The effects of a physical activity counseling program after an exacerbation in patients with Chronic Obstructive Pulmonary Disease: a randomized controlled pilot study

BMC Pulmonary Medicine

Thierry Troosters¹  Wim Janssens¹  Carlos Augusto Camillo¹  Heleen Demeyer¹  Miek Hornikx² 

[1] Department of Respiratory Diseases, University Hospitals Leuven, KU Leuven-University of Leuven, Leuven, B-3000, Belgium;Department of Cardiovascular Diseases, University Hospitals Leuven, KU Leuven-University of Leuven, Leuven, B-3000, Belgium

关键词: Real-time feedback;    Physical activity counseling;    Exacerbation;    COPD;   

Others  :  1231051
DOI  :  10.1186/s12890-015-0126-8

 received in 2015-01-14, accepted in 2015-10-12,  发布年份 2015

【 摘 要 】

Background

In some patients with COPD, the disease is characterized by exacerbations. Severe exacerbations warrant a hospitalization, with prolonged detrimental effects on physical activity. Interventions after an exacerbation may improve physical activity, with longstanding health benefits. Physical activity counseling and real-time feedback were effective in stable COPD. No evidence is available on the use of this therapeutic modality in patients after a COPD exacerbation.

Methods

Thirty patients were randomly assigned to usual care or physical activity counseling, by telephone contacts at a frequency of 3 times a week and real-time feedback. Lung function, peripheral muscle strength, functional exercise capacity, symptom experience and COPD-related health status were assessed during hospital stay and 1 month later.

Results

Both groups significantly recovered in physical activity (PAsteps: control group: 1013 ± 1275 steps vs intervention group: 984 ± 1208 steps (p = 0.0005); PAwalk: control group: 13 ± 14 min vs intervention group: 13 ± 16 min (p = 0.0002)), functional exercise capacity (control group: 64 ± 59 m (p = 0.002) vs intervention group: 67 ± 84 m (p = 0.02)) and COPD-related health status (CAT: control group: −5 [−7 to 1] (p = 0.02) vs intervention group: −3 [−10 to 1] points (p = 0.03)). No differences between groups were observed.

Conclusion

From our pilot study, we concluded that telephone based physical activity counseling with pedometer feedback after an exacerbation did not result in better improvements in physical activity and clinical outcomes compared to usual care. Because of the difficult recruitment and the negative intermediate analyses, this study was not continued.

Trial registration

Clinicaltrials.gov NCT02223962. Registered 4 September 2013.

