Public Release:  An Internet-mediated exercise program improves quality of life in COPD patients

American Thoracic Society

ATS 2014, SAN DIEGO ─ A pedometer-based walking program supported by Internet-based instruction and support can improve health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD), according to a new study presented at the 2014 American Thoracic Society International Conference.

"Low levels of physical activity among individuals with COPD can contribute to impaired quality of life and have been linked to higher risk of exacerbations, hospitalizations, and death. However, getting patients to change behavior and stick to an exercise program can be difficult," said lead author Marilyn Moy, MD of the Department of Veterans Affairs, VA Boston Healthcare System and Assistant Professor of Medicine at Harvard Medical School. "In our study, supporting an exercise program with online resources that provided instruction, individualized goals and timely feedback, COPD-specific education, and support improved HRQOL and daily step count in COPD patients compared with those who were given a pedometer alone ."

The study involved 238 Veterans with COPD who were recruited nationally and 45% of whom lived in rural areas. Participants were randomized to either the pedometer-based exercise program with access to the support website or to the group using a pedometer alone. HRQOL at baseline and four-month follow-up was measured with the St. George's Respiratory Questionnaire (SGRQ). Daily step count to assess engagement in physical activity was a secondary outcome.

A significantly greater proportion of persons in the intervention group than in the control group had at least a 4-unit improvement in SGRQ-TS (53% vs. 39% respectively, P=0.05), the minimum clinically important difference. There was no significant between-group difference in 4-month SGRQ-TS (2.3 units, P=0.14). For domain scores, the intervention group had a significantly lower (reflecting better HRQL) mean than control group by 4.6 units for Symptoms (P=0.046) and by 3.3 units for Impact (P=0.049). Compared to control group, participants in the intervention group walked 779 more steps per day at 4 months (P=0.005).

"This Internet-based intervention significantly improved HRQOL and daily step count in our patients with COPD," said Dr. Moy. "The results are exciting because patients can walk more to make themselves feel better and potentially change the disease course. The potential for this safe and accessible home-based intervention to sustain exercise in persons with COPD, to complement existing pulmonary rehabilitation programs, and to be integrated into COPD self-management programs merits further study."

Dr. Moy and her colleagues are launching a study funded by VA Rehabilitation R&D which will look at whether this intervention impacts 6 minute walk test distance and risk of exacerbations and hospitalizations in persons with COPD.

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* Please note that numbers in this release may differ slightly from those in the abstract. Many of these investigations are ongoing; the release represents the most up-to-date data available at press time.

Abstract 50511

An Internet-Mediated, Pedometer-Based Walking Program Improves HRQL In Veterans With COPD
Type: Scientific Abstract
Category: 15.04 - Pulmonary Rehabilitation: Education/Self-Management/Action Plans (PR)
Authors: M.L. Moy1, R. Collins2, C.H. Martinez2, R. Kadri3, P. Roman3, R.G. Holleman3, H.M. Kim3, H.Q. Nguyen4, M.D. Cohen5, D.E. Goodrich2, N.D. Giardino2, C.R. Richardson3; 1Department of Veterans Affairs, VA Boston Healthcare System, Harvard Medical School - Boston, MA/US, 2University of Michigan Health System - Ann Arbor, MI/US, 3VA Ann Arbor Healthcare System - Ann Arbor, MI/US, 4Kaiser Permanente Southern California - Pasadena, CA/US, 5VA New York Harbor - Brooklyn, NY/US

Abstract Body

Background: Persons with COPD typically have low levels of physical activity, which is associated with low health-related quality of life (HRQL). Interventions to increase physical activity could improve HRQL.

Objective: To test the effect of an internet-mediated, pedometer-based walking intervention on HRQL in COPD.

Methods: 238 Veterans with an ICD-9 code for COPD were recruited nationally and randomized in a 2:1 ratio to exercise intervention (website plus Omron pedometer) or a wait-list control (pedometer alone). The St. George's Respiratory Questionnaire (SGRQ) assessed HRQL at baseline and 4 months. Participants in the intervention group had access to the study website which provided individualized goals and feedback, education, and an online community. They were instructed to upload step-counts at least once a week. Subjects in the wait-list control group used the pedometer, but had no access to content on the website and had no instructions to exercise. T-tests compared baseline subject characteristics between groups. Paired t-tests compared SGRQ Total Score (SGRQ-TS) and domain scores (Symptoms, Activities, Impacts) at 4 months to baseline within arms. Linear regression models assessed the effect of study arm on SGRQ scores. Covariates included baseline SGRQ scores, age, sex, MMRC dyspnea score, smoking status, and rural/urban status.

Results: Subjects, mean age 67 ± 9 years, were 94% male. 45% of subjects lived in a rural setting, as determined by zip codes matched with the Rural Urban Commuting Area Codes. 221 participants had complete SGRQ data; 5 additional patients had responses that allowed calculation of at least one domain score. There were no significant differences in baseline characteristics between study arms. Those within the intervention group showed significant improvement in SGRQ-TS by 3.2 units (P <0.001). There was no significant difference in SGRQ-TS (2.5 units, P=0.1) between the two groups. A greater proportion of persons in the intervention than in the control group had at least a 4-unit improvement in SGRQ-TS (53% vs 39%, P=0.05). For domain scores, Symptoms improved by 7.2 units (P <0.001) and Impacts by 2.8 units (P<0.05) among those in the intervention group. Those within the control group showed no significant changes. Compared to control, those in the intervention had an improvement of 5.1 units (P=0.02) for Symptoms and 3.6 units (P=0.04) for Impacts scores. There was no significant difference in Activities score (0.7 unit, P=0.71) between the two groups.

Conclusion: An Internet-mediated, pedometer-based exercise intervention improves HRQL in persons with COPD.

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