Efficacy of an mHealth intervention to stimulate physical activity in COPD patients after pulmonary rehabilitation

Abstract

Physical inactivity in patients with chronic obstructive pulmonary disease (COPD) is associated with poor health status and increased disease burden. The present study aims to test the efficacy of a previously developed mobile (m)Health intervention to improve or maintain physical activity in patients with COPD after pulmonary rehabilitation.A randomised controlled trial was performed in 32 physiotherapy practices in the Netherlands. COPD patients were randomised into intervention or usual care groups. The intervention consisted of a smartphone application for the patients and a monitoring website for the physiotherapists. Measurements were performed at 0, 3, 6 and 12 months. Physical activity, functional exercise capacity, lung function, health-related quality of life and body mass index were assessed.157 patients started the study and 121 completed it. There were no significant positive effects of the intervention on physical activity (at 0 months: intervention 5824±3418 steps per weekday, usual care 5717±2870 steps per weekday; at 12 months: intervention 4819±2526 steps per weekday, usual care 4950±2634 steps per weekday; p=0.811) or on the secondary end-points. There was a significant decrease over time in physical activity (p<0.001), lung function (p<0.001) and mastery (p=0.017), but not in functional exercise capacity (p=0.585).Although functional exercise capacity did not deteriorate, our mHealth intervention did not improve or maintain physical activity in patients with COPD after a period of pulmonary rehabilitation.

Smartphone-Based Physical Activity Telecoaching in Chronic Obstructive Pulmonary Disease: Mixed-Methods Study on Patient Experiences and Lessons for Implementation (Preprint)

“…Adherence with the step counter was excellent, in line with previous studies [4,7,10,11]. By contrast, adherence with the smartphone tasks was lower.…”

“…This is in contrast to a 4-week pilot (telecoaching) study which showed a positive relationship between the degree of adherence of wearing a smartphone-based activity coach and the benefits from the intervention during the first two weeks albeit this association disappearing during the third week [10]. Despite a high degree of adherence with the PA telecoaching program (89.0% of the days used) in the trial by Vorrink and colleagues [20], the program was not able to induce significant improvements in PA [7]. The latter might be partly explained by the low degree of adherence of the primary care physiotherapists (due to financial reasons and time constraints) in using the foreseen website to adjust the patient's PA goals and to send motivating messages to the patients, which highlights the importance of introducing (semi-)…”

“…It offers the possibility of coaching patients from a distance in an automated or semi-automated way, reducing the burden of face-to-face interactions for patients and health care providers. Telecoaching has shown to be effective in enhancing PA in some studies [4,5,6], but not in others [7]. The present mixed methods study was conducted as a planned part of a multicenter PA telecoaching trial (MrPAPP study), which had a positive outcome [5].…”

Advances in rehabilitation for chronic diseases: improving health outcomes and function

“…Interventions that use technology such as the internet and wearable devices have shown promise in supporting home based physical activity 109110111112113114. Most recently, tele-rehabilitation efforts used videoconferencing for home virtual supervision, but this still required personnel time and specialized exercise equipment 115116117118…”

Promoting physical activity in COPD: Insights from a randomized trial of a web-based intervention and pedometer use

“…pedometers, accelerometers) with goal-setting can increase daily PA in COPD patients [15]. Many types of goal-setting, including in-person counseling, daily diary use [18, 19], and messaging through smartphone applications[20, 21], have demonstrated short-term efficacy in increasing daily PA among COPD patients. In our previous Taking Healthy Steps (THS) study[22], goal-setting was mediated through the use of a pedometer (Omron HJ-720 ITC, Omron Healthcare, Inc., Bannockburn, IL) plus a website based on the Theory of Self-Regulation which provided individualized step-count goals, iterative step-count feedback, education on disease self-management and motivation, and an online community of social support.…”