【 授权许可】

   
2015 Hornikx et al.

【 图 表 】

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【 参考文献 】

• [1]Decramer M, Janssens W, Miravitlles M. Chronic obstructive pulmonary disease. Lancet. 2012; 379:1341-51.
• [2]Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P 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; 176:532-55.
• [3]Roca M, Verduri A, Corbetta L, Clini E, Fabbri LM, Beghe B. Mechanisms of acute exacerbation of respiratory symptoms in chronic obstructive pulmonary disease. Eur J Clin Invest. 2013; 43:510-21.
• [4]Rodriguez-Roisin R. COPD exacerbations.5: management. Thorax. 2006; 61:535-44.
• [5]Wedzicha JA, Seemungal TA. COPD exacerbations: defining their cause and prevention. Lancet. 2007; 370:786-96.
• [6]Burtin C, Decramer M, Gosselink R, Janssens W, Troosters T. Rehabilitation and acute exacerbations. Eur Respir J. 2011; 38:702-12.
• [7]Pitta F, Troosters T, Probst VS, Spruit MA, Decramer M, Gosselink R. Physical activity and hospitalization for exacerbation of COPD. Chest. 2006; 129:536-44.
• [8]Thorpe O, Kumar S, Johnston K. Barriers to and enablers of physical activity in patients with COPD following a hospital admission: a qualitative study. Int J Chron Obstruct Pulmon Dis. 2014; 9:115-28.
• [9]Garcia-Aymerich J, Lange P, Benet M, Schnohr P, Anto JM. Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study. Thorax. 2006; 61:772-8.
• [10]Waschki B, Kirsten A, Holz O, Muller KC, Meyer T, Watz H et al.. Physical activity is the strongest predictor of all-cause mortality in patients with COPD: a prospective cohort study. Chest. 2011; 140:331-42.
• [11]Vaes AW, Cheung A, Atakhorrami M, Groenen MT, Amft O, Franssen FM et al.. Effect of ‘activity monitor-based’ counseling on physical activity and health-related outcomes in patients with chronic diseases: a systematic review and meta-analysis. Ann Med. 2013; 45:397-412.
• [12]Watz H, Pitta F, Rochester CL, Garcia-Aymerich J, ZuWallack R, Troosters T et al.. An official European Respiratory Society statement on physical activity in COPD. Eur Respir J. 2014; 44(6):1521-37.
• [13]Coronado M, Janssens JP, de Muralt B, Terrier P, Schutz Y, Fitting JW. Walking activity measured by accelerometry during respiratory rehabilitation. J Cardiopulm Rehabil. 2003; 23:357-64.
• [14]Dallas MI, McCusker C, Haggerty MC, Rochester CL, ZuWallack R. Using pedometers to monitor walking activity in outcome assessment for pulmonary rehabilitation. Chron Respir Dis. 2009; 6:217-24.
• [15]Egan C, Deering BM, Blake C, Fullen BM, McCormack NM, Spruit MA et al.. Short term and long term effects of pulmonary rehabilitation on physical activity in COPD. Respir Med. 2012; 106:1671-9.
• [16]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; 31:52-9.
• [17]Mercken EM, Hageman GJ, Schols AM, Akkermans MA, Bast A, Wouters EF. Rehabilitation decreases exercise-induced oxidative stress in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005; 172:994-1001.
• [18]Pitta F, Troosters T, Probst VS, Langer D, Decramer M, Gosselink R. Are patients with COPD more active after pulmonary rehabilitation? Chest. 2008; 134:273-80.
• [19]Sewell L, Singh SJ, Williams JE, Collier R, Morgan MD. Can individualized rehabilitation improve functional independence in elderly patients with COPD? Rev Port Pneumol. 2005; 11:593-6.
• [20]Steele BG, Belza B, Hunziker J, Holt L, Legro M, Coppersmith J et al.. Monitoring daily activity during pulmonary rehabilitation using a triaxial accelerometer. J Cardiopulm Rehabil. 2003; 23:139-42.
• [21]Steele BG, Belza B, Cain KC, Coppersmith J, Lakshminarayan S, Howard J et al.. A randomized clinical trial of an activity and exercise adherence intervention in chronic pulmonary disease. Arch Phys Med Rehabil. 2008; 89:404-12.
• [22]Walker PP, Burnett A, Flavahan PW, Calverley PM. Lower limb activity and its determinants in COPD. Thorax. 2008; 63:683-9.
• [23]Jones SE, Green SA, Clark AL, Dickson MJ, Nolan AM, Moloney C et al.. Pulmonary rehabilitation following hospitalisation for acute exacerbation of COPD: referrals, uptake and adherence. Thorax. 2014; 69:181-2.
• [24]Arnold E, Bruton A, Ellis-Hill C. Adherence to pulmonary rehabilitation: a qualitative study. Respir Med. 2006; 100:1716-23.
• [25]Garrod R, Marshall J, Barley E, Jones PW. Predictors of success and failure in pulmonary rehabilitation. Eur Respir J. 2006; 27:788-94.
• [26]Greening NJ, Williams JE, Hussain SF, Harvey-Dunstan TC, Bankart MJ, Chaplin EJ et al.. An early rehabilitation intervention to enhance recovery during hospital admission for an exacerbation of chronic respiratory disease: randomised controlled trial. BMJ. 2014; 349:g4315.
• [27]Taylor R, Dawson S, Roberts N, Sridhar M, Partridge MR. Why do patients decline to take part in a research project involving pulmonary rehabilitation? Respir Med. 2007; 101:1942-6.
• [28]Breyer MK, Breyer-Kohansal R, Funk GC, Dornhofer N, Spruit MA, Wouters EF et al.. Nordic walking improves daily physical activities in COPD: a randomised controlled trial. Respir Res. 2010; 11:112. BioMed Central Full Text
• [29]Recio-Rodriguez JI, Martin-Cantera C, Gonzalez-Viejo N, Gomez-Arranz A, Arietaleanizbeascoa MS, Schmolling-Guinovart Y et al.. Effectiveness of a smartphone application for improving healthy lifestyles, a randomized clinical trial (EVIDENT II): study protocol. BMC Public Health. 2014; 14:254. BioMed Central Full Text
• [30]Butler L, Furber S, Phongsavan P, Mark A, Bauman A. Effects of a pedometer-based intervention on physical activity levels after cardiac rehabilitation: a randomized controlled trial. J Cardiopulm Rehabil Prev. 2009; 29:105-14.
• [31]Guiraud T, Granger R, Gremeaux V, Bousquet M, Richard L, Soukarie L et al.. Telephone support oriented by accelerometric measurements enhances adherence to physical activity recommendations in noncompliant patients after a cardiac rehabilitation program. Arch Phys Med Rehabil. 2012; 93:2141-7.
• [32]De Blok BM, de Greef MH, ten Hacken NH, Sprenger SR, Postema K, Wempe JB. 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.
• [33]Hospes G, Bossenbroek L, ten Hacken NH, van Hengel P, de Greef MH. Enhancement of daily physical activity increases physical fitness of outclinic COPD patients: results of an exercise counseling program. Patient Educ Couns. 2009; 75:274-8.
• [34]Moy ML, Janney AW, Nguyen HQ, Matthess KR, Cohen M, Garshick E et al.. Use of pedometer and internet-mediated walking program in patients with chronic obstructive pulmonary disease. J Rehabil Res Dev. 2010; 47:485-96.
• [35]Pitta F, Troosters T, Spruit MA, Probst VS, Decramer M, Gosselink R. Characteristics of physical activities in daily life in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005; 171:972-7.
• [36]Van Remoortel H, Raste Y, Louvaris Z, Giavedoni S, Burtin C, Langer D et al.. Validity of six activity monitors in chronic obstructive pulmonary disease: a comparison with indirect calorimetry. PLoS One. 2012; 7: Article ID e39198
• [37]Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A et al.. Standardisation of spirometry. Eur Respir J. 2005; 26:319-38.
• [38]Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC. Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl. 1993; 16:5-40.
• [39]Decramer M, Lacquet LM, Fagard R, Rogiers P. Corticosteroids contribute to muscle weakness in chronic airflow obstruction. Am J Respir Crit Care Med. 1994; 150:11-6.
• [40]Troosters T, Gosselink R, Decramer M. Six minute walking distance in healthy elderly subjects. Eur Respir J. 1999; 14:270-4.
• [41]Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999; 54:581-6.
• [42]Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Kline LN. Development and first validation of the COPD assessment test. Eur Respir J. 2009; 34:648-54.
• [43]Kon SS, Canavan JL, Jones SE, Nolan CM, Clark AL, Dickson MJ et al.. Minimum clinically important difference for the COPD assessment test: a prospective analysis. Lancet Respir Med. 2014; 2:195-203.
• [44]Evans WJ, Morley JE, Argiles J, Bales C, Baracos V, Guttridge D et al.. Cachexia: a new definition. Clin Nutr. 2008; 27:793-9.