Pedometers to enhance physical activity in COPD: a randomised controlled trial

Laura Mendoza, Paula Horta, José Espinoza, Miguel Aguilera, Nicolás Balmaceda, Ariel Castro, Mauricio Ruiz, Orlando Díaz, Nicholas S Hopkinson, Laura Mendoza, Paula Horta, José Espinoza, Miguel Aguilera, Nicolás Balmaceda, Ariel Castro, Mauricio Ruiz, Orlando Díaz, Nicholas S Hopkinson

Abstract

Physical inactivity is a cardinal feature of chronic obstructive pulmonary disease (COPD), and is associated with increased morbidity and mortality. Pedometers, which have been used in healthy populations, might also increase physical activity in patients with COPD. COPD patients taking part in a 3-month individualised programme to promote an increase in their daily physical activity were randomised to either a standard programme of physical activity encouragement alone, or a pedometer-based programme. Assessments were performed by investigators blinded to treatment allocation. Change in average 1-week daily step count, 6-min walking distance (6MWD), modified Medical Research Council scale, St George's respiratory questionnaire (SGRQ) and COPD assessment test (CAT) were compared between groups. 102 patients were recruited, of whom 97 completed the programme (pedometer group: n=50; control group: n=47); 60.8% were male with a mean±sd age of 68.7±8.5 years, and forced expiratory volume in 1 s (FEV1) 66.1±19.4% and FEV1/forced vital capacity 55.2±9.5%. Both groups had comparable characteristics at baseline. The pedometer group had significantly greater improvements in: physical activity 3080±3254 steps·day(-1) versus 138.3±1950 steps·day(-1) (p<0.001); SGRQ -8.8±12.2 versus -3.8±10.9 (p=0.01); CAT score -3.5±5.5 versus -0.6±6.6 (p=0.001); and 6MWD 12.4±34.6 versus -0.7±24.4 m (p=0.02) than patients receiving activity encouragement only. A simple physical activity enhancement programme using pedometers can effectively improve physical activity level and quality of life in COPD patients.

Conflict of interest statement

Conflict of interest: None declared.

Copyright ©ERS 2015.

Figures

FIGURE 1
FIGURE 1
CONSORT (Consolidated Standards of Reporting Trials) flow diagram of the study participants.
FIGURE 2
FIGURE 2
Significant differences in a) step count, b) health status, c) chronic obstructive pulmonary disease assessment test (CAT) and d) 6-min walking distance (6MWD) response between the control group and the pedometer group. SGRQ: St George’s Respiratory Questionnaire. ––––: mean; ······: zero values; - - -: level of minimal clinical difference for each variable [, –25].
FIGURE 3
FIGURE 3
Monthly increase in step count for patients in the pedometer group. Data are presented as mean with error bars representing sem of the daily steps obtained at each monthly visit during follow-up. ANOVA: p<0.001. Comparison between basal and 1 month of follow-up (p=0.026, CI=−3110–−125), 1–2 months of follow-up (p=0.071, CI=−2930–69.8) and 2–3 months of follow-up (p=0.20, CI=−1850–1160).

References

    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: 731–739.
    1. Shrikrishna D, Patel M, Tanner RJ, et al. . Quadriceps wasting and physical inactivity in patients with COPD. Eur Respir J 2012; 40: 1115–1122.
    1. Watz H, Waschki B, Meyer T, et al. . Physical activity in patients with COPD. Eur Respir J 2009; 33: 262–272.
    1. Pitta F, Troosters T, Spruit MA, et al. . Characteristics of physical activities in daily life in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2005; 171: 972–977.
    1. Kelly JL, Elkin SL, Fluxman J, et al. . Breathlessness and skeletal muscle weakness in patients undergoing lung health screening in primary care. COPD 2013; 10: 40–54.
    1. Waschki B, Kirsten A, Holz O, et al. . Physical activity is the strongest predictor of all-cause mortality in patients with COPD: a prospective cohort study. Chest 2011; 140: 331–342.
    1. Parada A, Klaassen J, Lisboa C, et al. . Reducción de la actividad física en pacientes con enfermedad pulmonar obstructiva crónica [Reduction of physical activity in patients with chronic obstructive pulmonary disease]. Rev Med Chile 2011; 139: 1562–1572.
    1. Garcia-Aymerich J, Lange P, Benet M, et al. . Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study. Thorax 2006; 61: 772–778.
    1. Hopkinson NS, Polkey MI. Does physical inactivity cause chronic obstructive pulmonary disease?. Clin Sci (Lond) 2010; 118: 565–572.
    1. Swallow EB, Gosker HR, Ward KA, et al. . A novel technique for nonvolitional assessment of quadriceps muscle endurance in humans. J Appl Physiol 2007; 103: 739–746.
    1. Vestbo J, Hurd SS, Agusti AG, et al. . Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2013; 187: 347–365.
    1. Bravata DM, Smith-Spangler C, Sundaram V, et al. . Using pedometers to increase physical activity and improve health: a systematic review. JAMA 2007; 298: 2296–2304.
    1. Dodd JW, Hogg L, Nolan J, et al. . The COPD assessment test (CAT): response to pulmonary rehabilitation. A multicentre, prospective study. Thorax 2011; 66: 425–429.
    1. Lacasse Y, Goldstein R, Lasserson TJ, et al. . Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2006; 4: CD003793.
    1. Egan C, Deering BM, Blake C, et al. . Short term and long term effects of pulmonary rehabilitation on physical activity in COPD. Respir Med 2012; 106: 1671–1679.
    1. Rabe KF, Hurd S, Anzueto A, et al. . Global Strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD Executive Summary. Am J Respir Crit Care Med 2007; 176: 532–555.
    1. Mendoza IL, Espinoza RJ, Aguilera RM, et al. . Programa de incentivo de la actividad física apoyado con contadores de pasos en la enfermedad pulmonar obstructiva crónica [A program of physical activity enhancement using pedometers in chronic obstructive pulmonary disease]. Rev Chil Enferm Respir 2013; 29: 135–140.
    1. Miller MR, Hankinson J, Brusasco V, et al. . Standardisation of spirometry. Eur Respir J 2005; 26: 319–338.
    1. Bestall JC, Paul EA, Garrod R, et al. . Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax 1999; 54: 581–586.
    1. Jones PW, Quirk FH, Baveystock CM, et al. . A self-complete measure of health status for chronic airflow limitation. The St. George’s Respiratory Questionnaire. Am Rev Respir Dis 1992; 145: 1321–1327.
    1. Jones PW, Harding G, Berry P, et al. . Development and first validation of the COPD Assessment Test. Eur Respir J 2009; 34: 648–654.
    1. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002; 166: 111–117.
    1. Polkey MI, Spruit MA, Edwards LD, et al. . Six-minute-walk test in chronic obstructive pulmonary disease: minimal clinically important difference for death or hospitalization. Am J Respir Crit Care Med 2013; 187: 382–386.
    1. Kon SS, Canavan JL, Jones SE, et al. . Minimum clinically important difference for the COPD Assessment Test: a prospective analysis. Lancet Respir Med 2014; 2: 195–203.
    1. Jones PW. St. George’s respiratory questionnaire: MCID. COPD 2005; 2: 75–79.
    1. Mador MJ, Patel AN, Nadler J. Effects of pulmonary rehabilitation on activity levels in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil Prev 2011; 31: 52–59.
    1. Bastin A, Starling L, Ahmed R, et al. . High prevalence of undiagnosed and severe chronic obstructive pulmonary disease at first hospital admission with acute exacerbation. Chron Respir Dis 2010; 7: 91–97.
    1. Yohannes A, Stone R, Lowe D, et al. . Pulmonary rehabilitation in the United Kingdom. Chron Respir Dis 2011; 8: 193–199.
    1. Nici L, Donner C, Wouters E, et al. . American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med 2006; 173: 1390–1413.
    1. Casaburi R, ZuWallack R. Pulmonary rehabilitation for management of chronic obstructive pulmonary disease. N Engl J Med 2009; 360: 1329–1335.
    1. de Blok BM, de Greef MH, ten Hacken NH, et al. . The effects of a lifestyle physical activity counseling program with feedback of a pedometer during pulmonary rehabilitation in patients with COPD: a pilot study. Patient Educ Couns 2006; 61: 48–55.
    1. Puente-Maestu L, Sanz ML, Sanz P, et al. . Comparison of effects of supervised versus self-monitored training programmes in patients with chronic obstructive pulmonary disease. Eur Respir J 2000; 15: 517–525.
    1. Hospes G, Bossenbroek L, Ten Hacken NH, et al. . Enhancement of daily physical activity increases physical fitness of outclinic COPD patients: results of an exercise counseling program. Patient Educ Couns 2009; 75: 274–278.
    1. Wewel AR, Gellermann I, Schwertfeger I, et al. . Intervention by phone calls raises domiciliary activity and exercise capacity in patients with severe COPD. Respir Med 2008; 102: 20–26.
    1. Moy ML, Weston NA, Wilson EJ, et al. . A pilot study of an Internet walking program and pedometer in COPD. Respir Med 2012; 106: 1342–1350.
    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: 582–591.
    1. Jones RC, Price D, Ryan D, et al. . Opportunities to diagnose chronic obstructive pulmonary disease in routine care in the UK: a retrospective study of a clinical cohort. Lancet Respir Med 2014; 2: 267–276.
    1. Moy ML, Teylan M, Danilack VA, et al. . An index of daily step count and systemic inflammation predicts clinical outcomes in chronic obstructive pulmonary disease. Ann Am Thoracic Soc 2014; 11: 149–157.
    1. Garcia-Rio F, Rojo B, Casitas R, et al. . Prognostic value of the objective measurement of daily physical activity in patients with COPD. Chest 2012; 142: 338–346.
    1. Moy ML, Teylan M, Weston NA, et al. . Daily step count predicts acute exacerbations in a US cohort with COPD. PLoS One 2013; 8: e60400.
    1. Celli B, Cote C, Marin J, et al. . The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med 2004; 350: 1005–1012.

Source: PubMed

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