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BACKGROUND: Pulmonary rehabilitation (PR) is the standard of care for chronic obstructive pulmonary disease (COPD) management. However, significant barriers limit access and adherence to PR and alternatives are needed. The purpose of this randomized controlled trial is to test the efficacy of a web-based, pedometer-mediated intervention to increase physical activity (PA) for persons with COPD who decline PR or meet U.S. guidelines for referral to PR but have not participated (CAPRI-1). In addition, we will test whether the intervention maintains PA following PR in an exploratory aim (CAPRI-2). METHODS: Participants with COPD (N = 120) will be recruited and randomized 1:1 to a 12-week web-based, pedometer-mediated intervention or usual care (UC) (CAPRI-1). The intervention provides: 1) objective monitoring of walking and iterative feedback, 2) individualized step-count goals, 3) motivational messages and educational content, and 4) an online community. The primary outcome is change in daily step count from baseline to 12 weeks. Secondary outcomes include: (a) exercise capacity; (b) self-reported PA; (c) PA intensity; (d) exercise self-regulatory efficacy, (e) health-related quality of life, (f) dyspnea, (g) depression symptoms, and (h) healthcare utilization. CAPRI-2 will test whether participants (N = 96) assigned to the intervention following PR completion show greater maintenance of daily step count compared to UC at 3, 6, 9, and 12 months. DISCUSSION: If the intervention is efficacious, it may be an alternative for those who cannot attend PR or a maintenance program following completion of conventional PR. We also present adaptations made to the protocol in response to the COVID-19 pandemic.
Subject(s)
COVID-19 , Pulmonary Disease, Chronic Obstructive , Humans , Quality of Life , Pandemics , Exercise , Randomized Controlled Trials as TopicABSTRACT
Background Physical activity and dietary habit optimization in women with gestational diabetes mellitus (GDM) or such a history can improve both short-term [1,2] and long-term outcomes [3]. This requires strategies that are accessible, usable, and perceived as beneficial. Aim To examine uptake and engagement for the following interventions: (1) step and weight tracking through an online platform using a pedometer and weight scale, with delivery of weekly goals;(2) weekly telephone-based health coaching;and (3) a combination of these. We are assessing recruitment, completion of health coaching sessions and/or step count and weight data upload, and participant perspectives. Method Five-city pilot randomized controlled trial (Montreal, Halifax, Calgary, Winnipeg, Toronto;Canada). Women with GDM are recruited at 20-32 weeks' gestation. Data collection is through web-based questionnaire, electronic tracking of data upload, coaching session logs, chart review (gestational weight gain;blood pressure;A1C;glucose levels;offspring sex, weight, and gestational age), in-depth telephone interview (perspectives, breastfeeding status), and mailed in pedometers with concealed windows worn for 7 days (baseline and 37 weeks). Participants are randomized to one of the 3 interventions described or a control arm (resource website only). Results The trial started in August 2019 with COVID-related interruptions. By June 30, 2022, 192/225 mothers were recruited (recruitment ongoing): 27/192 (14%) withdrew, 13 are currently undergoing interventions, and 152 completed final questionnaires. An interim process analysis of the first 52 indicates that those randomized to step and weight tracking employ the pedometer and scale a mean 81.6% (SD 29.6%) and 69.0% (SD 32.0%) of the time, respectively. High proportions report step tracking (92.3%, n = 24/26) and health coach conversations (87.5% n = 21/24) as useful, with weight tracking endorsed by over half (61.5%, n = 16/26). Conclusion The findings will inform a larger scale clinical trial in terms of impacts on gestational weight gain and appropriate for size offspring status.Copyright © 2023 Elsevier B.V.
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Background: Physical inactivity and sedentary behaviour is associated with worse clinical and inflammatory outcomes and impaired quality of life in people with severe asthma (pwSA) (Cordova-Rivera et al. JACI:IP 2018;6(3):814-22). Since March 2020, national lockdowns have been periodically implemented in the UK to reduce the transmission of COVID-19, however, the impact of these restrictions on physical activity in pwSA has yet to be evaluated. Aim(s): To compare physical activity levels prior to and during COVID-19 lockdown in pwSA. Method(s): A preliminary retrospective analysis of physical activity (step count objectively assessed via an in-built smartphone pedometer (Reilly et al. J Asthma 2021:1-9)) between March-June 2019 (usual daily living) versus March-June 2020 (first UK lockdown) in adults attending a specialist asthma service Results: Twelve adults with severe asthma receiving biological therapies (male: n = 4) (age: 52 +/- 16;FEV % predicted: 64 +/- 16) were recruited. A significant and clinically meaningful reduction in daily step count was observed between 2019 and 2020 for all months: March (-25%) (P=0.02);April (-40%) (P=0.02);May (-33%) (P = 0.04);June (-38%) (P = 0.001). Total absolute reduction in daily step-count: 4627 +/- 1833 versus 3054 +/- 1967 (-34%) (P<0.001). Conclusion(s): COVID-19 restrictions reduced step-based physical activity by approximately one-third in pwSA. These findings underline the importance of monitoring and promoting physical activity during routine asthma review given the potential adverse impact on health and disease-related outcomes.
