The effects of a lifestyle physical activity counseling program with feedback of a pedometer during pulmonary rehabilitation in patients with COPD: A pilot study

Abstract

Objective

To study the effects of a lifestyle physical activity counseling program with feedback of a pedometer during pulmonary rehabilitation.

Methods

Twenty-one chronic obstructive pulmonary disease (COPD) patients were randomized to an experimental group that followed a regular rehabilitation program plus the counseling intervention or to a control group that only followed rehabilitation. The primary outcome was daily physical activity assessed by pedometers. Secondary outcomes were physical fitness, health-related quality of life, activities of daily living, depression and self-efficacy.

Results

The experimental group showed an increase of 1430 steps/day (+69% from baseline), whereas the control group showed an increase of 455 steps/day (+19%) (p = 0.11 for group × time interaction). The secondary outcomes showed no differences.

Conclusion and practice implications

This study showed that the use of the pedometer, in combination with exercise counseling and the stimulation of lifestyle physical activity, is a feasible addition to pulmonary rehabilitation which may improve outcome and maintenance of rehabilitation results.

Introduction

A major symptom experienced by patients with chronic obstructive pulmonary disease (COPD) is dyspnea during exertion. This symptom often leads to lower physical activity levels, which in turn may lead to deconditioning and a reduction in health-related quality of life.

Pulmonary rehabilitation has proved to being able to reverse this process, and the effects are well documented [1], [2], [3]. However, long-term effects are less clearly defined. Studies that have followed patients for a longer period show that benefits diminish after about 1 year [4], [5]. Ries et al. [5] hypothesized that due to the unstable nature of their disease, COPD patients may easily return to the spiral of inactivity and deconditioning when an intensive maintenance strategy is absent after the rehabilitation. Interestingly, home-based pulmonary rehabilitation programs have proven to provide long lasting effects, even after 5 years. One important feature of these programs was the use of normal life style activities [6], [7], [8].

We hypothesize that a physically active lifestyle of patients with COPD is essential for maintaining the benefits after rehabilitation. This can be achieved through lifestyle physical activities like walking, cycling, stair-climbing and gardening. By incorporating these activities during pulmonary rehabilitation, daily physical activity levels may remain higher after rehabilitation and the benefits of rehabilitation may last longer. The Dutch Norms for Healthy Physical Activity (DNHPA), which is derived from the norms of the American College of Sports Medicine (ACSM) [9], [10], [11], serve as reference for the effects of lifestyle physical activities on health.

In this study, we tried to enhance daily physical activity in patients with COPD by using a lifestyle physical activity counseling program with feedback of a pedometer. Such a program might be relevant for these patients because lifestyle physical activity programs turn out to be very effective in improving physical activity in healthy adults [12], [13], [14]. Because intensity and duration are interchangeable concerning energy expenditure in physical activity [15], lifestyle physical activities of moderate intensity with longer duration can replace high intensive physical activities of shorter duration. Low to moderate intensity activities are more appropriate for patients with COPD because of their low exercise tolerance, which is due to ventilator limitation and oxygen-uptake problems [16]. Furthermore, exercise counseling interventions have shown to be effective in increasing physical activity [17], [18] and are of interest in maintaining physical activity [19], because they can be tailored to the needs and circumstances of the individual [17], [19]. Finally, pedometers have proved to accurately detect steps taken, as an indication of volume of physical activity [20], [21], [22], and the feedback of the pedometer can be an important resource in increasing physical activity behaviors [23]. Pedometers offer new perspectives in changing physical activity behavior because patients can monitor themselves and can set concrete goals for increasing physical activity. Up to now, several studies have shown that pedometers are successful in increasing physical activity in healthy adults [24], [25] and in various patient groups [26], [27], [28], [29], [30]. Schönhofer et al. [31] demonstrated that pedometers are feasible to assess the level of physical activity in patients with COPD.

Consequently, a lifestyle physical activity counseling program with continuous monitoring and feedback from a pedometer may be a suitable strategy for increasing and maintaining physical activity in patients with COPD. Until now, no intervention studies have been carried out that used a lifestyle physical activity counseling program with feedback of a pedometer in patients with COPD. Before long-term effects of this method can be measured, first the short-term effects must be mapped out. Therefore, the purpose of this study was to investigate the short-term effects of a lifestyle physical activity counseling program with feedback of a pedometer during a standard pulmonary rehabilitation on daily physical activity. Secondary effects on physical fitness, health-related quality of life, activities of daily living, depression and self-efficacy were also measured.