Combined strategies to improve physical activity in COPD

Regular physical activity (PA) is at present considered an important health-related behavior in the general population and in patients suffering from a chronic disease (1). Daily PA levels are decreased in patients with Chronic Obstructive Pulmonary Disease (COPD) since this is often an unpleasant experience due to symptoms of dyspnea and muscle fatigue. A decrease in PA, as part of the vicious cycle of inactivity is already present in the early stages of the disease and has been related to the risk of exacerbations and mortality rate in this population. To counteract the negative influences of inactivity, patients should be motivated towards a more active lifestyle. Several studies looked at possible interventions to increase PA, with various results.

A recent study, conducted by our research group, showed a significant improvement of PA levels after a 3-month tele coaching intervention. Yet, more research is needed to further improve and optimize the effects of coaching interventions.

With this research project, we will investigate the effect of a long-term (12 months) coaching intervention on improving and maintaining physical activity levels, leading to long lasting health benefits in patients with COPD. Compliance in coaching interventions over longer a period can be difficult. We hypothesize that a tele coaching intervention 1) including patients’ preference (i.e. the choice of the pedometer); and 2) in which patients keep contact with the coaches, though from a distance, are possible ways to optimize the compliance in a long-term coaching interventions. The first aim of the present PhD project is to validate different activity trackers (Fitbit Zip, worn at the waist and Fitbit Alta, worn at the wrist) in patients with COPD and investigating patients’ preferences in wearing these devices over longer period.

Previous research shows that less symptoms of dyspnea are a predictor for a successful coaching intervention. Endoscopic lung volume reduction aims to improve ventilatory capacity in patients with severe emphysema due to a decrease of hyperinflation. This intervention decreases symptoms of dyspnea abruptly and can thereby make patients more prone to benefit from the tele coaching intervention. We want to investigate the causal relationship of improving symptoms of dyspnea with change of PA through the coaching intervention. We hypothesize that combining endoscopic lung volume reduction with tele coaching can improve the effectiveness of the coaching intervention.

This research project will tackle important research questions regarding the long-term use of a tele coaching program with different activity trackers and the optimization of this coaching program by integrating it with medical interventions. These factors are crucial in maximizing the effect of coaching interventions and providing the best clinical practice towards patients with COPD.