Pedometer Intervention Has No Effect on Physical Activity After Pulmonary Rehabilitation for COPD

Giving a pedometer to patients with chronic obstructive pulmonary disease (COPD) who underwent pulmonary rehabilitation (PR) did not improve patients’ long-term physical activity beyond the effects of the PR program, according to a recent study.

The STAR study, published in the International Journal of Chronic Obstructive Pulmonary Disease, contradicted previous research that suggested that pedometers are effective at improving physical activity after patients go through PR, which despite known benefits, often fails at getting patients to develop physical activity habits in the long-term.

“Our results suggest that the addition of a brief pedometer-based intervention does not substantially enhance the long-term PA-promoting effect of inpatient PR in COPD and should therefore not be implemented into the clinical practice of PR in this brief duration,” wrote the investigators.

Pedometers, either used alone or in addition to PR, are regarded as a very effective intervention method to encourage and monitor physical activity. However, there is no data available on the long-term effects of pedometers on physical activity behavior in patients with COPD who have gone through PR.

For the single-center, randomized controlled design, patients underwent a 3-week long PR program at the Rehabilitation Clinic of Bad Reichenhall, Germany. The investigators examined the physical activity levels of patients 2 weeks prior to starting PR, at the start of PR, right after the PR program was completed, 6 weeks after ending PR, and 6 months after ending PR. Quality of life, depression, COPD-related anxiety, fear avoidance in COPD, and dyspnea were also analyzed.

Out of the 418 patients who were recruited, 327 were analyzed: 167 were entered into the intervention group (IG) featuring PR and a pedometer, and 160 were entered into the control group (CG) that featured only PR. The mean (SD) age of the patients was 58.02 (5.43) years and 69% (n = 226) were male. The patients were recruited between June 2016 and June 2018 and the follow-up period completed in December 2019.

Both patient groups showed a significant increase in daily steps and moderate-intensity physical activity from the 2 weeks prior to PR (baseline) to 6 weeks after PR. The mean changes were slightly higher for both outcomes in the IG (steps, +1153; moderate-intensity physical activity, +8.0 min) compared with the CG (steps, +745; moderate-intensity physical activity, +4.3 min).

Similar results were seen for step counts at 6 months post-PR (IG, +795 steps; CG, +299 steps). After 6 months, moderate-intensity physical activity levels were almost identical to the levels at baseline.

There was also a small reduction in daily sedentary time from baseline to 6 weeks after PR (intervention group, -12.1 min; control group, -10.9 min).

However, none of the changes between the 2 groups for steps, moderate-intensity physical activity, and sedentary time was statistically significant (P > .05 for all). Additionally, none of the changes between the IG and the CG produced statistically significant changes for health-related quality of life.

The investigators said that the observed changes could have been attributed to the high quality of the PR programs offered in Germany. It was also possible that the pedometer-based intervention lasted for too short of a duration and that the groups had a high physical activity level at baseline, thus, reducing the effectiveness of the intervention.

“The high-quality standard rehabilitation program employed for both the IG and the CG led to a considerable PA-promoting effect, which was difficult to increase via the—perhaps too short—pedometer intervention,” said the investigators.

The study had some limitations, including that the sample size at 6 months was smaller than the pre-calculated number (288 vs 351) and that there was a higher-than-expected dropout rate. Additionally, water-based activities were not calculated, the 10-hour wear-time requirement for the pedometer did not cover the full day, and the study population was younger than general COPD population. Generalizability of the results was hampered because the data was collected from a single center in a single country.

Reference

Geidl W, Carl J, Schuler M, et al. Long-term benefits of adding a pedometer to pulmonary rehabilitation for COPD: The randomized controlled STAR trial. Int J Chron Obstruct Pulmon Dis. July 2, 2021;16:1977–1988. doi:10.2147/COPD.S304976