A web-based physical activity intervention benefits persons with low self-efficacy in COPD: results from a randomized controlled trial.
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SUBMITTER: Robinson SA
PROVIDER: S-EPMC8111682 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Improving exercise capacity is a primary objective in COPD. Declines in exercise capacity result in reduced physical activity and health-related quality of life (HRQoL). Self-management interventions can teach patients skills and behaviours to manage their disease. Technology-mediated interventions have the potential to provide easily accessible support for disease self-management. We evaluated the effectiveness of a web-based self-management intervention, focused on physical activity promotion, on exercise capacity in COPD. This 6-month randomised controlled trial (NCT02099799) enrolled 153 persons with COPD at two US sites (VABoston, n=108; VABirmingham, n=45). Participants were allocated (1:1) to the web-based self-management intervention (physical activity promotion through personalised, progressive step-count goals, feedback, online COPD-related education and social support via an online community) or usual care. The primary outcome was exercise capacity (6-min walk distance (6 MWD)). Secondary outcomes included physical activity (daily steps per day), HRQoL (St. George's Respiratory Questionnaire Total Score), dyspnoea, COPD-related knowledge and social support. Change in step-count goals reflected intervention engagement. Participants' mean age was 69 (sd=7), and mean forced expiratory volume in 1 s % predicted was 61% (sd=21%). Change in 6MWD did not differ between groups. Intervention participants improved their mean daily step counts by 1312 more than those in the usual care group (p<0.001). Groups did not differ on other secondary outcomes. VABirmingham participants were significantly more engaged with the intervention, although site did not modify the effect of the intervention on 6MWD or secondary outcomes. The intervention did not improve exercise capacity but improved physical activity at 6 months. Additional intervention modifications are needed to optimise its COPD self-management capabilities.
| S-EPMC8405869 | biostudies-literature
Project description:ObjectiveTo estimate the cost savings associated with a pedometer-based, web-mediated physical activity intervention in a cohort of US veterans with chronic obstructive pulmonary disease (COPD).Study designEconomic analysis.MethodsWe constructed a decision tree from the health care system perspective incorporating adjusted relative risk of a pedometer-based, web-mediated intervention for COPD-related acute exacerbations, acute exacerbation-related costs (ie, emergency department visits and hospitalizations), and intervention-related costs. Total COPD-related costs were estimated per patient across 12 months. Probabilistic sensitivity analysis with Monte Carlo simulation was used to estimate uncertainty in the model findings.ResultsIn the deterministic (base case) model, the model estimated costs to be $4236 per participant who used the pedometer-based, web-mediated intervention compared with $7913 per participant in the control group (estimated $3677 saved in 1 year compared with the control group). The model findings were robust to probabilistic sensitivity analysis, with a difference in mean costs of $4582 (95% probability interval, $4084-$5080; P < .001). Cost savings in the model were driven by the adjusted relative risk of the web-based intervention, probability of a COPD-related acute exacerbation, rate of hospitalization, probability of hospitalization, and cost of hospitalization.ConclusionsA pedometer-based, web-mediated physical activity intervention yielded substantial cost savings. Increased implementation of the intervention could markedly reduce the economic burden of COPD for payers and patients.
| S-EPMC10760514 | biostudies-literature
Project description:This study examined the malleability of math self-efficacy (SE) among children with poor calculation fluency via an intervention that targeted four sources of SE (mastery experiences, vicarious experiences, social persuasions, and emotional and physiological states). The effect of pure strategy training was contrasted with an intervention that integrated strategy training and explicit SE support. Moreover, the changes in SE source experiences and their relation with math SE, as well as the relation between math-SE profiles and calculation fluency development, were examined. In a quasi-experimental design, 60 Finnish children with calculation fluency problems in Grades 2 to 4 participated in strategy training (N = 38) or in an intervention that integrated SE support with strategy training (N = 32) for 12 weeks. The results showed that the explicit SE intervention integrated with strategy training enhanced math SE among children with poor calculation fluency and low SE (effect size, r = 0.61). Changes in mastery experiences and social persuasions were positively associated with changes in math SE among children who received the explicit SE intervention. An initially high math-SE profile and a profile indicating an increase from low to high math SE were related to growth in calculation fluency that approached the children's average age level during the interventions. In conclusion, an integrated approach that combined skill training and SE intervention was especially beneficial for children with poor calculation fluency and low math SE.
| S-EPMC8377810 | biostudies-literature
Project description: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.
