Physical activity is increased by a 12-week semiautomated telecoaching programme in patients with COPD: a multicentre randomised controlled trial

H Demeyer, Z Louvaris, A Frei, R A Rabinovich, C de Jong, E Gimeno-Santos, M Loeckx, S C Buttery, N Rubio, T Van der Molen, N S Hopkinson, I Vogiatzis, M A Puhan, J Garcia-Aymerich, M I Polkey, T Troosters, Mr Papp PROactive study group and the PROactive consortium, Wim Janssens, Paul Van den Brande, Maarten Spruyt, Miek Hornikx, Rebecca Tanner, Yogini Raste, Claire Yerramasu, Helma Oosterom, Gilbert Buesching, Alexandra Strassman, Martin Frey, Alexander Turk, Stephan Keusch, Alice Zürcher, Ignasi Serra, Nathalie Ivanoff, Niklas Karlsson, Solange Corriol-Rohou, Ian Jarrod, Damijen Erzen, Mario Scuri, Paul McBride, Nadia Kamel, Margaret Tabberer, Fabienne Dobbels, Pim de Boer, Enkeleida Nikai, Bill MacNee, H Demeyer, Z Louvaris, A Frei, R A Rabinovich, C de Jong, E Gimeno-Santos, M Loeckx, S C Buttery, N Rubio, T Van der Molen, N S Hopkinson, I Vogiatzis, M A Puhan, J Garcia-Aymerich, M I Polkey, T Troosters, Mr Papp PROactive study group and the PROactive consortium, Wim Janssens, Paul Van den Brande, Maarten Spruyt, Miek Hornikx, Rebecca Tanner, Yogini Raste, Claire Yerramasu, Helma Oosterom, Gilbert Buesching, Alexandra Strassman, Martin Frey, Alexander Turk, Stephan Keusch, Alice Zürcher, Ignasi Serra, Nathalie Ivanoff, Niklas Karlsson, Solange Corriol-Rohou, Ian Jarrod, Damijen Erzen, Mario Scuri, Paul McBride, Nadia Kamel, Margaret Tabberer, Fabienne Dobbels, Pim de Boer, Enkeleida Nikai, Bill MacNee

Abstract

Rationale: Reduced physical activity (PA) in patients with COPD is associated with a poor prognosis. Increasing PA is a key therapeutic target, but thus far few strategies have been found effective in this patient group.

Objectives: To investigate the effectiveness of a 12-week semiautomated telecoaching intervention on PA in patients with COPD in a multicentre European randomised controlled trial.

Methods: 343 patients from six centres, encompassing a wide spectrum of disease severity, were randomly allocated to either a usual care group (UCG) or a telecoaching intervention group (IG) between June and December 2014. This 12-week intervention included an exercise booklet and a step counter providing feedback both directly and via a dedicated smartphone application. The latter provided an individualised daily activity goal (steps) revised weekly and text messages as well as allowing occasional telephone contacts with investigators. PA was measured using accelerometry during 1 week preceding randomisation and during week 12. Secondary outcomes included exercise capacity and health status. Analyses were based on modified intention to treat.

Main results: Both groups were comparable at baseline in terms of factors influencing PA. At 12 weeks, the intervention yielded a between-group difference of mean, 95% CI (lower limit - upper limit; ll-ul) +1469, 95% CI (971 to 1965) steps/day and +10.4, 95% CI (6.1 to 14.7) min/day moderate PA; favouring the IG (all p≤0.001). The change in 6-min walk distance was significantly different (13.4, 95% CI (3.40 to 23.5) m, p<0.01), favouring the IG. In IG patients, an improvement could be observed in the functional state domain of the clinical COPD questionnaire (p=0.03) compared with UCG. Other health status outcomes did not differ.

Conclusions: The amount and intensity of PA can be significantly increased in patients with COPD using a 12-week semiautomated telecoaching intervention including a step counter and an application installed on a smartphone.

Trial registration number: NCT02158065.

Keywords: Exercise; Pulmonary Rehabilitation.

Conflict of interest statement

Competing interests: None declared.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Figures

Figure 1
Figure 1
Flow chart for the calculation of the new goal (steps) during the intervention period.
Figure 2
Figure 2
Consolidated Standards of Reporting Trials (CONSORT) diagram. Valid data based on two weekdays with at least eight hours of wearing time during baseline and final visit. *No information on screening in site of Edinburgh. ACT, Actigraph; ATH, Athens; DAM, Dynaport Movemonitor; EDI, Edinburgh; GRO, Groningen; LEU, Leuven; LON, London; PA, physical activity; ZUR, Zurich.
Figure 3
Figure 3
Changes in physical activity by group. Patients in the intervention group presented in solid line, and patients in the control group presented as dotted line. Data are presented as mean, 95% (ll to ul); Steps and time in at least moderate physical activity (MPA) analyses are based on Actigraph measurement and include 140 control and 140 intervention patients, Walking time and movement intensity (MI) are based on Dynaport Movemonitor measurement and include 132 control and 129 intervention patients. *indicates significant within-group changes (p

