Figures
- FIGURE 1
PRISMA flow diagram for database search and study selection process.
- FIGURE 2
Effect sizes of pedometer-based physical activity (PA) promotion on steps per day in patients with COPD. PR: pulmonary rehabilitation.
- FIGURE 3
Comparison between improvements in daily steps shown by various implementation modalities. Vertical dashed line indicates the lower levels of minimal important difference in patients with COPD. PA: physical activity.
Tables
- TABLE 1
Search criteria for computerised literature search conducted in PubMed
Search Query 1 (“Chronic obstructive pulmonary disease” [Text Word] OR “COPD” [Text Word] OR “Chronic Lung Disease” [Text Word] OR “Chronic Obstructive Lung Disease” [Text Word] OR “Emphysema” [Text Word] OR “Chronic Bronchitis” [Text Word]) 2 (“exercise” [Text Word] OR “rehabilitation” [Text Word] OR “exercise training” [Text Word] OR “pulmonary exercise training” [Text Word] OR “physical exercise training” [Text Word] OR “pulmonary rehabilitation” [Text Word] OR “exercise rehabilitation” [Text Word] OR “cardiopulmonary rehabilitation” [Text Word] OR “rehabilitation program#” [Text Word] OR “exercise program#” [Text Word] OR “physical activity advice” [Text Word] OR “physical activity counselling” [Text Word] OR “physical activity promotion” [Text Word] OR “accelerometer#” [Text Word] OR “Pedometer#” [Text Word] OR “activity monitor#” [Text Word] OR “step count#” [Text Word] OR [Text Word] OR “telerehabilitation” [Text Word] OR “e-Health intervention” [Text Word]) 3 (“Activity” [Text Word] OR “Motor activity” [Text Word] OR “physical inactivity” [Text Word] OR “risk factor” [Text Word] OR “outcome assessment” [Text Word] OR “activity” [Text Word] OR “step#” [Text Word] OR “walk#” [Text Word]) 4 (Randomised controlled trial OR clinical trial OR experimental study) 5 1 AND 2 AND 3 AND 4 Text word includes all words and numbers in the title, abstract, other abstract, MeSH terms, MeSH subheadings, publication types, substance names, personal name as subject, corporate author, secondary source, comment/correction notes. #: all terms that begin with specific word.
- TABLE 2
Characteristics of included studies
First author [ref.] I/C Age years FEV1 % pred L Male/female Patient recruitment Intervention arm Control arm Type of feedback Weekly goals Time-points/outcomes Altenburg [14] 24/24 65 (58–72) 78 (66–95) 32/16 General practices (primary care) PA counselling 30 min ×5 sessions using MI, GS and pedometer: 12 weeks Received care appropriate to their health status Face-to-face No 3 months/daily steps Altenburg [14] 23/23 68 (61–72) 58 (40–69) 34/12 Outpatient hospital clinics (secondary care) PA counselling 30 min ×5 sessions using MI, GS and pedometer: 12 weeks
Patients were recruited from outpatient hospital clinics (secondary care)Received care appropriate to their health status Face-to-face No 3 months/daily steps Altenburg [14] 22/15 54±9.6 43±25.9 32/25 Pulmonary rehabilitation centre PA counselling (30 min ×5 sessions using MI, GS and pedometer 12 weeks) added to PR 2 h 3 times per week: 9 weeks PR 2 h 3 times per week: 9 weeks Face-to-face No 3 months/daily steps Arbillaga-Etxarri [20] 220/293 69±9 58±17 448/65 Primary care and 5 hospital care centres Six components: MI, urban walking training walking, pedometer and personalised calendar, phone updates, exercise leaflet, group walking sessions General health counselling and info booklet Remote No 12 months/daily steps Bender [21] 57/58 65±7 54.3±11 48/67 Pulmonary outpatient clinics Pedometer and personally selected goals involving enjoyed activities of daily living
A target of increasing 15% daily steps per month for 3 monthsPedometer with no goal setting or communication about physical activity.
