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Short-term physical activity gains in online, pedometer-based intervention not continued at 12 months

Despite early findings at 4 months suggesting that an internet-mediated, pedometer-based physical activity intervention was effective among patients with COPD, such results were not maintained at 12 months, according to data published in the Journal of Medical Internet Research.

“Physical activity is significantly reduced in persons with chronic obstructive pulmonary disease (COPD), even at the earliest stages of the disease,” Marilyn L. Moy, MD, of the Pulmonary and Critical Care Medicine Section at the VA Boston Healthcare System, in Massachusetts, and colleagues wrote. “Its clinical course is punctuated with acute exacerbations, during and following which persons further reductions in [physical activity].… Despite the evidence and recommendations, effective long-term [physical activity] interventions are lacking in the clinical care of patients with COPD.”

To analyze the effects of an online, pedometer-based walking intervention — called Taking Healthy Steps — among patients with COPD at 12 months, the researchers randomly assigned 239 veterans into either an intervention group or a wait-list control group, at a 2:1 ratio. During the first 4 months, patients in the intervention group were instructed to wear a pedometer every day and upload the daily step counts at least once per week. In addition, they were provided access to a website that offered individualized goal setting, iterative feedback, educational and motivational content and a community forum. In the subsequent 8-month maintenance phase, the only change was that patients no longer received educational content.

Patients in the wait-list control group were instructed to wear a pedometer, but did not receive any step-count goals or instructions to increase physical activity. The primary outcome was health-related quality of life assessed by the St. George’s Respiratory Questionnaire Total Score (SGRQ-TS), and the secondary outcome was daily step count.

According to the researchers, there were no significant differences in SGRQ-TS or daily step count between the two groups at 12 months. The difference in daily step count between the two groups peaked, and was statistically significant at 4 months (P < .001), approached zero in months 8 to 12. A mean of 76.7% of the 366-day study period had valid step-count data provided by patients in the intervention group. The amount of valid step-count data decreased over the months of the study (P < .001). The mean number of log-ins to the website each month also decreased significantly over the months (P < .001). The online community forum was used at least once by 83.8% of the participants. Self-reported goal commitment and intervention engagement were not significantly different at 12 months compared to 4 months.

“Although we report negative findings for the study overall, lessons learned about device adherence and website engagement are highly informative for guiding the development of future [physical activity] interventions that can effectively promote long-term behavior change and sustain [physical activity],” Moy and colleagues wrote. “… The reasons for the observed decline in daily step counts over time require further exploration. Participants may not have continued to wear the pedometer, log into the website and walk over the 12 months for a variety of possible reasons that we did not assess, such as waning interest with the intervention, progression of underlying COPD, flare-up of comorbidities, or occurrence of intercurrent life events (eg, spouse illness).” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.