| S-EPMC5718161 | biostudies-literature
Project description:The Internet is a trusted source of health information for growing majorities of Web users. The promise of online health interventions will be realized with the development of purely online theory-based programs for Web users that are evaluated for program effectiveness and the application of behavior change theory within the online environment. Little is known, however, about the demographic, behavioral, or psychosocial characteristics of Web-health users who represent potential participants in online health promotion research. Nor do we understand how Web users' psychosocial characteristics relate to their health behavior-information essential to the development of effective, theory-based online behavior change interventions.This study examines the demographic, behavioral, and psychosocial characteristics of Web-health users recruited for an online social cognitive theory (SCT)-based nutrition, physical activity, and weight gain prevention intervention, the Web-based Guide to Health (WB-GTH).Directed to the WB-GTH site by advertisements through online social and professional networks and through print and online media, participants were screened, consented, and assessed with demographic, physical activity, psychosocial, and food frequency questionnaires online (taking a total of about 1.25 hours); they also kept a 7-day log of daily steps and minutes walked.From 4700 visits to the site, 963 Web users consented to enroll in the study: 83% (803) were female, participants' mean age was 44.4 years (SD 11.03 years), 91% (873) were white, and 61% (589) were college graduates; participants' median annual household income was approximately US $85,000. Participants' daily step counts were in the low-active range (mean 6485.78, SD 2352.54) and overall dietary levels were poor (total fat g/day, mean 77.79, SD 41.96; percent kcal from fat, mean 36.51, SD 5.92; fiber g/day, mean 17.74, SD 7.35; and fruit and vegetable servings/day, mean 4.03, SD 2.33). The Web-health users had good self-efficacy and outcome expectations for health behavior change; however, they perceived little social support for making these changes and engaged in few self-regulatory behaviors. Consistent with SCT, theoretical models provided good fit to Web-users' data (root mean square error of the approximation [RMSEA] < .05). Perceived social support and use of self-regulatory behaviors were strong predictors of physical activity and nutrition behavior. Web users' self-efficacy was also a good predictor of healthier levels of physical activity and dietary fat but not of fiber, fruits, and vegetables. Social support and self-efficacy indirectly predicted behavior through self-regulation, and social support had indirect effects through self-efficacy.Results suggest Web-health users visiting and ultimately participating in online health interventions may likely be middle-aged, well-educated, upper middle class women whose detrimental health behaviors put them at risk of obesity, heart disease, some cancers, and diabetes. The success of Internet physical activity and nutrition interventions may depend on the extent to which they lead users to develop self-efficacy for behavior change, but perhaps as important, the extent to which these interventions help them garner social-support for making changes. Success of these interventions may also depend on the extent to which they provide a platform for setting goals, planning, tracking, and providing feedback on targeted behaviors.
| S-EPMC3221350 | biostudies-literature
Project description:BackgroundThe majority of persons with dementia (PWD) are mainly cared for by their family members in the home. Evidence is however scarce on family caregivers' psychosocial burden and quality of life in Asian countries including Malaysia. This study describes the baseline data of a telephone-delivered psychoeducational intervention study and examines the determinants of outcome measures (caregiver burden, depressive and anxiety symptoms, quality of life and caregiving self-efficacy) among Malaysian family caregivers to PWD.MethodsThis was a cross-sectional study originated from the baseline survey of a randomized control trial of 121 family caregivers recruited from lists of PWD who were registered at memory and psychiatry clinics in three tertiary care hospitals in Malaysia. The participants were assessed for caregiver burden by the Zarit Burden Interview, depressive and anxiety symptoms by the Hospital Anxiety and Depression Scale, quality of life by the Control, Autonomy, Self-Realization, and Pleasure Scale, and caregiving self-efficacy by the Revised Scale for Caregiving Self-Efficacy.ResultsPrevalence of caregiver burden was 69.4%, depressive symptoms 32.2% and anxiety symptoms 32.2%. Family caregivers to PWD having perceived peer support e.g., social/family/friend/significant other supports were less likely to report caregiver burden, depressive and anxiety symptoms, and more likely to report higher levels of quality of life and caregiving self-efficacy. Being married and PWD's ability to self-care were associated with lesser likelihood of experiencing caregiver burden, depressive and anxiety symptoms. The other determinants of greater probability of reporting better quality of life were caregivers' employment and having Islamic faith. Marital status (married), PWD's ability to self-care, spousal relationship with PWD and shared caregiving process were associated with higher likelihood of reporting caregiving self-efficacy.ConclusionCaregiver burden, depressive and anxiety symptoms are prevalent in family caregivers to PWD in Malaysia. Social support and caregiving related factors influence family caregivers' quality of life and caregiving self-efficacy. Implementing psychoeducational intervention and support in the psychiatry and memory clinics may help improve the psychosocial burden, quality of life and caregiving self-efficacy in family caregivers of PWD.Trial registrationISRCTN14565552 (retrospectively registered).
| S-EPMC11301828 | biostudies-literature
Project description:This study investigated whether physical activity levels and other outcomes were maintained at 1-year from completion of a 2-year telerehabilitation intervention in COPD. During the post-intervention year, nine patients with COPD (FEV1 % of pred. 42.4±19.8%; age 58.1±6 years) were encouraged to exercise on a treadmill at home and monitor daily symptoms and training sessions on a webpage as during the intervention. Participants were not provided supervision or motivational support. Physical activity levels decreased from 3,806 steps/day to 2,817 steps/day (p= 0.039). There was a decline in time spent on light physical activity (p=0.009), but not on moderate-to-vigorous activity (p=0.053). Adherence to registration of symptoms and training sessions decreased significantly. Other outcomes including health status, quality of life, anxiety and depression, self-efficacy, and healthcare utilization did not change significantly. In conclusion, provision of equipment for self-management and unsupervised home exercise might not be enough to maintain physical activity levels.
