Clinical Pilates Programme on People With COPD Gold A: a Rehabilitation Nursing Approach.

Primary outcomes

1. Effect of a Clinical Pilates programme, as a tool in the field of Rehabilitation Nursing, on thoracic mobility in people with COPD Gold A.

   Time frame: Applied pre-intervention and post-intervention (with a 2-month interval). Both in Experimental and control group.

   Chirometric tests of the Thorax (Lanza et al., 2013).

   • The person stands with their hands on their hips, chest bare, with the investigator in front of them;
   • A tape measure is placed over the patient's rib cage in the axillary region;
   • The zero point of the tape measure is fixed in the anterior region of the chest at each level: axillary, with the tape passing through the axillary fold, and xiphoid, with the tape fixed to the xiphoid process. The other end of the tape goes around the chest and is pulled by the examiner over this fixed point, exerting as little pressure as possible on the person's body (the tape is adjusted but not tightened, ensuring that the contour of the soft tissues remains unchanged).
   • The person is asked to take a maximum breath in, followed by a maximum breath out, holding each for at least 2 seconds.
   • The measurement (cm) is recorded at the end of the breath out and the breath in.
   • The measurement is repeated.

2. Effect of a Clinical Pilates programme, as a tool in the field of Rehabilitation Nursing on pulmonary function in people with COPD Gold A.

   Time frame: Applied pre-intervention and post-intervention (with a 2-month interval). Both in Experimental and control group.

   Peak expiratory flow - Peak Flow (Miler et al., 2005).

   • The person sits with their neck in a neutral position, looking straight ahead;
   • They hold the Peak Flow meter and place it close to their mouth (ensuring that the indicator needle is set at 0);
   • The person takes a deep breath, places the Peak Flow in their mouth, between their teeth and with their tongue under the mouthpiece, and blows as hard as possible without pausing;
   • The highest value of at least three readings is recorded, with only readings that do not differ by more than 20L/min being considered;
   • Invalidate the result in case of excess saliva in the mouthpiece or coughing during exhalation;
   • The measurement range is between 50-800 L/min in accordance with the applicable standard ISO 23747:2015.

3. Effect of a Clinical Pilates programme, as a tool in the field of Rehabilitation Nursing on motor performance in people with COPD Gold A.

   Time frame: Applied pre-intervention and post-intervention (with a 2-month interval). Both in Experimental and control group.

   One-minute sit-to-stand test (Vaidya et al., 2016) and modified Borg scale (Borg, 1982).

   • The person sits on a chair leaning against the wall, with knees and hips bent at 90º, feet flat on the floor and hands resting on their legs;
   • The person is asked to stand up and sit down from the chair as quickly as possible without support for one minute.
   • The number of repetitions is counted.
   • At the end, the 'Modified Borg Scale' is applied.
   • The scale is placed in front of the person and they are asked to rate the degree of dyspnoea they perceive.
   • The rating ranges from 0 to 10, with 0 being 'No shortness of breath' and 10 being 'Maximum shortness of breath'.
   • The person indicates the number corresponding to the dyspnoea they feel.

4. Effect of a Clinical Pilates programme, as a tool in the field of Rehabilitation Nursing on physical activity levels in people with COPD Gold A.

   Time frame: Applied pre-intervention and post-intervention (with a 2-month interval). Both in Experimental and control group.

   Actigraph® GT3X+ accelerometer. The brand protocol requires wearing the device for a period of 4 days, including 2 days at the weekend.

   The device will be programmed for 6 hours on the first day of assessment and recordings will be made every 15 seconds.

   A record sheet will be provided to indicate the times when the accelerometer is put on and taken off.

   The device is placed on the non-dominant wrist and daily recording of at least 600 minutes (10 hours) is mandatory.

5. Effect of a Clinical Pilates programme, as a tool in the field of Rehabilitation Nursing on sleep quality in people with COPD Gold A.

   Time frame: Applied pre-intervention and post-intervention (with a 2-month interval). Both in Experimental and control group.

   The brand protocol requires wearing the device for a period of 4 days, including 2 days at the weekend.

   The device will be programmed for 6 hours on the first day of assessment and recordings will be made every 15 seconds.

   A record sheet will be provided to indicate the times when the accelerometer is put on and taken off.

   The device is placed on the non-dominant wrist and daily recording of at least 600 minutes (10 hours) is mandatory.

6. Effect of a Clinical Pilates programme, as a tool in the field of Rehabilitation Nursing on Health-related quality of life (HRQoL) in people with COPD Gold A.

   Time frame: Applied pre-intervention and post-intervention (with a 2-month interval). Both in Experimental and control group.

   EQ-5D-5L (Ferreira et al., 2023).

   Likert scale (1 to 5) self-assessment that considers 5 domains:

   • Mobility: from 'I have no mobility problems' to 'I am unable to walk';
   • Personal care: 'I have no problems washing or dressing myself' to 'I am unable to wash or dress myself';
   • Usual activities (e.g. domestic, leisure or family activities): 'I have no problem performing my usual activities' to 'I am unable to perform my usual activities';
   • Pain/Discomfort: 'I have no pain or discomfort' to 'I have extreme pain or discomfort';
   • Anxiety/Depression: 'I am not anxious and/or depressed' to 'I am extremely anxious and/or depressed';
   • Visual scale from 0 to 100, where 0 is 'worst health imaginable' and 100 is 'best health imaginable.' The person is asked to place an X on the scale to indicate how they feel about their health at the moment.