Long-term efficacy and effectiveness of a behavioural and community-based exercise intervention (Urban Training) to increase physical activity in patients with COPD: a randomised controlled trial

Abstract

There is a need to increase and maintain physical activity in patients with chronic obstructive pulmonary disease (COPD). We assessed 12-month efficacy and effectiveness of the Urban Training intervention on physical activity in COPD patients.This randomised controlled trial (NCT01897298) allocated 407 COPD patients from primary and hospital settings 1:1 to usual care (n=205) or Urban Training (n=202). Urban Training consisted of a baseline motivational interview, advice to walk on urban trails designed for COPD patients in outdoor public spaces and other optional components for feedback, motivation, information and support (pedometer, calendar, physical activity brochure, website, phone text messages, walking groups and a phone number). The primary outcome was 12-month change in steps·day−1 measured by accelerometer.Efficacy analysis (with per-protocol analysis set, n=233 classified as adherent to the assigned intervention) showed adjusted (95% CI) 12-month difference +957 (184–1731) steps·day−1 between Urban Training and usual care. Effectiveness analysis (with intention-to-treat analysis set, n=280 patients completing the study at 12 months including unwilling and self-reported non-adherent patients) showed no differences between groups. Leg muscle pain during walks was more frequently reported in Urban Training than usual care, without differences in any of the other adverse events.Urban Training, combining behavioural strategies with unsupervised outdoor walking, was efficacious in increasing physical activity after 12 months in COPD patients, with few safety concerns. However, it was ineffective in the full population including unwilling and self-reported non-adherent patients.

Use of pedometers as a tool to promote daily physical activity levels in patients with COPD: a systematic review and meta-analysis

“…In conclusion, our systematic review and meta-analysis provides evidence that pedometer-based physical activity promotion promotes steps per day when it is used as an intervention alone or alongside pulmonary rehabilitation, including two recently published RCTs [20,31]. Future trials should concentrate on high-quality study designs, with specific thought towards the optimal way of using pedometers during physical activity promotion (i.e.…”

“…This systematic review and meta-analysis of 19 RCTs provides evidence that pedometer physical activity promotion as a standalone intervention compared with usual care or alongside pulmonary rehabilitation Pedometer PA alone ALTENBURG [14] ARBILLAGA-ETXARRI [20] ALTENBURG [14] BENDER [21] DEMEYER [13] HORRNIX [24] HOSPES [25] MENDOZA [27] MOY [28] TABAK [30] VORNIK [32] WAN [33] Subtotal (95% CI) compared with pulmonary rehabilitation alone improves steps per day by a magnitude that is within the minimal important difference (MID) of 600-1100 steps·day −1 reported by DEMEYER et al [35] (table 3). Moreover, this meta-analysis suggests that pedometer physical activity promotion was more effective in patients with greater baseline physical activity levels and when pedometers were used to measure improvements in physical activity compared with accelerometers (table 4).…”

“…This systematic review and meta-analysis is the first to include two recently published RCTs reporting pedometer-based physical activity promotion implemented either alone [20] or alongside a combined pulmonary rehabilitation programme [31]. Moreover, we are the first to report that, regardless of how pedometers are used in the implementation of physical activity promotion, they can provide improvements in daily physical activity (steps per day) which exceed the MID.…”

“…When observing the effects of physical activity promotion, there was a positive effect on steps per day compared with usual care (n=12 RCTs; 0.53 (0.29-0.77), p<0.00001) (figure 2) [13,14,20,21,24,25,27,28,30,32,33], which equated to an improvement of ∼1000 steps·day −1 . A positive effect on steps per day was also found when pedometer physical activity promotion was added to pulmonary rehabilitation versus pulmonary rehabilitation alone (n=7 RCTs; 0.51 (0.13-0.88), p=0.006) (figure 2) [14,15,22,23,26,30,31].…”

Whither pulmonary rehabilitation? Will alternative modes help or hurt?

“…In this light, the novel and innovative intervention designed and reported by ARBILLAGA-ETXARRI et al [9] in this issue of the European Respiratory Journal is very interesting. Though not specifically promoted as such, their "Urban Training" programme is a rehabilitative intervention.…”