Physical activity is increased by a 12-week semiautomated telecoaching programme in patients with COPD: a multicentre randomised controlled trial

Abstract

Rationale: Reduced physical activity (PA) in patients with COPD is associated with a poor prognosis. Increasing PA is a key therapeutic target, but thus far few strategies have been found effective in this patient group.

Objectives: To investigate the effectiveness of a 12-week semiautomated telecoaching intervention on PA in patients with COPD in a multicentre European randomised controlled trial.

Methods: 343 patients from six centres, encompassing a wide spectrum of disease severity, were randomly allocated to either a usual care group (UCG) or a telecoaching intervention group (IG) between June and December 2014. This 12-week intervention included an exercise booklet and a step counter providing feedback both directly and via a dedicated smartphone application. The latter provided an individualised daily activity goal (steps) revised weekly and text messages as well as allowing occasional telephone contacts with investigators. PA was measured using accelerometry during 1 week preceding randomisation and during week 12. Secondary outcomes included exercise capacity and health status. Analyses were based on modified intention to treat.

Main results: Both groups were comparable at baseline in terms of factors influencing PA. At 12 weeks, the intervention yielded a between-group difference of mean, 95% CI (lower limit - upper limit; ll-ul) +1469, 95% CI (971 to 1965) steps/day and +10.4, 95% CI (6.1 to 14.7) min/day moderate PA; favouring the IG (all p≤0.001). The change in 6-min walk distance was significantly different (13.4, 95% CI (3.40 to 23.5) m, p<0.01), favouring the IG. In IG patients, an improvement could be observed in the functional state domain of the clinical COPD questionnaire (p=0.03) compared with UCG. Other health status outcomes did not differ.

Conclusions: The amount and intensity of PA can be significantly increased in patients with COPD using a 12-week semiautomated telecoaching intervention including a step counter and an application installed on a smartphone.

Trial registration number: NCT02158065.

Keywords: Exercise; Pulmonary Rehabilitation.

Figure 1

Flow chart for the calculation of the new goal (steps) during the intervention period.

Figure 2

Consolidated Standards of Reporting Trials (CONSORT) diagram. Valid data based on two weekdays with at least eight hours of wearing time during baseline and final visit. *No information on screening in site of Edinburgh. ACT, Actigraph; ATH, Athens; DAM, Dynaport Movemonitor; EDI, Edinburgh; GRO, Groningen; LEU, Leuven; LON, London; PA, physical activity; ZUR, Zurich.

Figure 3

Changes in physical activity by group. Patients in the intervention group presented in solid line, and patients in the control group presented as dotted line. Data are presented as mean, 95% (ll to ul); Steps and time in at least moderate physical activity (MPA) analyses are based on Actigraph measurement and include 140 control and 140 intervention patients, Walking time and movement intensity (MI) are based on Dynaport Movemonitor measurement and include 132 control and 129 intervention patients. *indicates significant within-group changes (p<0.05). NS, not significant.

Figure 4

Between-group differences in mean step count, adjusted for baseline data. Data are presented for the different subgroups, based on baseline characteristics; Global Initiative for Chronic Obstructive Lung Disease (GOLD) quadrants based on modified Medical Research Council (mMRC) to classify symptoms; number of patients mMRC (<2 vs ≥2; 166 vs 114), 6-min walk distance (6MWD) (≥450 vs <450 m; 140 vs 138), comorbidity (<2 vs ≥2; 238 vs 42), GOLD quadrants (A–B vs C–D; 129 vs 151), steps (≥5000 vs <5000; 115 vs 165); data represented as mean between-group effect with 95% CI. Numbers indicate the percentage of patients of the subgroup in the control/intervention group. Analyses are based on 278 patients for 6MWD and 280 for mMRC, comorbidity, GOLD and physical activity subgroups.