E classification (patients experiencing more than 2 moderate exacerbations or having multiple hospitalizations) (GOLD, 2025)
• Patients over 40 years of age (Adeloye et al, 2015).
• Patients who will continue their health check-ups at the Isparta City Hospital Pulmonology Outpatient Clinic,
• Patients who agree to participate in the study,
• Patients or at least one of their relatives who can read and write,
• Patients or at least one of their relatives who does not have communication problems will be included in the study.

Exclusion Criteria:

• Patients with serious orthopedic problems that may have a significant impact on daily activities,
• Patients with progressive neuromuscular disease,
• Patients who have experienced unstable angina pectoris or myocardial infarction within the last month,
• Patients living alone,
• Patients in groups A and B of the GOLD ABE classification will not be included. For patients in group A, mMRC 0-1, CAT<10 are used as criteria; for patients in group B, mMRC≥2, CAT≥10 are used as criteria (GOLD, 2025).