A scalable multi-level physical activity intervention for elderly persons with chronic obstructive pulmonary disease: First Steps

Harvard Medical School, Boston MA

Investigators

Abstract

? DESCRIPTION (provided by applicant): Physical activity (PA) is a modifiable health behavior that impacts the clinical course of chronic obstructive pulmonary disease (COPD). Patients with COPD are typically older persons who are at exceedingly high risk for sedentary behavior. Novel interventions to promote PA in persons with COPD are desperately needed. We developed a PA intervention, Every Step Counts (ESC), which combines a pedometer (Omron) with a website. ESC emphasizes an iterative process of behavior change with 4 main components: (1) individualized goal setting, (2) iterative feedback, (3) motivation, and (4) social support. Persons with COPD wear the pedometer every day and upload step counts to the study server at least weekly. An automated algorithm calculates a concrete, updated step-count goal each week. Patients receive immediate feedback on the pedometer and view graphs of their walking progress on the website, where motivational and educational content address barriers to exercise in COPD. Participants have access to an online community forum with other users for social support. In a randomized controlled trial, we have rigorously demonstrated that ESC increases daily step counts and improves health-related quality of life (HRQL) in elderly persons with COPD. In its current form our intervention is a research prototype. We propose to collaborate with an industry partner, Modus Health, to upgrade it for wide scale clinical use. We will use the COPD-StepWatch Activity Monitor (COPD-SAM) as the PA sensor. Unlike the Omron, the COPD-SAM will wirelessly upload step-counts to a wristwatch, smart phone, personal computer, and/or tablet. The mobile devices or computer will upload data to the Modus Cloud, and retrieve and display step-count goals and motivational and educational content. Wireless transmission and mobile connectivity will allow the majority of patients to use our intervention, provide near constant interaction between the user and intervention, and minimize burden on the user. We also propose to combine our technology-based intervention with regular peer and provider interactions. Monthly in-person sessions with peers led by existing clinical staff will provide additional social support and motivation. Our current PA intervention has no platform on which clinicians view patients' PA data. Modus Health will develop a platform on which clinicians can view accurate trends in cumulative PA data. Providers, when they routinely see their patients, can use the PA data to provide targeted feedback and motivation. We will implement the intervention in an outpatient pulmonary clinic and test its effectiveness in a real-world trial. The 2008 Physical Activity Guidelines for Americans state, When older adults cannot do 150 minutes of moderate-intensity aerobic activity a week because of chronic conditions, they should be as physically active as their abilities and conditions allow. We provide a concrete solution to operationalize the clinical response to this recommendation with an accessible, scalable, and sustainable multi-level PA intervention for patients with COPD.