A Web-Based Pedometer-Mediated Intervention Maintains Benefits After Pulmonary Rehabilitation: A Pilot Study.

RATIONALE: The optimal content and delivery method of pulmonary rehabilitation (PR) maintenance programs are unknown. We developed a web-based, pedometer-mediated intervention, based on the Behavioral Theory of Self-Regulation, to promote physical activity in persons with COPD. In this pilot single-arm cohort study, we examined whether it can maintain benefits after PR completion. METHODS: US Veterans with COPD who completed PR were enrolled for 12 months. At baseline and follow-up every 3 months, the Fitbit Inspire-2 pedometer objectively measured daily step count. The 6-minute walk test (6MWT) assessed exercise capacity, modified Medical Research Council (mMRC) score assessed dyspnea, and St. George's Respiratory Questionnaire Total Score (SGRQ-TS) examined health-related quality of life. Linear mixed-effects models (PROC MIXED, SAS v9.4) for repeated measures examined change from baseline over 12 months. Models adjusted for age, FEV1%predicted, supplemental oxygen use, and PR delivery mode. Adjusted least square (LS) means ± standard errors or p values for change are presented. RESULTS: Twenty participants who completed PR had mean±sd age 72±6 years and FEV1%predicted 57±23%. There was no significant decline in daily step count over 12 months of using the intervention (n=20, p=0.80). For the 7 participants who performed 6MWTs, there was an improvement of 66±14 m post-PR compared to pre-PR, p<0.001. There was a clinically relevant, but not statistically significant, decrease in 6MWT distance of 26±24 m (n=8, p=0.27) over 12 months. The adjusted LS mean for 6MWT distance at 12 months (361±20 m) trended lower than the value post-PR (403±19 m), p=0.10, but not significantly different than the value pre-PR (337±19 m), p=0.37. There were no significant changes in mMRC dyspnea score (n=8, 0.02±0.39, p=0.96) or SGRQ-TS (n=20, 0.42±2.82, p=0.88). CONCLUSION: These results suggest that a web-based, pedometer-mediated intervention may be an effective part of a long-term maintenance program after completion of PR.