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Promoting physical activity in COPD: Insights from a randomized trial of a web-based intervention and pedometer use.

ABSTRACT: Low physical activity is highly prevalent among COPD patients and is associated with increased healthcare utilization and mortality and reduced HRQL. The addition of a website to pedometer use is effective at increasing physical activity; however, the timeline of change and impact of environmental factors on efficacy is unknown.U.S. Veterans with COPD were randomized (1:1) to receive either (1) a pedometer and website which provided goal-setting, feedback, disease-specific education, and an online community forum or (2) pedometer alone for 3 months. Primary outcome was change in daily step count. Secondary outcomes included 6MWT distance, HRQL, dyspnea, depression, COPD knowledge, exercise self-efficacy, social support, motivation, and confidence to exercise. Generalized linear mixed-effects models evaluated the effect of the pedometer plus website compared to pedometer alone.Data from 109 subjects (98.5% male, mean age 68.6 ± 8.3 years) were analyzed. At 13 weeks, subjects in the pedometer plus website group had significant increases daily step count from baseline relative to the pedometer alone group (804 ± 356.5 steps per day, p = 0.02). The pedometer plus website group had significant improvements in daily step count from baseline beginning in week 3 which were sustained until week 13. In subgroup analyses, the pedometer plus website attenuated declines in daily step count during the transition from summer to fall. No significant differences in secondary outcomes were noted between groups.A website added to pedometer use improves daily step counts, sustains walking over 3 months, and attenuates declines in physical activity due to season.

SUBMITTER: Wan ES

PROVIDER: S-EPMC5718161 | biostudies-literature | 2017 Sep

REPOSITORIES: biostudies-literature

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Promoting physical activity in COPD: Insights from a randomized trial of a web-based intervention and pedometer use.

Wan Emily S ES Kantorowski Ana A Homsy Diana D Teylan Merilee M Kadri Reema R Richardson Caroline R CR Gagnon David R DR Garshick Eric E Moy Marilyn L ML

Respiratory medicine 20170725

<h4>Rationale</h4>Low physical activity is highly prevalent among COPD patients and is associated with increased healthcare utilization and mortality and reduced HRQL. The addition of a website to pedometer use is effective at increasing physical activity; however, the timeline of change and impact of environmental factors on efficacy is unknown.<h4>Methods</h4>U.S. Veterans with COPD were randomized (1:1) to receive either (1) a pedometer and website which provided goal-setting, feedback, disea ...[more]

PMID: 29206627

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Project description:BackgroundComputer-tailored physical activity (PA) interventions delivered through the Internet represent a promising and appealing method to promote PA at a population level. However, personalized advice is mostly provided based on subjectively measured PA, which is not very accurate and might result in the delivery of advice that is not credible or effective. Therefore, an innovative computer-tailored PA advice was developed, based on objectively pedometer-measured PA.ObjectiveThe study aim was to evaluate the effectiveness of a computer-tailored, pedometer-based PA intervention in working adults.MethodsParticipants (≥18 years) were recruited between May and December 2012 from eight Flemish workplaces. These workplaces were allocated randomly to an intervention or control group. Intervention group participants (n=137) received (1) a booklet with information on how to increase their steps, (2) a non-blinded pedometer, and (3) an Internet link to request computer-tailored step advice. Control group participants (n=137) did not receive any of the intervention components. Self-reported and pedometer-based PA were assessed at baseline (T0), and 1 month (T1) and 3 months (T2) months post baseline. Repeated measures analyses of covariance were used to examine intervention effects for both the total sample and the at-risk sample (ie, adults not reaching 10,000 steps a day at baseline).ResultsThe recruitment process resulted in 274 respondents (response rate of 15.1%) who agreed to participate, of whom 190 (69.3%) belonged to the at-risk sample. Between T0 and T1 (1-month post baseline), significant intervention effects were found for participants' daily step counts in both the total sample (P=.004) and the at-risk sample (P=.001). In the at-risk sample, the intervention effects showed a daily step count increase of 1056 steps in the intervention group, compared to a decrease of 258 steps in the control group. Comparison of participants' self-reported PA revealed a significant intervention effect for time spent walking in the at-risk sample (P=.02). Intervention effects were still significant 3 months post baseline for participants' daily step counts in both the total sample (P=.03) and the at-risk sample (P=.02); however, self-reported PA differences were no longer significant.ConclusionsA computer-tailored, pedometer-based PA intervention was effective in increasing both pedometer-based and self-reported PA levels, mainly in the at-risk participants. However, more effort should be devoted to recruit and retain participants in order to improve the public health impact of the intervention.Trial registrationClinicalTrials.gov: NCT02080585; https://clinicaltrials.gov/ct2/show/NCT02080585 (Archived by WebCite at http://www.webcitation.org/6VvQnRQSy).

