An Internet-Mediated Pedometer-Based Program Improves Health-Related Quality-of-Life Domains and Daily Step Counts in COPD

doi:10.1378/chest.14-1466

Chest

Volume 148, Issue 1, July 2015, Pages 128-137

https://doi.org/10.1378/chest.14-1466 Get rights and content

BACKGROUND

Low levels of physical activity (PA) are associated with poor outcomes in people with COPD. Interventions to increase PA could improve outcomes.

METHODS

We tested the efficacy of a novel Internet-mediated, pedometer-based exercise intervention. Veterans with COPD (N = 239) were randomized in a 2:1 ratio to the (1) intervention group (Omron HJ-720 ITC pedometer and Internet-mediated program) or (2) wait-list control group (pedometer). The primary outcome was health-related quality of life (HRQL), assessed by the St. George's Respiratory Questionnaire (SGRQ), at 4 months. We examined the SGRQ total score (SGRQ-TS) and three domain scores: Symptoms, Activities, and Impact. The secondary outcome was daily step counts. Linear regression models assessed the effect of intervention on outcomes.

RESULTS

Participants had a mean age of 67 ± 9 years, and 94% were men. There was no significant between-group difference in mean 4-month SGRQ-TS (2.3 units, P = .14). Nevertheless, a significantly greater proportion of intervention participants than control subjects had at least a 4-unit improvement in SGRQ-TS, the minimum clinically important difference (53% vs 39%, respectively, P = .05). For domain scores, the intervention group had a lower (reflecting better HRQL) mean than the control group by 4.6 units for Symptoms (P = .046) and by 3.3 units for Impact (P = .049). There was no significant difference in Activities score between the two groups. Compared with the control subjects, intervention participants walked 779 more steps per day at 4 months (P = .005).

CONCLUSIONS

An Internet-mediated, pedometer-based walking program can improve domains of HRQL and daily step counts at 4 months in people with COPD.

TRIAL REGISTRY

ClinicalTrials.gov; No.: NCT01102777; URL: www.clinicaltrials.gov

Section snippets

Participants and Study Design

Potential participants were identified from a national database of veterans who had received medical services in the previous year and had a COPD diagnosis (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code of 491.x, chronic bronchitis; 492.x, emphysema; or 496.x, chronic airway obstruction NEC). Veterans from the United States and Puerto Rico were enrolled between December 2011 and January 2013.²⁵ We excluded veterans from one of the 21 Veterans

Participant Characteristics

Participant characteristics include mean age 67 ± 9 years, male sex (94%), rural residence (45%), mMRC dyspnea score ≥ 2 (31%), current smokers (25%), and supplemental oxygen use (24%) (Table 1). There were no significant differences in baseline characteristics between study groups.

Of the 238 participants, 221 had complete SGRQ data at baseline and 4 months. At 4 months, SGRQ-TS could not be calculated for 13 participants (6%): nine THS participants and four control subjects. There was no

Discussion

An Internet-mediated, pedometer-based walking program can improve domains of HRQL and daily step counts at 4 months in people with COPD. Although there was no statistically significant improvement in SGRQ-TS in the intervention group compared with the control group, we found that a greater proportion of intervention participants than control subjects had a clinically significant improvement in SGRQ-TS. Furthermore, we showed that our intervention can significantly improve the SGRQ Symptoms and

Acknowledgments

Author contributions: C. R. R. was the primary investigator and had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. M. L. M., R. K., H. Q. N., M. D. C., D. E. G., N. D. G., and C. R. R. were involved in the conception and design of all stages of the study; M. L. M., C. H. M., R. K., P. R., H. Q. N., M. D. C., and C. R. R. were involved in study data collection; R. J. C., C. H. M., R. K., P. R., R. G. H., H.

