The Urban Training™ intervention, which combines behavioral strategies with unsupervised outdoor walking, is efficacious in increasing physical activity after 12 months in patients with chronic obstructive pulmonary disease (COPD), according to study results published in the European Respiratory Journal.
Individuals with COPD are not nearly as active as their healthy counterparts, and the inactivity that comes with the disease is associated with a poorer prognosis. Although studies have been conducted to determine the benefit of behavioral strategies to increase physical activity in individuals with chronic diseases, few have followed patients for a year or more.
Researchers assessed the efficacy of the Urban Training™ intervention in 407 patients with COPD from both primary care and hospital settings between October 2013 and January 2016 (ClinicalTrials.gov Identifier: NCT01897298).
Participants were randomly assigned on a 1:1 basis to either usual care or Urban Training™. The latter involved a baseline motivational interview with a respiratory physiotherapist trained in behavioral strategies; a recommendation to walk on outdoor urban trails designed for patients with COPD; and other components such as a pedometer and a personalized calendar to monitor activity, the European Lung Foundation (ELF) information brochure “Living an active life with COPD,” a once-monthly group for a walk on a trail with an experienced trainer, and a phone number to contact the physiotherapists with any questions. Usual care included general health counseling and the ELF brochure.
Of the initial study population 280 (69%) completed the final visit. These patients were more physically fit and had greater functional exercise capacity at baseline than patients who did not complete the study in both the Urban Training™ and usual care groups. After 12 months, the patients in the Urban Training™ group had increased their number of daily steps by 816 compared with 64 steps in the usual care group. In the adjusted analysis, the difference in steps between the 2 groups was 957, favoring the Urban Training™ group.
However, the investigators found no differences between the intervention groups for any of the secondary outcomes, including functional exercise capacity or cognitive impairment, an exploratory outcome. In patients with mild-to-moderate COPD, Urban Training™ was associated with an adjusted difference of 959 steps, whereas in patients with severe-to-very severe COPD the difference was 383 steps.
The investigators noted that adherence was self-reported and that the intent-to-treat analysis included patients who had not been adherent to the intervention, which is a study limitation that may have resulted in an underestimation of the efficacy of Urban Training™. Other limitations included the lack of intermediate assessments and the loss of approximately 30% of patients to follow-up, which could have biased the results.
Although the intervention was efficacious in increasing physical activity in patients with COPD, it was ineffective in the full population that included unwilling and self-reported nonadherent patients, the researchers concluded.
Arbillaga-Etxarri A, Gimeno-Santos E, Barberan-Garcia A, et al. Long-term efficacy and effectiveness of a behavioural and community-based exercise intervention (Urban Training™) to increase physical activity in patients with COPD. A randomised controlled trial [published online August 30, 2018]. Eur Respir J. doi:10.1183/13993003.00063-2018