How to Get COPD Patients to Exercise

Researchers recently examined the methods necessary to optimize a self-managed behavior-change program for patients with chronic obstructive pulmonary disease (COPD) and reported their findings in BMJ Open.

The study was written by Jean Bourbeau, MD, of the Respiratory Epidemiology Clinical Research Unit at McGill University in Montreal, Canada, and colleagues.

Self-managed behavior-change programs are designed to help patients improve exercise capacity enough to impact the amount of physical activity patients are able to perform. Although many studies have shown a link between lack of physical activity and declining lung function, the authors say that “interventions are complex, involving multiple inter-related components, and must be standardized but personalized and administered consistently to all patients to show a treatment effect.” They add that “published studies provide little guidance, lacking necessary details.”

In order to learn more about effective methods for behavior-change programs, the researchers considered the PHYSACTO study, which they describe as “a phase IIIb study designed to assess the effect of a new COPD maintenance bronchodilator therapy and supervised exercise training on exercise capacity and physical activity outcomes including the amount of physical activity and perceived difficulties.”

The researchers go on to say, “The objectives with respect to the behavior-modification program are to explore the extent to which potential moderating variables could influence the increase in physical activity during everyday tasks.”

The participants in the PHYSACTO study were randomized into groups which received tiotropium+olodaterol with and without exercise therapy, tiotropium, or placebo. A 12-week behavior-change program was included for all four groups. Since PHYSACTO is a multicenter study, the program was standardized across locations.

A site case manager with at least 2 years’ experience with COPD patients was selected for each and provided with a 3 day training period. Participants each had individual sessions, followed by group sessions at weeks 2, 5, 8, 11, and at follow-up. Both outcome and process measures were taken throughout the study.

Without established processes based on evidence it will remain difficult to measure the success of self-managed behavior-change programs for COPD patients. The researchers believe “this multicenter study is a first step towards integrating a more coherent and careful plan at the patient, provider, and system or organizational levels.”