Sustaining training effects through physical activity coaching (STEP): a randomized controlled trial

Abstract

Background: Pulmonary rehabilitation (PR) programs improve physical fitness, symptoms and quality of life (QoL) of patients with COPD. However, improved physical activity (PA) is not guaranteed after PR and the clinical benefits fade off after PR discharge. We aimed to investigate whether a 9 months PA-telecoaching program is able to improve PA of patients with COPD, after 3 months of PR and if this leads to maintenance of PR-acquired benefits.

Methods: Patients with COPD enrolled in a 6-month PR program were randomized to a (semi-automated) PA-telecoaching program or usual care, 3 months after PR initiation. The intervention consisted of a smartphone application with individual targets and feedback (for 6 months) and self-monitoring with a step counter (for 9 months). Patients were followed up for 9 months after randomization. Primary outcome was PA (daily step count by accelerometery), secondary outcomes were exercise tolerance, quadriceps force, dyspnea and QoL.

Results: Seventy-three patients were included (mean ± SD: 65 ± 7 years, FEV₁ 49 ± 19%, 6MWD 506 ± 75 m, PA 5225 ± 2646 steps/day). The intervention group presented a significant improvement in steps/day at every visit compared to usual care (between-group differences mean ± SE: 1431 ± 555 steps/day at 9 months after randomization, p = 0.01). Secondary outcomes did not differ between the groups.

Conclusion: The semi-automated PA-telecoaching program implemented after 3 months of PR was effective to improve the amount of PA (steps/day) during PR and after follow-up. However, this was not accompanied by the maintenance of other PR-acquired benefits.

Trial registration: ClinicalTrials.gov. Identifier: NCT02702791. Retrospectively registered on March 9, 2016. Start study October 2015. https://clinicaltrials.gov/ct2/show/NCT02702791?term=NCT02702791&draw=2&rank=1 .

Keywords: Chronic obstructive pulmonary disease; Physical activity; Rehabilitation and telemedicine.

Fig. 1

Study design. Four study visits: a visit at randomization (i.e. after 3 months of PR; V0), a visit at the end of PR (i.e. after 6 months of PR; V1), a visit after 3 months of follow-up from PR (V2) and a visit after 6 months of follow-up from PR (V3). Data at the start of PR (i.e. 3 months before randomization) were also used for analysis (V-1). Patients were followed up for 9 months after initiation of the PA telecoaching program. PR, pulmonary rehabilitation; V, visit; UCG, usual care group; IG, intervention group

Fig. 2

Flow diagram of STEP trial. Numbers refer to the total number of patients evaluated at each timepoint, independently of obtaining valid physical activity measures. PR, pulmonary rehabilitation program; COPD, Chronic Obstructive Pulmonary Disease; m, months; V, visit. Each visit (i.e. V-1, V0, V1, V2, V3) has an interval of 3 months in between

Fig. 3

Comparison of the changes in PA between patients from both the IG and UCG, adjusted for daylight at each visit point. p-values indicate the interaction effect (with V0 as the reference). PA; physical activity; IG, intervention group; UCG, usual care group; n, number; m, months; PR, pulmonary rehabilitation. Data based on multiple imputation