Project description:BackgroundDespite many advantages of web-based health behavior interventions such as wide accessibility or low costs, these interventions are often accompanied by high attrition rates, particularly in usage under real-life conditions. It would therefore be helpful to implement strategies such as the use of financial incentives to motivate program participation and increase adherence.ObjectiveThis naturalistic study examined real-life usage data of a 12-week web-based physical activity (PA) intervention (Fitness Coach) among insurants who participated in an additional incentive program (incentive group) and those who did not (nonincentive group). Users in the incentive group had the perspective of receiving €30 (about US $33) cash back at the end of the intervention.MethodsRegistration and real-life usage data as part of routine data management and evaluation of the Fitness Coach were analyzed between September 2016 and June 2018. Depending on the duration of use and the weekly recording of tasks, 4 adherence groups (low, occasional, strong, and complete adherence) were defined. Demographic characteristics were collected by a self-reported questionnaire at registration. We analyzed baseline predictors and moderators of complete adherence such as participation in the program, age, gender, and BMI using binary logistic regressions.ResultsA total of 18,613 eligible persons registered for the intervention. Of these, 15,482 users chose to participate in the incentive program (incentive group): mean age 42.4 (SD 14.4) years, mean BMI 24.5 (SD 4.0) kg/m2, median (IQR) BMI 23.8 (21.7-26.4) kg/m2; 65.12% (10,082/15,482) female; and 3131 users decided not to use the incentive program (nonincentive group): mean age 40.7 (SD 13.4) years, mean BMI 26.2 (SD 5.0) kg/m2, median BMI 25.3 (IQR 22.6-28.7) kg/m2; 72.18% (2260/3131) female. At the end of the intervention, participants in the incentive program group showed 4.8 times higher complete adherence rates than those in the nonincentive program group (39.2% vs 8.1%), also yielding significantly higher odds to complete the intervention (odds ratio [OR] 12.638) for the incentive program group. Gender significantly moderated the effect with men in the incentive group showing higher odds to be completely adherent than women overall and men in the nonincentive group (OR 1.761). Furthermore, older age and male gender were significant predictors of complete adherence for all participants, whereas BMI did not predict intervention completion.ConclusionsThis is the first naturalistic study in the field of web-based PA interventions that shows the potential of even small financial incentives to increase program adherence. Male users, in particular, seem to be strongly motivated by incentives to complete the intervention. Based on these findings, health care providers can use differentiated incentive systems to increase regular participation in web-based PA interventions.

Project description:ObjectiveNurses make up the majority of the workforce in any healthcare system. Physical inactivity due to heavy workloads has been widely reported among nurses. This study aimed to examine whether a self-liberation intervention could help nurses increase their physical activity levels that would result in other health benefits.MethodsA two-armed randomized controlled trial was implemented among 40 nurses (20 per arm). The control arm received information about the benefits of physical activity, but with no intervention. The intervention arm received the same information and were given pedometers for 12 weeks to record their daily steps while also receiving weekly reminders. Measurements were taken for anthropometric data, self-reported physical activity, exercise stage-of-change, exercise self-efficacy, and pedometer steps (intervention arm only). All statistical analyses were two-sided, with p ⩽ 0.05.ResultsThe respondents' mean age was 47.9 ± 7.02 years with 90% being female. After the intervention, the intervention arm achieved a higher self-efficacy score (4.60 ± 1.75 to 5.63 ± 2.48) while a decline was observed in the control arm (5.02 ± 2.08 to 4.50 ± 1.90). At baseline, 16.7% (n = 3) of the control arm and 27.8% (n = 5) of the intervention arm were classified as moderately physically active (McNemar's test = 1.20, p = 0.549). After 12 weeks, this proportion increased to 27.7% (n = 5) in the control arm and 50.0% (n = 9) in the intervention arm (McNemar's test = 5.00, p = 0.172). For the intervention arm, mean daily step counts rose from 8889 ± 579.84 at week 1 to 9930 ± 986.52 at week 12 and reached the level of statistical significance (p < 0.01). Waist circumference of the intervention arm decreased significantly more than that of the control group (p < 0.01).ConclusionThe self-liberation intervention using a pedometer had positive effects on assisting sedentary nursing staff to progress through the stages of health behavior change and on their exercise self-efficacy, which could further help increase their exercise adherence and overall physical and mental wellbeing.

Dataset Information

Promoting physical activity in COPD: Insights from a randomized trial of a web-based intervention and pedometer use.

Publications

Promoting physical activity in COPD: Insights from a randomized trial of a web-based intervention and pedometer use.

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