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Background: The Diabetes College Brazil Study (NCT03914924) is a pioneer randomized clinical trial designed to promote behavioral changes in adults living with prediabetes and diabetes. Method(s): A single-center randomized pilot study involving a 12-week exercise intervention aiming the participants accumulate at least 150 min of aerobic exercise and two sessions of resistance exercise per week with a 6-month follow-up after the intervention. The follow-up objective was to support the participants in maintaining the health benefits arising from the intervention through monthly structured phone calls. Physical activity (PA) level (seven days using a pedometer), exercise self-efficacy (Bandura's Exercise Self-Efficacy Scale), and quality of life (Medical Outcomes Study 36-Item Short-Form Health Survey) were assessed at pre, post-intervention (PI), and post-follow-up (PF). Variables measured in the PI and PF were compared by unpaired t-test. The aerobic exercise time in minutes/week was collected during monthly phone calls and compared by ANOVA. The weekly frequency of resistance exercise sessions was also collected and analyzed by absolute frequencies. The association between the interest variables was analyzed using the Pearson correlation test. Result(s): Of 21 participants who were assessed at PF, 12 answered all phone calls along with follow-up (75% male, 57.4 +/- 10.7 years, 8.3% prediabetes, 41.6% Type 1 diabetes, and 50% Type 2 diabetes) and were included in this study. There was no significant difference between the values obtained in the PI and PF for PA level (41947+/-28868 vs. 49915+/-33054 total steps/week, 5992+/-4124 vs. 7131+/-4722 average steps/day;P=0.09), exercise self-efficacy (65.6+/-13.1 vs. 71.8+/-22.3;P=0.31), physical health (82.7+/-22,84.1 vs. 81.4+/-20.5;P=0.64) and mental health (65.9+/-40.7 vs. 70,5+/-38,4;P=0.70) components of quality of life, revealing maintenance of the exercise intervention benefits after six months. Most participants aerobically exercised above 150 min/week in moderate-intensity during the follow-up, with no change in average exercise time over the six months (225.0+/-154.8, 197.0+/-133.9, 235.0+/-143.9, 142.0+/-102.6, 174.0+/-177.5 minutes/week;P=0.12). The proportion of participants who maintained resistance exercise were 41%, 58%, 66%, 50%, and 50%, and the average weekly frequency was more than three times a week during the follow-up. The average minutes of aerobic exercise/week during the follow-up was moderately correlated with total steps/week (r=0.59, P=0.06) and with mental (r=0.49, P=0.12) and physical (r=0.49, P=0.12) health components of quality of life, and strongly correlated with exercise self-efficacy (r=0.63, P=0.04). Conclusion(s): Participants maintained the health benefits of the intervention at the six-month follow-up, despite the social restrictions due to the COVID-19 pandemic.
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Purpose: The COVID-19 pandemic has increased the demand for tele-medicine, particularly for lung transplant (LTX) recipients who are immunosuppressed and often live far from transplant centres. We report the feasibility of a 3-month semi-automated tele-coaching intervention in this population. Methods: The intervention consists of a pedometer and smartphone app, allowing transmission of activity data to a platform (Linkcare v2.7) that provides feedback, activity goals, education and contact with the researcher as required. Remote assessment pre- and post-intervention included patient acceptability using a project specific questionnaire, physical activity using accelerometry (Actigraph GT3X), HADS and the SF-36 questionnaire. Results: So far, all eligible patients approached were willing to be randomised to the intervention or usual care (n=14;COPD=4, ILD=7;CF=1;PH=2). For the intervention, usage of the pedometer was excellent, with patients wearing it for 6.9±0.1 days/week and rating the pedometer and telephone contact (9±2 out of 10) as the most vital aspects. Patient feedback has been positive, with 80% of patients responding that they ‘liked’ taking part and that it ‘helped them a lot’ to increase their activity levels. Daily steps and VMU are presented in Figure 1 and SF-36 scores in Figure 2. There were no changes in HADS scores between groups. Conclusion: Tele-coaching appears feasible in LTX recipients, with patients showing excellent adherence and providing positive feedback after 3 months. This is promising, with the on-going need to develop and evaluate ways of supporting patients remotely.