A small 1-1 telephone call to communicate daily stepsRemote No 3 months/daily steps Cruz [15] 16/16 66.5±8.4 66.9±20.1 27/5 3 primary care centres and a district hospital PA-focused behavioural counselling (average 25 min ×8 sessions using SCT, SE, MI and pedometer and diary feedback: 6 months) added to PR (1 h 3 times per week ET and 1.5 h once a week EDU session: 3 months) PR (1 h 3 times per week ET and 1.5 h once a week EDU session: 3 months) Face-to-face Yes 3 months/daily steps De Blok [22] 172/171 67±8 56±20 219/124 N/A Lifestyle PA counselling (3 min ×4 sessions using MI, GS and pedometer: 9 weeks) added to PR (9 weeks) PR (9 weeks) Face-to-face No 9 weeks/daily steps Demeyer [13] 172/171 67±8 56±20 219/124 6 rehabilitation centres across Europe Received the usual care plus the tele-coaching platform
This includes a one-to-one interview, a step counter and smartphone coaching applicationReceived a standard leaflet explaining the importance of PA in COPD as well as information about PA recommendations Remote Yes 3 months/daily steps Holland [23] 80/86 69±11 50±19 99/67 Pulmonary rehabilitation waiting list Home rehabilitation, which involved a pedometer and 7-weekly structured telephone calls based around motivational interviewing to improve walking fitness Centre-based rehabilitation with encouragement to exercise at home, no pedometer issued Remote No 12 months/daily steps Horrnix [24] 15/15 67±7 43±17 17/13 Hospitalised exacerbation patients Pedometer worn with telephone calls three times per week for 1 month to motivate and stimulate patients to increase their PA levels No contact and didn't received any motivational messages, just advice about increasing PA before hospital discharge Remote Yes 1-month, daily steps Hospes [25] 18/17 62±8 64±15 21/14 Outpatient clinic 12-week customised exercise counselling to enhance daily physical activity
Based on principles of goal setting and implementation of goalsNo counselling programmes Face-to-face No 3 months/daily steps Kawagoshi [26] 12/15 75±9 59.3±22 24/3 N/A Home-based rehabilitation in addition to monitored daily physical activity using pedometer and received monthly feedback on physical activity levels Multidisciplinary home-based PR programme for 12 months Face-to-face No 12 months, daily steps Mendoza [27] 52/50 68±8 66±19 62/40 Outpatient clinics at private and public hospitals Received pedometer and physical activity diary alongside counselling to improve physical activity Received counselling at each visit to increase their physical activity levels and advised to walk for at least 30 min per day Face-to-face No 3 months/daily steps Moy [28] 154/84 66±9 223/15 National Database of Veterans Pedometer and access to a website with components including; step count feedback, weekly goals, motivational content to enhance activity levels Wore pedometer and recorded steps.
Received no instruction about exercise and were not assigned step goals or websiteRemote Yes 4 months/daily steps Nolan [29] 76/76 69.0±9.0 50.5±21.2 110/42 Hospital-based PR unit Lifestyle PA counselling (30 mins ×8 sessions using GS and pedometer: 8 weeks) added to PR (1 h ×2 times per week: 8 weeks) PR (1 h ×2 time per week: 8 weeks) Face-to-face Yes 9 weeks/daily steps Tabak [30] 14/16 66±7 52±13 19/11 Hospital clinic Tele-rehabilitation intervention for 4 weeks Received no tele-rehabilitation
Usual care was defined as usual medication/physiotherapyRemote Yes 1 month/daily steps Varas [31] 21/19 67±8 49±16 31/9 Pulmonology consultants 5 group physiotherapy sessions, 8 weeks counselling to increase daily activity levels, through telephone meetings Informative sessions on the benefits of exercise, pedometer issued but no additional support Remote Yes 8 weeks/daily steps Vorrnik [32] 84/73 62±9 55±17 78/79 Outpatient physiotherapy practises Consisted of two compartments: 1) smartphone application; 2) physiotherapist-based website for providing real-time goals and feedback for 6 months No intervention Remote Yes 3 months/daily steps Wan [33] 57/52 68±8 61±21 95/14 General pulmonary clinics Pedometer and received access to a website which provided four key components; individualised goal setting, iterative step-count feedback, motivational content and online community forum for 3 months Received a pedometer and written material about exercise but weren't assigned step-count goals Remote Yes 3 months, daily steps Data are presented as n, mean±sd or mean (range). FEV1: forced expiratory volume in 1 s; PA: physical activity; N/A: not applicable; PR: pulmonary rehabilitation; MI: motivational interviewing; GS: goal setting; SCT: social cognitive theory; SE: self-efficacy; ET: exercise training; EDU: education.
