The Reconditioning Exercise and Chronic Obstructive Pulmonary Disease Trial II (REACT II): rationale and study design for a clinical trial of physical activity among individuals with chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of mortality in the United States. In addition, persons with COPD are at risk for lower levels of physical activity, leading to further morbidity and mortality. Several studies have demonstrated that long-term exercise therapy confers benefits upon physical functioning among patients with COPD, and some studies indicate that embedding cognitive-behavioral interventions into group-mediated exercise programs is useful in promoting compliance to activity recommendations. However, compliance to long-term activity is low among COPD patients, and the effectiveness of behavioral interventions to enhance long-term activity among these patients has not been extensively explored. Thus, the primary objective of the Reconditioning Exercise and COPD Trial II (REACT II) trial is to determine whether a group-mediated cognitive-behavioral intervention will result in increased physical activity after 12 months, compared to a standard exercise therapy experience among older adults with COPD. The cognitive-behavioral intervention is designed to promote independent physical activity by encouraging participants to self-regulate physical activity with minimal dependence upon staff. The primary study outcome is kcal expended per week in moderate physical activity, and the study is designed to provide 90% power to detect a 400 kcal/week difference in moderate energy expenditure between the two intervention groups. Other outcomes to be compared between the two interventions include physical function, self-reported physical disability, health-related quality of life, exercise capacity, body composition and inflammatory mediators.

Promoting physical activity in independent living communities.

PURPOSE: Recent studies evaluating physical activity programming in independent living facilities reveal that oftentimes programs have poor attendance rates, with difficulty in motivating older residents identified as a primary barrier. To better understand how to promote physical activity in the independent living setting, a brief cognitive-behavioral feedback intervention was evaluated as a means to mobilize older adults to attend introductory activity programs. METHODS: Residents in three independent living communities (N = 79; mean age = 81.6 (SD = 6.1) yr) were randomly assigned to either a brief tailored feedback session, based on social cognitive theory and recent research on risk perception, or to a standard information-only condition. All participants were provided information advertising an introductory physical activity session. RESULTS: Of the 38 participants randomized to the cognitive-behavioral intervention, 20 attended the physical activity session, as compared to five of the 41 participants in the information-only condition. The difference between groups for attendance at the session was significant (chi2 (1, N = 79) = 24.31, P < 0.001). CONCLUSION: The findings support the efficacy of a brief intervention to generate interest in physical activity. Effective and feasible interventions intended to make environments more engaging are warranted and should include individualized feedback that emphasizes the role played by physical activity in independent living.

Perceived difficulty, importance, and satisfaction with physical function in COPD patients.

BACKGROUND: Research suggests that patients' satisfaction with their physical functioning (SPF) is a critical component of HRQL. This study was designed to examine the extent to which perceptions of physical function and the value placed on physical function are related to satisfaction ratings. The sample consisted of older adults suffering from a progressively debilitating disease, chronic obstructive pulmonary disease (COPD). METHODS: During baseline assessments, COPD patients participating in a randomized controlled physical activity trial completed measures of SPF, perceived difficulty, and perceived importance. RESULTS: An ANCOVA controlling for age and gender indicated that perceived difficulty, perceived importance, and their interaction accounted for 43% of the variance in SPF. Additionally, participants were most satisfied with important tasks that they performed with little difficulty. Participants were least satisfied with important tasks that they perceived as highly difficult. CONCLUSION: The results of the present study indicate that not being able to perform valued tasks produces discontent that is reflected in lower rating of satisfaction with physical functioning. Clearly, the significance of loss in function to individual patients is related to the importance of the functional activities that may be compromised. These data have implications for the scope of patient assessment in clinical care and for the conceptual basis of future research in the area of physical functioning.

Active living for assisted living: promoting partnerships within a systems framework.

In response to a growing need for assistance among our aging population, assisted-living facilities have been designed to fill the widening chasm between community living and nursing care. Although sedentary behavior has been linked to functional limitations and disability, no comprehensive information exists about the social and physical environments and the programming available to promote physical activity in assisted living. Accordingly, this article includes data from an exploratory study that underscores the issues clearly related to physical activity for older adults in assisted living. The intent of this exploratory study was to partner with executive directors in order to conduct an analysis of the social and physical characteristics of assisted living. Interviews were conducted with executive directors (N=21) to discuss methods for assessing and promoting positive lifestyle behaviors with distinct emphasis on the targeted behavior of physical activity. Potential ways in which the social and physical environments could be modified to promote and support physically active living were identified. Clearly, promoting physical activity in assisted living is a challenge and will require a partnership with assisted living communities to develop effective and feasible systems-based interventions designed to make environments more engaging and, thereby, promote active living.