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Keywords: Peripheral arterial disease;Exercise;Behaviour change Purpose: Walking is recommended for adults with peripheral arterial disease. However, provision of supervised walking programmes is variable and adherence to self-directed walking tends to be low. MOtivating Structured walking Activity for Intermittent Claudication (MOSAIC) is a physiotherapist-led, structured, home-based intervention that incorporates motivational interviewing and behaviour change principles to increase participants’ motivation and commitment to walking. This trial investigated whether MOSAIC improved walking performance compared to usual care in adults with peripheral arterial disease. Methods: This multicentre, parallel group, two-arm, randomised, controlled superiority trial enrolled participants from six NHS Trusts between January 2018 and March 2020. Inclusion criteria comprised: aged ≥50 years with established peripheral arterial disease and intermittent claudication. Exclusion criteria included: unstable disease;walking >90 min/week;contraindications to exercise or completed/offered any medically supervised exercise in previous/upcoming six-months. The primary outcome was six-minute walk distance (6MWD, metres (m)) at three-months (clinically meaningful change: ≥8 m). Secondary outcomes included pain-free walking distance measured during six-minute walk test (PFWD, seconds), self-reported walking limitation (Walking Estimated-Limitation Calculated by History, WELCH, range 0–100;self-reported maximum walking distance, SR-MWD (m)), activities of daily living (Nottingham Extended Activities of Daily Living Questionnaire, NEADL, range 0–66), and quality of life (Vascular Quality of Life Questionnaire-6, VASuQoL-6, range 6–24). All measures were collected at baseline and three-months by an assessor masked to participant allocation. The self-reported outcomes were also collected at six-months. Consenting participants were randomly assigned (by King's Clinical Trials Unit remote computer-generated randomisation system) to receive either MOSAIC (two face-to-face and two telephone consultations delivered over three-months by trained physiotherapists, a pedometer and a bespoke manual) or usual care. Participants and physiotherapists were not masked to group allocation. Participant recruitment and collection of primary outcome data at three-months was ceased early due to COVID-19 restrictions. All self-reported six-month outcomes were collected as per protocol. Outcomes were evaluated on an intention-to-treat basis using multiple regression with baseline value and stratification factors as covariates. Results: 190 participants (mean age (Standard Deviation) 68 (9) years, 57 (30%) female, 150 (79%) White) were recruited (95/group). At three-months, participants receiving MOSAIC had greater mean 6MWD compared to participants receiving usual care (adjusted mean difference (95% confidence interval (95%CI): 16.4 m (3.8, 29.1)). Secondary outcomes also indicated greater improvement for those receiving MOSAIC than usual care (adjusted mean differences (95% CI): PFWD (31.2 s (6.3, 56.0));WELCH (10.2 points (5.6, 14.8));SR-MWD (251 s (11.0;194.9));NEADL (2.8 points (0.1;5.4));VASuQoL-6 (0.6 points (−0.2;1.4)). At six months, there was a sustained improvement in WELCH in participants receiving MOSAIC compared to usual care (adjusted mean difference (95% CI): 7.4 points (2.5, 1.3)). Results for the other secondary outcomes were inconclusive (SR-MWD (309.9 s (−17.8;637.6)), NEADL (−1.6 points (−4.6, 1.5)), VASuQoL-6 (0.6 points (−0.4;1.6)). Thirty-seven adverse events (25 MOSAIC, 12 usual care) were reported. Conclusion(s): MOSAIC is an effective treatment for the management of peripheral arterial disease and could be integrated into physiotherapy practice to support walking behaviour change. Impact: MOSAIC is an effective treatment for the management of peripheral arterial disease and could be integrated into physiotherapy practice to support walking behaviour change. Funding acknowledgements: This work was suppor ed by The Dunhill Medical Trust [grant number: [R477/0516].
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Aim: To assess feasibility of a novel remotely-supervised exercise programme at a vascular hub during the COVID-19 lockdown. Methods: Participants with arterial claudication (ABPI <0.90) who were able to walk 50m were enrolled into a 3-month programme by a vascular specialist nurse. The initial appointment addressed smoking cessation and best medical therapy. Baseline walking distance, ABPI and quality of life (QoL) were measured using the Intermittent Claudication Questionnaire. Following this, up to 8 WhatsApp video calls with a vascular specialist physiotherapist were undertaken to provide a tailored exercise programme. The MapmywalkVC App, or a pedometer, were used to monitor walking distances. Participants were instructed to record their daily longest walk and email results to their physiotherapist before each consultation. Results: 12 participants were enrolled, of these 2 participants were unsuitable. Median age was 63 years and 2 (20%) were female. Baseline median ABPI was 0.7 (IQR 0.5-0.8), median baseline absolute walking distance was 75m (IQR 50-140) and median baseline QoL was 51/80 (IQR 15-79). 7 participants (70%) successfully completed the programme and were discharged. Their median daily longest walk was 2000m (IQR 200- 4000) and QoL scores improved to 6/80 (IQR 2-20) (p=0.02). Remaining 3 participants required revascularisation for disease progression. Reimbursement tariffs for the supervised exercise programme were £700 per patient, whereas for revascularisation were £2000 - £5000. Conclusion: Remotely supervised exercise was feasible and improved walking distance and quality of life in 70% of participants. Approximately £3000 per patient was saved from a reduction in revascularisation procedures in our unit.