- TABLE 3
Qualitative synthesis of included studies using PEDro scale for the quality of randomised controlled trials
First author [ref.] Eligibility criteria Random allocation Concealed allocation Baseline similarity Blinding (subject) Blinding (therapist) Blinding (assessor) Measure >85% ITT Group comparison Point measure Quality score Altenburg [14] * * * * * * * * 8 Arbillaga-Etxarri [20] * * * * * * * * * 9 Bender [21] * * * * * * * 7 De Blok [22] * * * * * * * * 8 Cruz [15] * * * * * * * * * * 10 Demeyer [13] * * * * * * * * * 9 Holland [23] * * * * * * * * * 9 Horrnix [24] * * * * * * * 7 Hospes [25] * * * * * * * 7 Kawagoshi [26] * * * * * * * * 8 Mendoza [27] * * * * * * * * 8 Moy [28] * * * * * * * * 8 Nolan [29] * * * * * * * * * * 10 Tabak [30] * * * * * * * * 8 Varas [31] * * * * * * * * 8 Vorrnik [32] * * * * * * * * * 9 Wan [33] * * * * * * * * * 9 ITT: intention to treat. *: yes, score=1. The higher the given score, the better the quality. Cut-off points of the scale were: excellent (9–10), good (6–8), fair (4–5) and poor (3).
- TABLE 4
Subgroup analysis on physical activity (PA) outcomes of included studies
Subgroups Overall analysis Pedometer PA alone Pedometer PA promotion + PR n Effect size I2 % n Effect size I2 % n Effect size I2 % SMD 95% CI SMD 95% CI SMD 95% CI Goal setting Weekly 9 0.50 0.21–0.78 77 6 0.44 0.16–0.71 70 3 0.82 −0.23–1.88 88 Infrequent 10 0.55 0.24–0.85 75 6 0.64 0.19–1.09 84 4 0.29 0.04–0.54 0 Duration <3 months 15 0.57 0.31–0.84 78 10 0.57 0.27–0.88 79 5 0.60 0.00–1.20 76 >3 months 4 0.34 0.18–0.50 0 2 0.36 0.17–0.55 0 2 0.35 −0.10–0.80 34 Type of feedback Remote 10 0.47 0.27–0.67 68 8 0.46 0.24–0.68 67 2 0.67 −0.32–1.66 83 Face-to-face 9 0.60 0.14–1.06 81 3 0.70 −0.06–1.46 86 5 0.48 −0.03–0.99 65 Measure of PA Accelerometer 8 0.38 0.09–0.67 79 4 0.36 −0.03–0.75 83 4 0.44 −0.04–0.91 74 Pedometer 11 0.64 0.35–0.92 69 8 0.64 0.31–0.97 75 3 0.63 0.00–1.26 48 Baseline PA levels Low baseline PA 7 0.32 0.10–0.53 51 4 0.46 0.21–0.70 36 3 0.11 −0.10–0.33 0 High baseline PA 11 0.67 0.36–0.98 80 8 0.59 0.24–0.94 83 3 0.95 0.22–1.67 63 PR: pulmonary rehabilitation; SMD: standard mean difference.
Vol 28 Issue 154
Table of Contents
Use of pedometers as a tool to promote daily physical activity levels in patients with COPD: a systematic review and meta-analysis