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Physical activity in adults with COPD is poor, but behaviour change interventions could help improve activity. This systematic review aims to examine behaviour change interventions to promote physical activity and health outcomes for adults with COPD.
Eight databases were searched from inception until April 2023: Web of Science, CENTRAL, MEDLINE, EMBASE, APA PsychINFO, CINAHL, PROSPERO, Cochrane Airways Trials Register. Relevant studies were appraised to determine the impact of behaviour change interventions on physical activity outcomes. Interventions were mapped to Michie's Theoretical Domains Framework (TDF) and a meta-analysis and narrative synthesis conducted. The Cochrane risk of bias tool 2 and the GRADE criteria evaluated bias and the quality and certainty of the evidence.
Twelve randomized controlled trials (RCTs) were included in the review (n = 1211). The most frequently utilized behaviour change interventions included counselling, stepcount monitoring, social support and goal setting. The most commonly measured outcomes across studies were steps-per-day, physical activity levels, exercise capacity and quality of life. A meta-analysis of comparable studies demonstrated there was no difference in stepcount in favour of behaviour change interventions with respect to steps-per-day (SMD 0.16, 95 % CI -0.03, 0.36; p = 0.10). There was some evidence of short-term improvement in physical activity and quality of life, with behaviour change interventions related to goals, behaviour regulation and social influences.
People with COPD may benefit from behaviour change interventions to increase physical activity and quality of life in the short-term. The overall certainty and quality of the evidence is low.
Chronic obstructive pulmonary disease access and adherence to pulmonary rehabilitation intervention (CAPRI): Protocol for a randomized controlled trial and adaptations during the COVID-19 pandemic
2023, Contemporary Clinical Trials
Pulmonary rehabilitation (PR) is the standard of care for chronic obstructive pulmonary disease (COPD) management. However, significant barriers limit access and adherence to PR and alternatives are needed. The purpose of this randomized controlled trial is to test the efficacy of a web-based, pedometer-mediated intervention to increase physical activity (PA) for persons with COPD who decline PR or meet U.S. guidelines for referral to PR but have not participated (CAPRI-1). In addition, we will test whether the intervention maintains PA following PR in an exploratory aim (CAPRI-2).
Participants with COPD (N = 120) will be recruited and randomized 1:1 to a 12-week web-based, pedometer-mediated intervention or usual care (UC) (CAPRI-1). The intervention provides: 1) objective monitoring of walking and iterative feedback, 2) individualized step-count goals, 3) motivational messages and educational content, and 4) an online community. The primary outcome is change in daily step count from baseline to 12 weeks. Secondary outcomes include: (a) exercise capacity; (b) self-reported PA; (c) PA intensity; (d) exercise self-regulatory efficacy, (e) health-related quality of life, (f) dyspnea, (g) depression symptoms, and (h) healthcare utilization. CAPRI-2 will test whether participants (N = 96) assigned to the intervention following PR completion show greater maintenance of daily step count compared to UC at 3, 6, 9, and 12 months.
If the intervention is efficacious, it may be an alternative for those who cannot attend PR or a maintenance program following completion of conventional PR. We also present adaptations made to the protocol in response to the COVID-19 pandemic.
The effectiveness of self-care interventions in chronic illness: A meta-analysis of randomized controlled trials
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To characterize and explain variation in the comparative effectiveness of self-care interventions on relevant outcomes of chronic illness compared with controls.
Meta-analysis and meta-regression.
Data extraction was framed within the context of a previously-published scoping review of randomized trials designed to enhance self-care in type 2 diabetes mellitus, heart failure, hypertension, asthma, coronary artery disease, and chronic obstructive pulmonary disease (published between 2008 and 2019). Data were pooled using random-effects meta-analyses. Meta-regression was used to test the effect of potential moderators on trial effectiveness.
145 trials involving 36,853 participants were included. Overall, the effect size of self-care interventions on improving outcomes was small (Hedges' g = 0.29 (95% CI = 0.25–0.33), p < 0.001) with statistically significant heterogeneity across trials (Q = 514.85, p < 0.001, I² = 72.0%). A majority of trials (n = 83, 57.2%) were rated as having a high risk of bias. There was no statistically significant difference in trial effectiveness based on the use of theory, specific components of self-care addressed, the number of modes of delivery, the number of behavioral change techniques, specific modes of delivery, specific behavioral change techniques, intervention duration, total number of hours of intervention, or either participant age or gender.
Self-care interventions are modestly effective in improving outcomes. Poor trial quality limits the strength of conclusions in this area of science. There is much to be done to enhance the design, conduct and reporting of self-care trials in order to gain more insight into the effectiveness of self-care interventions.
New review highlights poor trial design as major impediment to understanding the contribution of self -care to outcomes in chronic illness.
Predictors of Outpatient Pulmonary Rehabilitation Uptake, Adherence, Completion, and Treatment Response Among Male U.S. Veterans With Chronic Obstructive Pulmonary Disease
2022, Archives of Physical Medicine and Rehabilitation
To examine predictors of uptake (never start), adherence (drop out), and completion of pulmonary rehabilitation (PR), as well as PR treatment response based on minimal clinically important difference (MCID) on the 6-minute walk test (6MWT) distance and Chronic Respiratory Questionnaire–Self-Report (CRQ-SR).
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Participants completed baseline (time 1) measures of depression (Beck Depression Inventory-II), health-related quality of life (CRQ-SR), self-efficacy (Exercise Self-Regulatory Efficacy Scale [Ex-SRES]), and COPD knowledge. Exercise capacity was assessed with the 6MWT. Participants who completed all 18 sessions of PR repeated assessments (time 2). Logistic regression models examined predictors of uptake, adherence, and completion of PR as well as treatment response based on MCID.
Participants were referred to PR with 24.90% never starting, 28.90% dropping out, and 46.20% completing. No differences emerged between never starters and dropouts. Having a history of any cancer increased the likelihood of completing PR (vs never starting; odds ratio [OR], 3.18; P=.003). Greater CRQ-SR dyspnea score, indicating less dyspnea, was associated with increased likelihood of completing PR (OR, 1.12; P=.006). Past smoking compared with current smoking was associated with increased likelihood of completion (OR, 3.89; P≤.002). Those without a history of alcohol use disorder had increased likelihood of completing PR (OR, 2.23; P=.048). Greater baseline 6MWT distance was associated with lower likelihood of achieving MCID in 6MWT (OR, 0.99; P<.001). Greater Ex-SRES was associated with decreased likelihood of achieving 6MWT MCID (OR, 0.98; P=.023).
Findings suggest that early psychoeducation on dyspnea management and smoking and alcohol cessation may increase completion of PR.
Use of Web-based Pedometer for Chronic Obstructive Pulmonary Disease: A Meta-analysis of Randomized Controlled Trials
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View all citing articles on Scopus

