Using step counters to promote physical activity and exercise capacity in patients with chronic obstructive pulmonary disease: a meta-analysis

Abstract

Background: Although step counters are popularly employed for physical rehabilitation in chronic obstructive pulmonary disease (COPD) patients, their effectiveness is inconsistent and even questioned. This meta-analysis aimed to investigate whether step counter use increases physical activity or improves exercise capacity in COPD patients.

Methods: Electronic databases were searched for randomized controlled trials that assessed the efficacy of step counter use in increasing physical activity or in improving exercise capacity. Data were aggregated using a random-effects model to get the overall effect sizes [standard mean difference (SMD) with 95% confidence interval (CI)], and subgroup analyses were performed.

Results: A total of 15 trials enrolling 1316 patients with moderate to severe COPD were included. Step counter use increased physical activity compared with controls (SMD = 0.57, 95% CI 0.31-0.84), which is equal to a magnitude of 1026 steps/day in daily steps. It also enhanced exercise capacity with an effect size of 0.30 (95% CI 0.16-0.45), approximating to a magnitude of 11.6 m in the 6-min walking distance. Step counter use could augment physical activity (SMD = 0.64, 95% CI 0.19-1.08) and exercise capacity (SMD = 0.32, 95% CI 0.01-0.62) for patients receiving pulmonary rehabilitation. Yet it cannot enhance physical activity or exercise capacity in patients with severe COPD or among studies with intervention durations ⩾6 months (both p > 0.50).

Conclusions: Step counter use increases physical activity and improves exercise capacity in COPD patients, at least in the short term, which supports the notion of recommending step counter use in COPD management.

Keywords: chronic obstructive pulmonary disease; exercise capacity; physical activity; step counter.

Figure 1.

Flow diagram of literature search and selection processes. COPD, chronic obstructive pulmonary disease; RCT, randomized controlled trial. ^aTwo articles enrolled the same groups of patients but with different follow-up periods,^, which were treated as 1 RCT, while one article provided three different comparisons, resulting in 3 separate RCTs, 15 RCTs in total were therefore included.

Figure 2.

Effect sizes of step counter use on physical activity in patients with chronic obstructive pulmonary disease. CI, confidence interval; PR, pulmonary rehabilitation; SD, standard deviation; SMD, standard mean difference; UC, usual care. ^aThis study enrolled patients from general practice. ^bThis study enrolled in outpatient hospital clinics. ^cThis study enrolled patients from a pulmonary rehabilitation center (i.e. receiving pulmonary rehabilitation programs). ^dData were collected using the methods described in Supplementary Table S2.

Figure 3.

Effect sizes of step counter use on exercise capacity in patients with chronic obstructive pulmonary disease. CI, confidence interval; PR, pulmonary rehabilitation; SD, standard deviation; SMD, standard mean difference; UC, usual care. ^aThis study enrolled patients from general practice. ^bThis study enrolled in outpatient hospital clinics. ^cThis study enrolled patients from a pulmonary rehabilitation center (i.e. receiving pulmonary rehabilitation programs). ^dData were collected using the methods described in Supplementary Table S2.