Original article
A Randomized Clinical Trial of an Activity and Exercise Adherence Intervention in Chronic Pulmonary Disease

https://doi.org/10.1016/j.apmr.2007.11.003Get rights and content

Abstract

Steele BG, Belza B, Cain KC, Coppersmith J, Lakshminarayan S, Howard J, Haselkorn JK. A randomized clinical trial of an activity and exercise adherence intervention in chronic pulmonary disease.

Objectives

To evaluate the effectiveness of an exercise adherence intervention to maintain daily activity, adherence to exercise, and exercise capacity over 1 year after completion of an outpatient pulmonary rehabilitation program.

Design

A 2-group, experimental design was used with randomization into intervention and usual care groups.

Setting

Outpatient pulmonary rehabilitation program in a university-affiliated medical center.

Participants

One hundred six subjects (98 men; 98 with chronic obstructive pulmonary disease) with a mean age of 67 years and chronic lung disease.

Intervention

Twelve-week adherence intervention (weekly phone calls and home visit) including counseling on establishing, monitoring, and problem-solving in maintaining a home exercise program.

Main Outcome Measures

Primary outcomes included daily activity (accelerometer), exercise adherence (exercise diary), and exercise capacity (six-minute walk test). All measures were performed at baseline, after the pulmonary rehabilitation program (8wk), after the adherence intervention (20wk), and at 1 year.

Results

A rank-based analysis of covariance showed less decline at 20 weeks in exercise adherence (intervention mean, +3min; control mean, −13min; P=.015) and exercise capacity (intervention mean, −10.7m; control mean, −35.4m; P=.023). There were no differences in daily activity at 20 weeks or any differences in any primary variable at 1 year.

Conclusions

The intervention enhanced exercise adherence and exercise capacity in the short term but produced no long-term benefit. These findings are in part attributed to the disappointing measurement characteristics of the accelerometer used to measure daily activity. The intervention was acceptable to participants. Further study is needed to fashion interventions that have more persistent benefit.

Section snippets

Design

The study was a randomized controlled trial of an exercise adherence intervention and used an intention-to-treat format. The study was approved by the institutional review board. Patients who completed an 8-week, outpatient pulmonary rehabilitation program were randomized to receive either the intervention (n=52) or usual care (n=54). There were several components to protocol implementation and randomization: (1) recruitment; (2) eligibility screening and time 1 (baseline) testing; (3)

Results

As seen in figure 1, 102 of 111 randomized subjects provided outcome data at week 20 while data were missing on 9 subjects at week 20. However, 4 of these 9 missing subjects did later provide data at week 52, so that the total number of subjects providing some follow-up data at either 20 or 52 weeks was 106, 54 in the control group and 52 in the intervention group. Eighty-five of the 106 subjects had COPD. Twelve subjects in the intervention group and 9 in the control group had interstitial

Discussion

This largely home-based intervention showed short-term maintenance of self-reported adherence to exercise and persistence of exercise capacity benefits compared with a nonintervention control group. Like other programs that used an adherence intervention post hoc, however, results persisted for only the duration of the intervention. The primary endpoint of daily activity measures by accelerometer did increase more during the exercise adherence intervention in the intervention group than in the

Conclusions

The benefits of the adherence intervention that included individualized coaching and a home visit provided only limited short-term improvement in exercise capacity and self-reported maintenance of exercise after pulmonary rehabilitation in this highly sedentary group of patients with chronic lung disease. No long-term benefits were evident. We recommend caution in the use of the RT3 accelerometer to measure free-living daily activity because of the unacceptably high signal-to-noise ratio

Acknowledgment

The views expressed in this article are those of the authors and do not necessarily represent the views of the U.S. Department of Veterans Affairs.

References (50)

  • A.J. Busch et al.

    Effects of a supervised home exercise program on patients with severe chronic obstructive pulmonary disease

    Phys Ther

    (1988)
  • P.J. Wijkstra et al.

    Effects of home rehabilitation on physical performance in patients with chronic obstructive pulmonary disease (COPD)

    Eur Respir J

    (1996)
  • J.M. Grosbois et al.

    Long-term benefits of exercise maintenance after outpatient rehabilitation program in patients with chronic obstructive pulmonary disease

    J Cardiopulm Rehabil

    (1999)
  • R.K. Dishman

    Motivating older adults to exercise

    South Med J

    (1994)
  • R.K. Dishman

    Motivation and exercise adherence

  • V. Carrieri-Kohlman et al.

    Impact of brief or extended exercise training on the benefit of a dyspnea self-management program in COPD

    J Cardiopulm Rehabil

    (2005)
  • J. Cockram et al.

    Maintaining exercise capacity and quality of life following pulmonary rehabilitation

    Respirology

    (2006)
  • D. Buchner

    Physical activity and quality of life in older adults

    JAMA

    (1997)
  • N.L. Ashworth et al.

    Home versus center based physical activity programs in older adults

    Cochrane Database Syst Rev

    (2005)
  • A.L. Ries et al.

    Maintenance after pulmonary rehabilitation in chronic lung disease: a randomized trial

    Am J Respir Crit Care Med

    (2003)
  • P.S. Heppner et al.

    Regular walking and long-term maintenance of outcomes after pulmonary rehabilitation

    J Cardiopulm Rehabil

    (2006)
  • W. D’Hoore et al.

    Risk adjustment in outcome assessment: the Charlson Comorbidity Index

    Methods Inform Med

    (1993)
  • K.J. Coleman et al.

    Relationships between Tritrac-R3D vectors, heart rate and self-report in obese children

    Med Sci Sports Exerc

    (1997)
  • P.C. Fehling et al.

    Comparison of accelerometers with oxygen consumption in older adults during exercise

    Med Sci Sports Exerc

    (1999)
  • H.F. Montoye et al.

    Estimation of energy expenditure by a portable accelerometer

    Med Sci Sports Exerc

    (1983)
  • Cited by (120)

    • Facilitators and Barriers to Attendance in a Nursing Home Exercise Program

      2021, Journal of the American Medical Directors Association
    View all citing articles on Scopus

    Supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service (grant no. NRI 98-194) and the University of Washington School of Nursing (research and intramural funding grant).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

    View full text