FUNDING/SUPPORT: This study was funded by the Department of Veterans Affairs, Health Services Research and Development Service [Grant IIR 09-366 to Dr Richardson]; the Department of Veterans Affairs, Rehabilitation Research and Development Service [Career Development Award F6847W to Dr Moy]; and the National Institutes of Health Heart, Lung, and Blood Institute [Grant T32 HL007749-20 to Dr Martinez].

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Chest

Original ResearchCOPDAn Internet-Mediated Pedometer-Based Program Improves Health-Related Quality-of-Life Domains and Daily Step Counts in COPD

BACKGROUND

METHODS

RESULTS

CONCLUSIONS

TRIAL REGISTRY

Section snippets

Participants and Study Design

Participant Characteristics

Discussion

Acknowledgments

Lancet

Respir Med

Chest

Chest

Respir Med

Respir Med

Chest

Chest

Chest

Chest

Lancet

Respir Med

Patient Educ Couns

Deaths from chronic obstructive pulmonary disease—United States, 2000-2005

MMWR Morb Mortal Wkly Rep

Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary

Am J Respir Crit Care Med

Characteristics of physical activities in daily life in chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Associations between physical activity and 30-day readmission risk in chronic obstructive pulmonary disease

Ann Am Thorac Soc

Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study

Thorax

An index of daily step count and systemic inflammation predicts clinical outcomes in chronic obstructive pulmonary disease

Ann Am Thorac Soc

Daily step count predicts acute exacerbations in a US cohort with COPD

PLoS One

An official American Thoracic Society/European Respiratory Society statement: update on limb muscle dysfunction in chronic obstructive pulmonary disease

Am J Respir Crit Care Med

An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation

Am J Respir Crit Care Med

Predictors of success and failure in pulmonary rehabilitation

Eur Respir J

Gender differences in symptoms and care delivery for chronic obstructive pulmonary disease

J Womens Health (Larchmt)

Original Research
COPD
An Internet-Mediated Pedometer-Based Program Improves Health-Related Quality-of-Life Domains and Daily Step Counts in COPD