| S-EPMC5536728 | biostudies-other
Project description:BackgroundTechnology-based physical activity (PA) interventions have been shown to improve daily step counts and health-related quality of life, but their effect on long-term clinical outcomes like acute exacerbations (AEs) is unknown in persons with COPD.MethodsU.S. Veterans with stable COPD were randomized (1:1) to either pedometer alone (control) or pedometer plus a website with feedback, goal-setting, disease education, and a community forum (intervention) for 3 months. AEs were assessed every 3 months over a follow-up period of approximately 15 months. Pedometer-assessed daily step counts, health-related quality-of-life (HRQL), and self-efficacy were assessed at baseline, end-of-intervention at 3 months, and during follow-up approximately 6 and 12 months after enrollment. Zero-inflated Poisson models assessed the effect of the intervention on risk for AEs, compared to controls. Generalized linear mixed-effects models for repeated measures examined between-group and within-group changes in daily step count, HRQL, and self-efficacy.ResultsThere were no significant differences in age, FEV1% predicted, baseline daily step count, AEs the year prior to enrollment, or duration of follow-up between the intervention (n = 57) and control (n = 52) groups. The intervention group had a significantly reduced risk of AEs (rate ratio = 0.51, [95%CI 0.31-0.85]), compared to the control group. There were no significant between-group differences in change in average daily step count, HRQL, or self-efficacy at 6 and 12 months after enrollment.ConclusionsA 3-month internet-mediated, pedometer-based PA intervention was associated with reduced risk for AEs of COPD over 12-15 months of follow-up. ClinicalTrials.gov identifier: NCT01772082.
| S-EPMC7269114 | biostudies-literature
Project description:People with chronic obstructive pulmonary disease lead sedentary lives and could benefit from increasing their physical activity. The purpose of this study was to determine if an exercise-specific self-efficacy enhancing intervention could increase physical activity and functional performance when delivered in the context of 4 months of upper body resistance training with a 12-month follow-up.IN THIS RANDOMIZED CONTROLLED TRIAL, SUBJECTS WERE ASSIGNED TO: exercise-specific self-efficacy enhancing intervention with upper body resistance training (SE-UBR), health education with upper body resistance training (ED-UBR), or health education with gentle chair exercises (ED-Chair). Physical activity was measured with an accelerometer and functional performance was measured with the Functional Performance Inventory. Forty-nine people with moderate to severe chronic obstructive pulmonary disease completed 4 months of training and provided valid accelerometry data, and 34 also provided accelerometry data at 12 months of follow-up. The self-efficacy enhancing intervention emphasized meeting physical activity guidelines and increasing moderate-to-vigorous physical activity.Differences were observed in light physical activity (LPA) after 4 months of training, time by group interaction effect (P=0.045). The SE-UBR group increased time spent in LPA by +20.68±29.30 minutes/day and the other groups decreased time spent in LPA by -22.43±47.88 minutes/day and -25.73±51.76 minutes/day. Changes in LPA were not sustained at 12-month follow-up. There were no significant changes in moderate-to-vigorous physical activity, sedentary time, or functional performance. Subjects spent most of their waking hours sedentary: 72%±9% for SE-UBR, 68%±10% for ED-UBR, and 74%±9% for ED-Chair.The self-efficacy enhancing intervention produced a modest short-term increase in LPA. Further work is needed to increase the magnitude and duration of effect, possibly by targeting LPA.
| S-EPMC4199844 | biostudies-literature
Project description:BackgroundChildren have a higher chance of decreasing health-related physical fitness during periods of school lockdown due to pandemic situations such as with COVID-19 disease.AimsTo establish the changes in children's self-perceived physical fitness (SPPF) during pandemic COVID-19 social distancing in a school lockdown and to describe the individual prevalence of changes in SPPF according to sex.MethodsIt is an intervention study with a convenient sample, 67 children (6-13 years old; 50.7% girls). An intervention occurred according to the Brazilian Base Nacional Comum Curricular (BNCC) and the State Education Secretary orientations for remote Physical Education classes. SPPF was evaluated through a questionnaire (QAPA). Generalized estimative equations (GEE) and the prevalence of changes in individual score delta (Δ) from baseline to follow-up determined the effects.ResultsPositive individual changes in SPPF were observed for 21.2% of girls and 26.4% of boys. Older children presented fewer SPPF total points. There was no interaction between the evaluation period, sex, and age. However, higher baseline SPPF values presented a negative association with the individual SPPF variation (β = - 2.52%; CI 95% - 3.97 to - 1.07; p = 0.001).ConclusionA remote Physical Education intervention effectively maintained or even increased individual results of children's SPPF. Thereby, this study suggests that this kind of initiative should be retained for the duration of social distancing and pandemic conditions to help children maintain an active lifestyle and, consequently, achieve health benefits. Improving intervention effectiveness by focusing on girls seems to be a challenge in this matter.Supplementary informationThe online version contains supplementary material available at 10.1007/s11332-022-00897-1.
| S-EPMC8801194 | biostudies-literature