The effects of a physical activity counseling program after an exacerbation in patients with Chronic Obstructive Pulmonary Disease: a randomized controlled pilot study

Abstract

BackgroundIn some patients with COPD, the disease is characterized by exacerbations. Severe exacerbations warrant a hospitalization, with prolonged detrimental effects on physical activity. Interventions after an exacerbation may improve physical activity, with longstanding health benefits. Physical activity counseling and real-time feedback were effective in stable COPD. No evidence is available on the use of this therapeutic modality in patients after a COPD exacerbation.MethodsThirty patients were randomly assigned to usual care or physical activity counseling, by telephone contacts at a frequency of 3 times a week and real-time feedback. Lung function, peripheral muscle strength, functional exercise capacity, symptom experience and COPD-related health status were assessed during hospital stay and 1 month later.ResultsBoth groups significantly recovered in physical activity (PAsteps: control group: 1013 ± 1275 steps vs intervention group: 984 ± 1208 steps (p = 0.0005); PAwalk: control group: 13 ± 14 min vs intervention group: 13 ± 16 min (p = 0.0002)), functional exercise capacity (control group: 64 ± 59 m (p = 0.002) vs intervention group: 67 ± 84 m (p = 0.02)) and COPD-related health status (CAT: control group: −5 [−7 to 1] (p = 0.02) vs intervention group: −3 [−10 to 1] points (p = 0.03)). No differences between groups were observed.ConclusionFrom our pilot study, we concluded that telephone based physical activity counseling with pedometer feedback after an exacerbation did not result in better improvements in physical activity and clinical outcomes compared to usual care. Because of the difficult recruitment and the negative intermediate analyses, this study was not continued.Trial registrationClinicaltrials.gov NCT02223962. Registered 4 September 2013.

Findings of the Chronic Obstructive Pulmonary Disease-Sitting and Exacerbations Trial (COPD-SEAT) in Reducing Sedentary Time Using Wearable and Mobile Technologies With Educational Support: Randomized Controlled Feasibility Trial (Preprint)

“…Present study uptake (31.5%) was also similar to that of a peri-exacerbation pulmonary rehabilitation study (32.3%) conducted in the same hospital (29) and the rate of recruitment was faster than a physical activity intervention using wearable technology (Fitbit Ultra) at a similar time point (average of 2.2 versus 0.6 patients per week) (30). Retention of participants to the two-week follow-up appointment (51.2%) was lower than the proportion of patients completing early pulmonary rehabilitation (71.7% of patients attending rehabilitation) (3).…”

One-year Mortality in COPD After an Exacerbation: The Effect of Physical Activity Changes During the Event

“…It seems that PA might increase during the 6 days following the discharge after one hospitalization and might change minimally or not at all for the following 6 weeks (28,29). So again, there would be a relative quick recovery of PA at the beginning of the event; after that improvement, it would slow down.…”

Interventions to modify physical activity in patients with COPD: where do we go from here?

“…We have recently observed in our centre that the likelihood of achieving an improvement in physical activity of at least 1000 steps per day, in response to participation in a pulmonary rehabilitation programme, increased gradually from 18% in patients with severely reduced functional exercise capacity (6-min walking distance (6MWD) <300 m) to 52% in patients with better preserved functional capacity (6MWD >450 m) [25]. We also observed that a physical activity coaching intervention was not effective in patients recruited immediately after an exacerbation-related hospital admission [26]. Patients with better preserved levels of functional exercise capacity are therefore probably good candidates for physical activity coaching programmes.…”

“…Integrating components of physical activity coaching interventions into pulmonary rehabilitation programmes might also be an attractive option for these patients. Two randomised controlled trials published after the final inclusion date for the review by MANTOANI et al [18] have studied this combined approach [26][27][28]. CRUZ et al [28] observed an increase in physical activity, while no additional effects of the combined intervention were observed in the study by BURTIN et al [27].…”