Figure 4

Between-group differences in mean step…

Figure 4

Between-group differences in mean step count, adjusted for baseline data. Data are presented…

Figure 4
Between-group differences in mean step count, adjusted for baseline data. Data are presented for the different subgroups, based on baseline characteristics; Global Initiative for Chronic Obstructive Lung Disease (GOLD) quadrants based on modified Medical Research Council (mMRC) to classify symptoms; number of patients mMRC (
Similar articles
Cited by
References
    1. Kraus WE, Bittner V, Appel L, et al. . The National Physical Activity Plan: a call to action from the American Heart Association: a science advisory from the American Heart Association. Circulation 2015;131:1932–40. 10.1161/CIR.0000000000000203 - DOI - PubMed
    1. Lee IM, Shiroma EJ, Lobelo F, et al. . Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet 2012;380:219–29. 10.1016/S0140-6736(12)61031-9 - DOI - PMC - PubMed
    1. Tudor-Locke C, Craig CL, Aoyagi Y, et al. . How many steps/day are enough? For older adults and special populations. Int J Behav Nutr Phys Act 2011;8:80 10.1186/1479-5868-8-80 - DOI - PMC - PubMed
    1. From the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2015. (accessed 28 Jul 2016).
    1. Van Remoortel H, Hornikx M, Demeyer H, et al. . Daily physical activity in subjects with newly diagnosed COPD. Thorax 2013;68:962–3. 10.1136/thoraxjnl-2013-203534 - DOI - PMC - PubMed
Show all 37 references
Publication types
MeSH terms
Associated data
Related information
Full text links [x]
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM
Figure 4
Figure 4
Between-group differences in mean step count, adjusted for baseline data. Data are presented for the different subgroups, based on baseline characteristics; Global Initiative for Chronic Obstructive Lung Disease (GOLD) quadrants based on modified Medical Research Council (mMRC) to classify symptoms; number of patients mMRC (

