Clinician-Facilitated Physical Activity Intervention Versus Pulmonary Rehabilitation for Improving Physical Activity in COPD: A Feasibility Study

Abstract

Pulmonary rehabilitation (PR) may not suit all individuals with chronic obstructive pulmonary disease (COPD) and may not result in increased physical activity. Higher levels of physical activity are associated with reduced mortality and morbidity. The aim of this study was to assess the feasibility of conducting a trial to investigate the effectiveness of a clinician-facilitated physical activity intervention (PAI) versus PR in improving physical activity in patients with COPD referred to PR. In this randomised controlled mixed methods feasibility study, all patients referred to PR who were eligible and willing were assessed at baseline and then randomised to the PAI or to PR. The assessments were repeated post-intervention and at 3-month follow-up. The main outcome was step count measured by Actigraph. Semi-structured interviews were conducted post-intervention. The N = 50 patients; mean (SD) age, 64.1(8.6) years, 24M were recruited and randomised; N = 23 (PAI) and n = 26 (PR): one patient was excluded from the analysis as that person did not meet the GOLD diagnostic criteria. Key feasibility criteria were met; recruitment was 11%, dropouts in PAI were 26% (n = 6) and 50% (n = 13/26) PR. Participants in both groups experienced a range of health benefits from their respective programmes. The PAI appears to be effective in increasing step counts in people with COPD: mean change (standard deviation) [confidence interval] for the PAI group was 972.0(3230.3)[-1080.3 to 3024.4], n = 12 and 4.3(662.7)[-440.9 to 449.5], n = 11 for the PR group. The PAI met all domains of fidelity. This study provides key information to inform a future-randomised controlled trial in physical activity.

Rehabilitación Pulmonar en Pacientes con Enfermedad Pulmonar Obstructiva Crónica

“…Igualmente, los estudios muestran mejoría en la disnea, fuerza muscular y tolerancia al ejercicio en pacientes con EPOC leve; estos pacientes se benefician de ser incluidos rutinariamente en programas de rehabilitación pulmonar (33,34), lo cual tiene una asociación con la reducción significativa en la tasa de exacerbación, posterior al tratamiento recibido en el programa de rehabilitación pulmonar (35). Deepak,et al (36), afirman que la rehabilitación pulmonar temprana en EPOC tiene beneficios significativos en la calidad de vida y la mejoría en el ejercicio.…”

A Detailed Description of Physical Activity Counseling Interventions to Support Physical Activity in People With Chronic Obstructive Pulmonary Disease

“…18,30 Interventions occurred in-hospital (n = 1), 35 in an outpatient clinic (n = 3), [16][17][18] remotely (eg, via telephone) (n = 3), 19,29,38 or across multiple settings (combination of in-hospital or outpatient setting) and remote sessions via telephone, email, or text (n = 10). 21,22,28,[31][32][33][34]36,37,39 Intervention setting was not reported in 1 study. 30 Common themes were identified regarding content and design of physical activity counseling interventions.…”

“…[16][17][18][19]21,22,[28][29][30][31][33][34][35]39 Goal setting either through an algorithm (eg, based on previous week's physical activity level or step count) or through collaborative goal setting was employed in 15 studies. [16][17][18][19]21,22,[28][29][30][32][33][34]36,38,39 More than half of included studies (n = 10) used a system such as a diary or a smartphone app to record physical activity such as daily step counts or exercise. 16,18,21,22,29,[31][32][33][34]39 In the studies that included goal setting, common themes were identified.…”

“…[16][17][18][19]21,22,28,30,31,33,35,37,39 Most (n = 14) used pedometers or activity monitors to provide feedback about physical activity level. [16][17][18][19]21,22,[28][29][30][31][33][34][35]39 Goal setting either through an algorithm (eg, based on previous week's physical activity level or step count) or through collaborative goal setting was employed in 15 studies. [16][17][18][19]21,22,[28][29][30][32][33][34]36,38,39 More than half of included studies (n = 10) used a system such as a diary or a smartphone app to record physical activity such as daily step counts or exercise.…”

Real-world use of rescue inhaler sensors, electronic symptom questionnaires and physical activity monitors in COPD

“…For instance, in a population study such as KORA, participants with higher lung function had more activity as measured by Actigraph hip accelerometers, but there were few COPD participants in this study 16. There are also efforts to integrate sensors in pulmonary rehabilitation research, such as a recent pilot study used an Actigraph CT3X+accelerometer to assess changes in steps after randomisation to pulmonary rehabilitation or a clinician-facilitated physical activity intervention 17…”