Lifestyle intervention helps with weight loss in COPD

Key takeaways:

• Patients with COPD and obesity in a lifestyle intervention program vs. only receiving usual care lost more weight.
• The groups had similar odds for clinically meaningful improvements in physical function.

A 12-month self-guided, low-intensity, video-based lifestyle intervention helped patients with COPD and obesity lose weight, according to results published in Annals of the American Thoracic Society.

However, researchers did not find clinically meaningful benefits in 6-minute walk distance or dyspnea after walking with the intervention.

“The pragmatic weight-loss intervention in this study can be viewed as demonstrating a proof of concept suggesting the need to test interventions with greater efficacy at producing weight loss for clinical benefits in COPD,” David H. Au, MD, MS, professor of medicine in the division of pulmonary and critical care medicine at University of Washington, and colleagues wrote. “At the same time, this study provides evidence for clinicians to consider lifestyle interventions as a treatment option for weight loss and cardiovascular risk management in patients with COPD who are overweight or obese.”

In a multicenter, patient-level pragmatic randomized clinical trial (INSIGHT-COPD) conducted in the U.S., Au and colleagues assessed 684 patients (mean age, 67 years; 41.2% women; 20.2% Black) with COPD and a BMI indicating obesity/overweight (mean BMI, 33 kg/m²) to find out how usual care plus a self-directed low-intensity video-based lifestyle intervention impacts 6-minute walk distance, modified Borg dyspnea after walking and weight at 12 months vs. usual care alone.

Patients assigned to the intervention group (n = 346) received usual care and participated in a self-directed video program with the Diabetes Prevention Program’s Group Lifestyle Balance curriculum, whereas the remaining patients (n = 338) only received usual care.

The average severity level of COPD among included patients was moderate, and the two groups had “generally balanced” baseline characteristics, according to researchers.

Between the two sets of patients, researchers found a longer 6-minute walk distance in the intervention group at 12 months (adjusted between-group difference, 42.3 feet; 95% CI, 7.9-76.7) using a model adjusted for treatment group, time point, smoking status and outcomes within the COVID-19 window.

By the end of the walking test, patients in the intervention group vs. the usual care group also had significantly less dyspnea (adjusted difference, –0.36; 95% CI, –0.63 to –0.09)

Lastly, more weight loss at the 12-month mark was achieved by patients who received the lifestyle intervention vs. usual care (adjusted difference, –1.34 kg; 95% CI, –2.33 to –0.34).

Significant adjusted between-group differences were also found for several secondary outcomes at 12 months, each favoring intervention over usual care: Framingham Risk score (–0.41; 95% CI, –0.71 to –0.1), BMI (–0.51; 95% CI, –0.85 to –0.17), 12-item Short Form Survey physical component scores for health-related quality of life (1.48; 95% CI, 0.35-2.6) and St. George’s Respiratory Questionnaire-C total scores for COPD-related quality of life (–2.42; 95% CI, –4.55 to –0.28).

Researchers further evaluated the odds for meeting clinically meaningful thresholds for each of the three primary measures with the intervention vs. usual care and only found heightened odds for weight loss (≥ 3% or ≥ 5% baseline weight). Patients in the intervention group and patients in the usual care group had similar likelihoods for improvements in walk distance and dyspnea after exercise.

In terms of safety, researchers noted one serious adverse event that may have been related to the intervention.

“The results provide justification for further research about how to address overweight status and obesity in patients with COPD more effectively, particularly whether lifestyle interventions in combination with pharmacotherapy or pulmonary rehabilitation may increase the demonstrated improvements in exercise, dyspnea and quality of life,” Au and colleagues wrote.