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AIM: To clarify the frequency and correlates of using applications for monitoring and increase of health and well-being among middle-aged and older adults during the COVID-19 pandemic in Germany. METHODS: Data were used from the nationally representative German Ageing Survey (n = 3,174 individuals in the analytical sample; June/July 2020). The frequency of using applications for monitoring and increasing health and well-being (from daily to never) was used as main outcome measure. RESULTS: Among individuals with access to the internet, 76% never used applications for monitoring and increase of health and well-being, whereas about 13% were rare and 11% were frequent users of such applications. Multinomial regressions showed that the likelihood of being a rare user (compared to never users of such applications) was positively associated with being male [RRR: 0.74, 95% CI: 0.59-0.93], the frequency of walks [e.g., several times a week compared to never: RRR: 2.76, 95% CI: 1.15-6.59] and worse self-rated health [RRR: 1.33, 95% CI: 1.11-1.59]. Furthermore, the likelihood of being a frequent user (compared to never users) was positively associated with younger age [RRR: 0.96, 95% CI: 0.94-0.98] and the frequency of walks [daily compared to never: RRR: 2.61, 95% CI: 1.07-6.35]. CONCLUSIONS: Applications for monitoring and increasing health and well-being are used by about one out of four middle-aged and older individuals with access to the internet in Germany during the COVID-19 pandemic. In international comparison, the proportion of users is rather low. Determining the factors associated with such use may help to address non-users.
Subject(s)
COVID-19 , Pandemics , Aged , Aging , Germany/epidemiology , Humans , Male , Middle Aged , SARS-CoV-2ABSTRACT
In Japan, a state of emergency (SoE) was declared in early April 2020 until late May in response to the first wave of the coronavirus disease (COVID-19). This longitudinal study analyzed the step counts of 18,817 citizens in Yokohama city in the first half of 2020 compared to the previous year, and investigated the association between the change in step counts and the individuals' neighborhood environment by sex and age using generalized linear mixed models. Step counts decreased especially in women and non-elderly people during the SoE. Older women were more susceptible to the neighborhood environment: high walkability (i.e., high population density, proximity to railway stations) adversely affected their step counts, whereas proximity to large parks came to have a positive effect during the SoE.
Subject(s)
Built Environment/statistics & numerical data , COVID-19/psychology , Residence Characteristics/statistics & numerical data , Walking/psychology , Walking/statistics & numerical data , Adult , Aged , Aged, 80 and over , Cities , Environment Design , Female , Humans , Japan , Longitudinal Studies , Male , Middle Aged , Sex Distribution , Young AdultABSTRACT
BACKGROUND: Older people are at increased risk of adverse health events because of reduced physical activity. There is concern that activity levels are further reduced in the context of the COVID-19 pandemic, as many older people are practicing physical and social distancing to minimize transmission. Mobile health (mHealth) and eHealth technologies may offer a means by which older people can engage in physical activity while physically distancing. OBJECTIVE: The objective of this study was to assess the evidence for mHealth or eHealth technology in the promotion of physical activity among older people aged 50 years or older. METHODS: We conducted a rapid review of reviews using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched for systematic reviews published in the English language in 3 electronic databases: MEDLINE, CINAHL Plus, and Scopus. Two reviewers used predefined inclusion criteria to select relevant reviews and extracted data on review characteristics and intervention effectiveness. Two independent raters assessed review quality using the AMSTAR-2 tool. RESULTS: Titles and abstracts (n=472) were screened, and 14 full-text reviews were assessed for eligibility. Initially, we included 5 reviews but excluded 1 from the narrative as it was judged to be of critically low quality. Three reviews concluded that mHealth or eHealth interventions were effective in increasing physical activity. One review found that the evidence was inconclusive. CONCLUSIONS: There is low to moderate evidence that interventions delivered via mHealth or eHealth approaches may be effective in increasing physical activity in older adults in the short term. Components of successful interventions include self-monitoring, incorporation of theory and behavior change techniques, and social and professional support.