Results from a Multi-Site Web-Based Physical Activity Intervention in COPD: Between Group and Site Differences

Robinson, Stephanie A.; Goldstein, Rebekah L.; Rivera, P.N. Cruz; Kadri, Reema; Cooper, John A.; Richardson, Caroline R.; Moy, Marilyn L.

doi:10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a2507

Cited by 3 publications

(13 citation statements)

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“…30 As previously published in two separate RCTs, participants assigned to our PA intervention experienced a significantly greater improvement in daily step counts compared to those who did not use the intervention. 18,[25][26][27] In this retrospective analysis of combined datasets, participants in group 1 improved their daily step counts compared to those in group (β=705 steps/day, 95% CI 261, 1,148; p=0.0020).…”

Section: Impact Of Web-based Pa Intervention On Painmentioning

confidence: 77%

“…The impact of our PA intervention on BP score was evaluated using a generalized linear regression model adjusting for age, percent predicted FEV1, BMI, dyspnea, and cohort. Finally, given our previous results demonstrating that our PA intervention is associated with a significant increase in daily step counts, 26,27 we evaluated pain as an effect modifier for the impact of the PA intervention on daily step counts using an interaction term (group*BP score). All analyses were performed in SAS software version 9.4 (Cary, NC, USA)…”

Section: Discussionmentioning

confidence: 99%

“…26 Cohort 3 (n=108) included people enrolled from VA Boston from 2015-2019 for a RCT in which participants were assigned to the technology-based PA intervention or usual care (NCT02099799). 27 People randomized to the intervention arm participated in the same web-based, pedometer-mediated intervention (Table 1). All protocols were approved by the VA Boston Healthcare System Institutional Review Board on Human Subjects Research (Protocol #1961, Protocol #2328, Protocol #2791), and written informed consent was obtained from participants.…”

Section: Study Participantsmentioning

confidence: 99%

“…This intervention has previously been shown to increase PA and improve HRQL at three and six months. 26,27 To evaluate the impact of the PA intervention on pain, study participants were divided into groups based on participation in the PA intervention. Group 1, those assigned to the intervention (n=111), consisted of participants in cohort 2 (n=57) and cohort 3 (n=54).…”

Section: Study Participantsmentioning

confidence: 99%

“…In addition, understanding the prevalence of pain in this population and studying how technology-based PA interventions impact pain are critical to effectively implement the GOLD recommendation to promote PA in all persons with stable COPD. 14 We have previously studied Veterans with COPD who self-selected to enroll in research studies using accelerometers and pedometers to directly measure PA. 18,[25][26][27] In one observational cohort study, we measured daily step counts over 14 days at two time points, 3 months apart, and evaluated the association between PA and 6MWT, HRQL, and acute exacerbation. 18,25 In two separate studies, we demonstrated the efficacy of a web-based, pedometer-mediated intervention to increase PA. 26,27 In this retrospective secondary analysis, we combined these three well-characterized cohorts in order to (1) understand the prevalence of pain in persons with COPD who are ready to engage in PA, (2) evaluate the cross-sectional and longitudinal associations between pain and exercise capacity (6WMT distance) and PA (directly measured daily step counts), (3) examine the impact of our web-based pedometer-mediated PA intervention on pain, and (4) assess the impact of pain on the response to our PA intervention.…”

Section: Introductionmentioning

confidence: 99%

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Pain in Veterans with COPD: Relationship with Physical Activity and Exercise Capacity

Raphaely

Mongiardo

Goldstein

et al. 2021

Preprint

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Background: Pain is a common but underappreciated symptom experienced by people with Chronic Obstructive Pulmonary Disease (COPD). The relationships between pain and physical activity (PA) and exercise capacity are poorly understood. Methods: This retrospective secondary analysis included three cohorts of Veterans with COPD and objective measures of PA (daily step counts) and exercise capacity (6-minute walk test [6MWT] distance) who participated in longitudinal studies evaluating PA. Pain was assessed using the Bodily Pain (BP) domain of the Veterans RAND-36. In two cohorts, participants were randomly assigned to a web-based, pedometer-mediated PA intervention which has previously been demonstrated to improve PA. Results: Three-hundred and seventy-three (373) unique study participants were included in this analysis. Eighty-three percent (n=311) of the population reported at least mild pain and/or at least a little bit of interference due to pain at baseline. Cross-sectionally, greater BP was associated with lower 6MWT distance (β=0.51; 95% CI 0.20, 0.82; p=0.0013). Longitudinally, worsening BP was associated with a decline in 6MWT distance (β=0.30; 95% CI 0.03, 0.58; p=0.0312). There was no association between baseline BP and baseline daily step counts, baseline BP and change in PA, or change in BP and change in PA. Compared to usual care, our PA intervention improved BP scores (β=6.17; 95% CI 1.84, 10.45; p=0.0054). BP scores did not affect the impact of the intervention on daily step counts.Conclusion: Pain is highly prevalent and significantly associated with lower exercise capacity among Veterans with COPD. Worsening pain co-occurred with decline in exercise capacity but not PA. Our intervention reduced pain, although pain did not affect the impact of the intervention on PA.

