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Randomized Controlled Trial
. 2016 Aug 8;18(8):e215.
doi: 10.2196/jmir.5622.

Long-Term Effects of an Internet-Mediated Pedometer-Based Walking Program for Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial

Marilyn L Moy  1 , Carlos H Martinez, Reema Kadri, Pia Roman, Robert G Holleman, Hyungjin Myra Kim, Huong Q Nguyen, Miriam D Cohen, David E Goodrich, Nicholas D Giardino, Caroline R Richardson
Affiliations
Randomized Controlled Trial

Long-Term Effects of an Internet-Mediated Pedometer-Based Walking Program for Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial

Marilyn L Moy et al. J Med Internet Res. .

Abstract

Background: Regular physical activity (PA) is recommended for persons with chronic obstructive pulmonary disease (COPD). Interventions that promote PA and sustain long-term adherence to PA are needed.

Objective: We examined the effects of an Internet-mediated, pedometer-based walking intervention, called Taking Healthy Steps, at 12 months.

Methods: Veterans with COPD (N=239) were randomized in a 2:1 ratio to the intervention or wait-list control. During the first 4 months, participants in the intervention group were instructed to wear the pedometer every day, upload daily step counts at least once a week, and were provided access to a website with four key components: individualized goal setting, iterative feedback, educational and motivational content, and an online community forum. The subsequent 8-month maintenance phase was the same except that participants no longer received new educational content. Participants randomized to the wait-list control group were instructed to wear the pedometer, but they did not receive step-count goals or instructions to increase PA. The primary outcome was health-related quality of life (HRQL) assessed by the St George's Respiratory Questionnaire Total Score (SGRQ-TS); the secondary outcome was daily step count. Linear mixed-effect models assessed the effect of intervention over time. One participant was excluded from the analysis because he was an outlier. Within the intervention group, we assessed pedometer adherence and website engagement by examining percent of days with valid step-count data, number of log-ins to the website each month, use of the online community forum, and responses to a structured survey.

Results: Participants were 93.7% male (223/238) with a mean age of 67 (SD 9) years. At 12 months, there were no significant between-group differences in SGRQ-TS or daily step count. Between-group difference in daily step count was maximal and statistically significant at month 4 (P<.001), but approached zero in months 8-12. Within the intervention group, mean 76.7% (SD 29.5) of 366 days had valid step-count data, which decreased over the months of study (P<.001). Mean number of log-ins to the website each month also significantly decreased over the months of study (P<.001). The online community forum was used at least once during the study by 83.8% (129/154) of participants. Responses to questions assessing participants' goal commitment and intervention engagement were not significantly different at 12 months compared to 4 months.

Conclusions: An Internet-mediated, pedometer-based PA intervention, although efficacious at 4 months, does not maintain improvements in HRQL and daily step counts at 12 months. Waning pedometer adherence and website engagement by the intervention group were observed. Future efforts should focus on improving features of PA interventions to promote long-term behavior change and sustain engagement in PA.

Clinicaltrial: Clinicaltrials.gov NCT01102777; https://clinicaltrials.gov/ct2/show/NCT01102777 (Archived by WebCite at http://www.webcitation.org/6iyNP9KUC).

Keywords: Internet; bronchitis, chronic; emphysema; exercise; motor activity; pulmonary disease, chronic obstructive; quality of life.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared. This study was initiated by the investigators, who do not receive any financial support from Omron Healthcare. The results of this study do not constitute endorsement of the Omron pedometer by the authors.

Figures

Figure 1
Figure 1
CONSORT diagram at 12 months.
Figure 2
Figure 2
Mean daily step count and 95% confidence intervals by month of study. Note: the Taking Healthy Steps (THS) curve is shifted to the right of the control curve on the x-axis for ease of visual display. Baseline data are included at month zero.
Figure 3
Figure 3
Percentage and 95% confidence intervals of days with valid step-count data in the intervention group by month of study.
Figure 4
Figure 4
Mean log-ins and 95% confidence intervals in the intervention group by month of study.
See this image and copyright information in PMC

References

    1. Moy ML, Danilack VA, Weston NA, Garshick E. Daily step counts in a US cohort with COPD. Respir Med. 2012 Jul;106(7):962–969. doi: 10.1016/j.rmed.2012.03.016. http://linkinghub.elsevier.com/retrieve/pii/S0954-6111(12)00126-6 - DOI - PMC - PubMed
    1. Waschki B, Kirsten AM, Holz O, Mueller K, Schaper M, Sack A, Meyer T, Rabe KF, Magnussen H, Watz H. Disease progression and changes in physical activity in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2015 Aug 1;192(3):295–306. doi: 10.1164/rccm.201501-0081OC. - DOI - PubMed
    1. Van Remoortel H, Hornikx M, Demeyer H, Langer D, Burtin C, Decramer M, Gosselink R, Janssens W, Troosters T. Daily physical activity in subjects with newly diagnosed COPD. Thorax. 2013 Oct;68(10):962–963. doi: 10.1136/thoraxjnl-2013-203534. http://thorax.bmj.com/cgi/pmidlookup?view=long&pmid=23604460 - DOI - PMC - PubMed
    1. Hurst JR, Vestbo J, Anzueto A, Locantore N, Müllerova H, Tal-Singer R, Miller B, Lomas DA, Agusti A, Macnee W, Calverley P, Rennard S, Wouters EF, Wedzicha JA, Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) Investigators Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med. 2010 Sep 16;363(12):1128–1138. doi: 10.1056/NEJMoa0909883. - DOI - PubMed
    1. Pitta F, Troosters T, Probst VS, Spruit MA, Decramer M, Gosselink R. Physical activity and hospitalization for exacerbation of COPD. Chest. 2006 Mar;129(3):536–544. doi: 10.1378/chest.129.3.536. - DOI - PubMed

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