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Welcome! Here we publish our views on new research and insights from the field of pulmonary medicine, most often focusing on topics related to exercise, nutrition, and other self-management techniques for those who suffer from chronic shortness of breath.

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Monday, September 20, 2010

Pedometer teamed with Internet a useful tool in boosting physical activity in COPD?

A significant challenge for respiratory care professionals in lifelong COPD disease management is ensuring that patients increase and maintain a higher level of daily physical activity.

The primary method for “kick-starting” physical activity in COPD patients is the treatment option known as pulmonary rehabilitation (PR). In a typical outpatient PR program, patients receive exercise training for 30-60 minutes, 2-3 days per week, over an 8-12 week period. The exercise training includes both aerobic/cardiovascular (i.e. walking on a treadmill, riding a stationary cycle or ergonometer) and strength training (lifting weights that strengthen upper and lower body muscles).

However, once a COPD patient completes a PR program, he/she is expected to self-manage an ongoing exercise program thereafter. Unfortunately, many COPD patients who’ve experienced significant gains in physical conditioning, reduced shortness of breath, and improved sense of well being during PR lose the benefits within one year because they don’t continue to exercise.

Why COPD patients who’ve experienced these health gains don’t maintain an exercise program is bedeviling to practitioners and researchers. It seems that in many cases exercise adherence falls as COPD patients leave PR because they lose their cheerleader/guider/motivator/feedback provider.

So practitioners and researchers continue to seek ways/methods to encourage exercise post-rehab and for those who are not eligible for rehab (which sadly, is about 99% of COPD patients). Researchers know it is not feasible from a cost or physical resource perspective to provide ongoing direct support ad infinitum, so they investigate ways to cost effectively provide feedback and motivation and thereby extend the length of home-based exercise programs.

One such way for encouraging greater daily physical activity might be to provide COPD patients with a pedometer to track their daily steps combined with an easy way to track progress and goals set by practitioners. That was the aim of a new research study reported in the Journal of Rehabilitation Research & Development.

In this study, the research team looked back at the results of a larger pedometer study to extract the experience of the 16 COPD patients who completed in the study (of the 205 people who completed the larger pedometer study, only 16 were identified as COPD patients).

To establish a baseline of steps taken in a given day, the study participants were asked to carry/wear a pedometer with the display screen covered during waking hours for a 7 day period. After the baseline was established, study participants were asked to carry/wear the pedometer during waking hours for 16 weeks, recording their steps taken at least once per week on an Internet-based tracking site. The Internet walking-tracking site provided feedback/motivational messages/goals for each patient based on their individual progress.

At the end of the study, COPD patients saw their daily steps taken rise by 988 over their baseline average of 3,596 (27% increase). By comparison, the non-COPD population of the larger study from which this data was extracted experienced a 60% gain in average daily steps taken over the 16 week period. (Moy ML, et al. Use of pedometer and Internet-mediated walking program in patients with chronic obstructive pulmonary disease. J Rehabil Res Dev. 2010;47(5):485-96)

While the COPD patients did indeed demonstrate a statistically significant rise in average daily steps taken, their increase was not as dramatic as the non-COPD participants. But from a practitioner perspective, a statistically significant rise in COPD patient daily activity is a huge step in the right direction.

It is not clear from the study whether the pedometer alone, or the pedometer combined with the Internet tracking service was responsible for the rise in steps taken since the study did not include test panels to evaluate the relative differences in steps taken between no intervention, pedometer alone, pedometer with Internet tracking service. However, understanding that a significant barrier to continued exercise among COPD patients is the lack of a feedback/motivation loop outside of the clinical environment, it would appear that the combination of live data from the pedometer teamed with the tracking/feedback Internet site is an interesting alternative to a traditional exercise program for COPD patients who are self-managing their disease.

If you are interested in starting a pedometer assisted walking program of your own, we’ve provided a link to our Breathe Better Marketplace where we’ve posted some of Consumer Reports top rated pedometers available through amazon.com. We’ve also included a link to Step Up To Better Health, the Internet-based walking tracking site used in the above mentioned study.

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