Chronic obstructive pulmonary disease (COPD) continues to become a larger percentage of underlying causes of death in adults in the US. Evidence shows that increased physical activity is the strongest predictor of mortality in these patients. Specifically, daily step counts predict acute exacerbations and hospitalizations as a result of COPD.
A pedometer is an inexpensive and widely available tool for a patient to keep track of their daily steps. In a study published in Chest, researchers demonstrated that adding an internet-based coaching tool improves patients’ daily step counts and quality of life.
In the study, both control and intervention groups tracked their daily step counts with the same model pedometer (Omron HJ-720ITC). To get baseline step counts, both groups wore the pedometers every day for a week with the display covered by a sticker. They uploaded their data at the end of the week.
Afterwards, the control group was only instructed to wear the pedometer every day and upload their daily step counts at least monthly. The only online access they had was to their weekly step count.
On the other hand, the intervention group uploaded their data weekly. They had access to a website with 4 components:
- iterative step-count feedback for self-monitoring
- educational and motivational content
- an online community forum for social support
- weekly individualized step count goals
Weekly goals were calculated based on their previous step counts (with a maximum of 10,000 steps per day).
The intervention group increased their mean daily step counts by 13% (447 steps) by the end of 4 months. In the same time period, there was not a statistically significant change in step count in the control group.
The researchers also looked at the effect of a number of potential predictors on daily step counts: age, baseline daily step count, severity of dyspnea, current smoking status, current oxygen use, and number of comorbidities. The only one that turned out to have an association was age. Each increasing year was associated with a 33 step decrease.
There was no significant difference in health-related quality of life between the two groups. Interestingly though, a larger proportion of the intervention group showed clinically significant improvement in this area compared to the control group. This difference was statistically significant.
Quality of life was further broken down into 3 domains: symptoms, impact, and activities. Impact was a measure of psychosocial issues caused by COPD and activities was a measure of caused, or were affected, by dyspnea.
When broken down into these three domains, the intervention group performed significantly better in symptoms and impact. There was still no statistically significant difference in the activities domain.
The takeaway from the study is COPD patients clearly benefit from the simple online tools provided in the study. With the possible exception of the online forum, these tools require little to no modification from developers after initially being created. Even the most complicated part of the initial creation is a relatively simple algorithm.
These tools could be made available by the creators of the study or easily replicated by any developer. If healthcare providers encourage their patients to use them, the evidence shows that they are likely to result in improved quality of life and greater physical activity: the strongest predictor of mortality in this group.
Sources: Morbidity and Mortality Weekly Report, Chest, PLoS One, Annals of the American Thoracic Society, Chest