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Section: Impact Of Web-based Pa Intervention On Painmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Study Participantsmentioning

confidence: 99%

Section: Study Participantsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pain in Veterans with COPD: Relationship with Physical Activity and Exercise Capacity

Raphaely

Mongiardo

Goldstein

et al. 2021

Preprint

View full text Add to dashboard Cite

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A randomised trial of a web-based physical activity self-management intervention in COPD

et al. 2021

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Improving exercise capacity is a primary objective in chronic obstructive pulmonary disease (COPD). Declines in exercise capacity result in reduced physical activity (PA) and health-related quality of life (HRQL). Self-management interventions can teach patients skills and behaviours to manage their disease. Technology-mediated interventions have the potential to provide easily accessible support for disease self-management. We evaluated the effectiveness of a web-based self-management intervention, focused on PA promotion, on exercise capacity in COPD. This 6-month randomised controlled trial (NCT02099799) enrolled 153 persons with COPD at two U.S. sites (VABoston, n=108; VABirmingham, n=45). Participants were allocated (1:1) to the web-based self-management intervention (PA promotion through personalised, progressive step-count goals, feedback, online COPD-related education, and social support via an online community), or usual care. The primary outcome was exercise capacity (6-min walk test distance [6 MWD]). Secondary outcomes included PA (daily steps per day), HRQL (St. George's Respiratory Questionnaire Total Score), dyspnoea, COPD-related knowledge, and social support. Change in step-count goals reflected intervention engagement. Participants were 69±7 years old, mean FEV1% predicted 61±21%. Change in 6 MWD did not differ between groups. Intervention participants improved daily step counts by an average of 1312 more than usual care (p<0.001). Groups did not differ on other secondary outcomes. VABirmingham participants were significantly more engaged with the intervention, although site did not modify the effect of the intervention on 6 MWD or secondary outcomes. The intervention did not improve exercise capacity, but improved PA at 6 months. Additional intervention modifications are needed to optimise its COPD self-management capabilities.

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Co-occurrence of pain and dyspnea in Veterans with COPD: Relationship to functional status and a pilot study of neural correlates using structural and functional magnetic resonance imaging

et al. 2021

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Persons with COPD experience co-occurring dyspnea and pain. Little is known about the relationship between symptom co-occurrence with physical activity (PA) and exercise. Novel diagnostic tools are needed for accurate symptom discrimination. In this secondary analysis, we examined relationships between baseline assessments of pain, dyspnea, objectively measured PA, and exercise capacity in persons with COPD who previously enrolled in three PA studies. Pain was assessed with the bodily pain domain of the Veterans RAND-36 (VR-36), and dyspnea with the modified Medical Research Council (mMRC) scale. Average daily step count was assessed with the Omron HJ-720ITC or FitBit Zip pedometer, and exercise capacity with 6-minute walk test (6MWT). We also conducted a pilot neuroimaging study. Neuroimaging data were acquired on a Siemens 3-Tesla Magnetom Prismafit whole-body scanner. Analysis of variance assessed trends in daily step count and 6MWT distance across categories of co-occurring pain and dyspnea. General linear models examined relationships between cortical thickness and resting state functional connectivity (fc) with symptoms and functional status. In 373 Veterans, 98% were male with mean age 70.5± 8.3 years and FEV1% predicted 59 ± 21%. Compared to those with no co-occurrence of pain and dyspnea, those with co-occurrence walked 1,291–1,444 fewer steps per day and had an 80–85 m lower 6MWT distance. Ten males participated in the pilot neuroimaging study. Predominant findings were that lower cortical thickness and greater fc were associated with higher pain and dyspnea, p<0.05. Greater cortical thickness and lower fc were associated with higher daily step count and 6MWT distance, p<0.05. Regional patterns of associations differed for pain and dyspnea, suggesting that cortical thickness and fc may discriminate symptoms. Co-occurring dyspnea and pain in COPD are associated with significant reductions in PA and exercise capacity. It may be feasible for neuroimaging markers to discriminate between pain and dyspnea.

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Results from a Multi-Site Web-Based Physical Activity Intervention in COPD: Between Group and Site Differences

Cited by 3 publications

References 0 publications

Pain in Veterans with COPD: Relationship with Physical Activity and Exercise Capacity

Pain in Veterans with COPD: Relationship with Physical Activity and Exercise Capacity

A randomised trial of a web-based physical activity self-management intervention in COPD

Co-occurrence of pain and dyspnea in Veterans with COPD: Relationship to functional status and a pilot study of neural correlates using structural and functional magnetic resonance imaging

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