References

    1. Kraus WE, Bittner V, Appel L, et al. . The National Physical Activity Plan: a call to action from the American Heart Association: a science advisory from the American Heart Association. Circulation 2015;131:1932–40. 10.1161/CIR.0000000000000203
    1. Lee IM, Shiroma EJ, Lobelo F, et al. . Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet 2012;380:219–29. 10.1016/S0140-6736(12)61031-9
    1. Tudor-Locke C, Craig CL, Aoyagi Y, et al. . How many steps/day are enough? For older adults and special populations. Int J Behav Nutr Phys Act 2011;8:80 10.1186/1479-5868-8-80
    1. From the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2015. (accessed 28 Jul 2016).
    1. Van Remoortel H, Hornikx M, Demeyer H, et al. . Daily physical activity in subjects with newly diagnosed COPD. Thorax 2013;68:962–3. 10.1136/thoraxjnl-2013-203534
    1. Gimeno-Santos E, Frei A, Steurer-Stey C, et al. . Determinants and outcomes of physical activity in patients with COPD: a systematic review. Thorax 2014;69:731–9. 10.1136/thoraxjnl-2013-204763
    1. Vaes AW, Garcia-Aymerich J, Marott JL, et al. . Changes in physical activity and all-cause mortality in COPD. Eur Respir J 2014;44:1199–209. 10.1183/09031936.00023214
    1. Shrikrishna D, Patel M, Tanner RJ, et al. . Quadriceps wasting and physical inactivity in patients with COPD. Eur Respir J 2012;40:1115–22. 10.1183/09031936.00170111
    1. Watz H, Waschki B, Meyer T, et al. . Physical activity in patients with COPD. Eur Respir J 2009;33:262–72. 10.1183/09031936.00024608
    1. Cindy Ng LW, Mackney J, Jenkins S, et al. . Does exercise training change physical activity in people with COPD? A systematic review and meta-analysis. Chron Respir Dis 2012;9:17–26. 10.1177/1479972311430335
    1. Troosters T, Bourbeau J, Maltais F, et al. . Enhancing exercise tolerance and physical activity in COPD with combined pharmacological and non-pharmacological interventions: PHYSACTO randomised, placebo-controlled study design. BMJ Open 2016;6:e010106 10.1136/bmjopen-2015-010106
    1. Watz H, Mailänder C, Baier M, et al. . Effects of indacaterol/glycopyrronium (QVA149) on lung hyperinflation and physical activity in patients with moderate to severe COPD: a randomised, placebo-controlled, crossover study (The MOVE Study). BMC Pulm Med 2016;16:95 10.1186/s12890-016-0256-7
    1. Conn VS, Hafdahl AR, Brown SA, et al. . Meta-analysis of patient education interventions to increase physical activity among chronically ill adults. Patient Educ Couns 2008;70:157–72. 10.1016/j.pec.2007.10.004
    1. Altenburg WA, ten Hacken NH, Bossenbroek L, et al. . Short- and long-term effects of a physical activity counselling programme in COPD: a randomized controlled trial. Respir Med 2015;109:112–21. 10.1016/j.rmed.2014.10.020
    1. Mendoza L, Horta P, Espinoza J, et al. . Pedometers to enhance physical activity in COPD: a randomised controlled trial. Eur Respir J 2015;45:347–54. 10.1183/09031936.00084514
    1. Field MJ, Institute of Medicine CoECAoT. Telemedicine: a guide to assessing telecommunications in health care. Washington DC: National Academy Press, 1996.
    1. Moy ML, Collins RJ, Martinez CH, et al. . An internet-mediated pedometer-based program improves health-related quality-of-life domains and daily step counts in COPD: a randomized controlled trial. Chest 2015;148:128–37. 10.1378/chest.14-1466
    1. Middelweerd A, Mollee JS, van der Wal CN, et al. . Apps to promote physical activity among adults: a review and content analysis. Int J Behav Nutr Phys Act 2014;11:97 10.1186/s12966-014-0097-9
    1. Rabinovich RA, Louvaris Z, Raste Y, et al. . Validity of physical activity monitors during daily life in patients with COPD. Eur Respir J 2013;42:1205–15. 10.1183/09031936.00134312
    1. Van Remoortel H, Raste Y, Louvaris Z, et al. . Validity of six activity monitors in chronic obstructive pulmonary disease: a comparison with indirect calorimetry. PLoS ONE 2012;7:e39198 10.1371/journal.pone.0039198
    1. Demeyer H, Burtin C, Van Remoortel H, et al. . Standardizing the analysis of physical activity in patients with COPD following a pulmonary rehabilitation program. Chest 2014;146:318–27. 10.1378/chest.13-1968
    1. Tudor-Locke C, Craig CL, Thyfault JP, et al. . A step-defined sedentary lifestyle index: <5000 steps/day. Appl Physiol Nutr Metab 2013;38:100–14. 10.1139/apnm-2012-0235
    1. Demeyer H, Burtin C, Hornikx M, et al. . The minimal important difference in physical activity in patients with COPD. PLoS ONE 2016;11:e0154587 10.1371/journal.pone.0154587
    1. Sasaki JE, John D, Freedson PS. Validation and comparison of ActiGraph activity monitors. J Sci Med Sport 2011;14:411–16. 10.1016/j.jsams.2011.04.003
    1. Miller MR, Hankinson J, Brusasco V, et al. . Standardisation of spirometry. Eur Respir J 2005;26:319–38. 10.1183/09031936.05.00034805
    1. Quanjer PH, Tammeling GJ, Cotes JE, et al. . Lung volumes and forced ventilatory flows—report working party standardization of lung-function tests European-Community for Steel and Coal—official statement of the European Respiratory Society. Eur Respir J 1993;6(Suppl 16):5–40. 10.1183/09041950.005s1693
    1. Holland AE, Spruit MA, Troosters T, et al. . An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J 2014;44:1428–46. 10.1183/09031936.00150314
    1. Maltais F, Decramer M, Casaburi R, et al. . 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 2014;189:e15–62. 10.1164/rccm.201402-0373ST
    1. Nguyen HQ, Gill DP, Wolpin S, et al. . Pilot study of a cell phone-based exercise persistence intervention post-rehabilitation for COPD. Int J Chron Obstruct Pulmon Dis 2009;4:301–13. 10.2147/COPD.S6643
    1. Tabak M, Vollenbroek-Hutten MM, van der Valk PD, et al. . A telerehabilitation intervention for patients with Chronic Obstructive Pulmonary Disease: a randomized controlled pilot trial. Clin Rehabil 2014;28:582–91. 10.1177/0269215513512495
    1. Burtin C, Langer D, van Remoortel H, et al. . Physical activity counselling during pulmonary rehabilitation in patients with COPD: a randomised controlled trial. PLoS ONE 2015;10:e0144989 10.1371/journal.pone.0144989
    1. Maddocks M, Kon SS, Canavan JL, et al. . Physical frailty and pulmonary rehabilitation in COPD: a prospective cohort study. Thorax 2016;71: 988–95. 10.1136/thoraxjnl-2016-208460
    1. Alahmari AD, Mackay AJ, Patel AR, et al. . Influence of weather and atmospheric pollution on physical activity in patients with COPD. Respir Res 2015;16:71 10.1186/s12931-015-0229-z
    1. Langer D, Demeyer H, Troosters T, et al. . The importance of physical activity for COPD health. ERS Monogr 2015;69:224–39.
    1. Spruit MA, Pitta F, McAuley E, et al. . Pulmonary rehabilitation and physical activity in patients with COPD. Am J Respir Crit Care Med 2015;192:924–33.
    1. Durheim MT, Smith PJ, Babyak MA, et al. . Six-minute-walk distance and accelerometry predict outcomes in chronic obstructive pulmonary disease independent of Global Initiative for Chronic Obstructive Lung Disease 2011 Group. Ann Am Thorac Soc 2015;12:349–56. 10.1513/AnnalsATS.201408-365OC
    1. ICT facts and figures, the world in 2015. accessed on 2–7–2015.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit