Effect of Physical Activity Coaching on Acute Care and Survival Among Patients With Chronic Obstructive Pulmonary Disease

Abstract

Key Points Question What is the real-world effectiveness of a 12-month community-based physical activity (PA) coaching intervention on reducing all-cause acute care use and death in patients with a history of a chronic obstructive pulmonary disease (COPD) exacerbation? Findings In this multisite, randomized clinical trial that included a population-based sample of 2707 patients with COPD, 321 of 1358 patients participated in the PA coaching intervention and increased PA significantly, but there were no significant differences in the all-cause primary outcome (compostite measure of all-cause hospitalizations, observation stays, emergency department visits, and death) at 12 months. Meaning Most patients with a COPD exacerbation did not engage in PA, and the limited PA did not lead to significant benefit in 12-month health care use.

Estimating and testing an index of bias attributable to composite outcomes in comparative studies

“…One study had the same association measure for both the composite outcome and any-cause death (BACO index = 1). 24 BACO index was lower than one in the other 16 studies, 25,26,[35][36][37][38][39][40][27][28][29][30][31][32][33][34] and the BACO was statistically significant in three of them. These works included the study by Yasuda et al in which a monotherapy with rivaroxaban (a non-vitamin K antagonist oral anticoagulant) was compared to a combination therapy with rivaroxaban plus a single antiplatelet agent.…”

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.…”

“…39 Sessions were conducted either in-person (n = 3 studies), 16,17,35 via telephone call (n = 2 studies), 29,38 or using combined methods (in-person, online, phone, text, and/or mail; n = 11 studies). 19,21,22,28,[31][32][33][34]36,37,39 Method of contact with participants was not reported in 2 studies. 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).…”

Innovative Strategies to Facilitate Patient-Centered Research in Multiple Chronic Conditions

“…Pragmatic trials allow for the evaluation of complex interventions in settings that more closely resemble the daily realities of managing MCC. For example, a recent pragmatic trial examined a physical activity intervention in over 2700 patients with chronic obstructive pulmonary disease, a burdensome condition associated with medical complexity and poor quality of life [ 11 ]. The study evaluated both traditional and patient-centered outcomes, and had few exclusion criteria, allowing for a cohort that reflected real-world patients and experiences.…”