COPD Home-Based Coaching Intervention: Effects on Physical Activity, Healthcare Utilization
Patients with severe and very severe FEV1 impairment reported increases in physical activity.
A home-based coaching intervention decreased sedentary behavior and increased physical activity levels in patients with chronic obstructive pulmonary disease (COPD), according to a study published in the Annals of the American Thoracic Society.
David B. Coultas, MD, of the Veterans Affairs Portland Healthcare System and Oregon Health & Science University, division of hospital and specialty medicine, Portland, and colleagues analyzed secondary outcomes of the Chronic Obstructive Pulmonary Disease Self-Management Activation Research Trial (COPD-SMART; ClinicalTrials.gov identifier: NCT01108991), a 2-arm randomized trial of stable adult outpatients with COPD recruited from primary care and pulmonary clinics.
A total of 325 outpatients with stable COPD enrolled in the trial and were randomly assigned to usual care or to a telephone-delivered, home-based, health coaching intervention during a period of 20 weeks. Secondary outcomes included physical activity and healthcare utilization as determined by self-report at 6, 12, and 18 months after randomization. Associations between the secondary outcomes and the treatment arm were evaluated using log-binomial and Poisson regression models.
While 73.6% of participants in the intervention group reported being persistently active during the 18-month follow-up period, only 57.8% of participants in the usual care group reported doing so — a mean difference of 15.8%. This association varied according to the severity of forced expiratory volume in 1 second (FEV1) impairment (P for interaction =.09). Of patients in the intervention group with moderate impairment (FEV1=50%-70% predicted), 86.0% reported being persistently active compared with 65.1% in the usual care group — a mean difference of 20.9%.
In patients with severe and very severe FEV1 impairment (FEV1 <50% predicted) who were in the intervention group, 63.3% reported being persistently active compared with 50.8% in the usual care group — a mean difference of 12.6%. However, the intervention was associated with a lower rate of lung-related healthcare utilization only in participants with severe spirometric impairment.
The researchers suggested that the intervention is not only effective, but feasible and generalizable as well.
Coultas DB, Jackson BD, Russo R, et al. Home-based physical activity coaching, physical activity, and healthcare utilization in COPD: COPD-SMART secondary outcomes [published online December 28, 2017]. Ann Am Thor Soc. doi:10.1513/AnnalsATS.201704-308OC