Taking Healthy Steps: rationale, design and baseline characteristics of a randomized trial of a pedometer-based internet-mediated walking program in veterans with chronic obstructive pulmonary disease

BMC Pulmonary Medicine, Feb 2014

Background Low levels of physical activity are common in patients with chronic obstructive pulmonary disease (COPD), and a sedentary lifestyle is associated with poor outcomes including increased mortality, frequent hospitalizations, and poor health-related quality of life. Internet-mediated physical activity interventions may increase physical activity and improve health outcomes in persons with COPD. Methods/Design This manuscript describes the design and rationale of a randomized controlled trial that tests the effectiveness of Taking Healthy Steps, an Internet-mediated walking program for Veterans with COPD. Taking Healthy Steps includes an uploading pedometer, a website, and an online community. Eligible and consented patients wear a pedometer to obtain one week of baseline data and then are randomized on a 2:1 ratio to Taking Healthy Steps or to a wait list control. The intervention arm receives iterative step-count feedback; individualized step-count goals, motivational and informational messages, and access to an online community. Wait list controls are notified that they are enrolled, but that their intervention will start in one year; however, they keep the pedometer and have access to a static webpage. Discussion Participants include 239 Veterans (mean age 66.7 years, 93.7% male) with 155 randomized to Taking Healthy Steps and 84 to the wait list control arm; rural-living (45.2%); ever-smokers (93.3%); and current smokers (25.1%). Baseline mean St. George’s Respiratory Questionnaire Total Score was 46.0; 30.5% reported severe dyspnea; and the average number of comorbid conditions was 4.9. Mean baseline daily step counts was 3497 (+/- 2220). Veterans with COPD can be recruited to participate in an online walking program. We successfully recruited a cohort of older Veterans with a significant level of disability including Veterans who live in rural areas using a remote national recruitment strategy. Trial registration Clinical Trials.gov NCT01102777

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

http://www.biomedcentral.com/content/pdf/1471-2466-14-12.pdf

Taking Healthy Steps: rationale, design and baseline characteristics of a randomized trial of a pedometer-based internet-mediated walking program in veterans with chronic obstructive pulmonary disease

Carlos H Martinez 4 Marilyn L Moy 2 3 Huong Q Nguyen 7 Miriam Cohen 6 Reema Kadri 0 Pia Roman 0 Robert G Holleman 0 Hyungjin Myra Kim 0 5 David E Goodrich 0 Nicholas D Giardino 8 Caroline R Richardson 0 1 0 Center for Clinical Management Research, VA Ann Arbor Healthcare System , 2215 Fuller Rd, 48105 Ann Arbor, MI , USA 1 Department of Family Medicine, University of Michigan , 1018 Fuller St, 48104-1213 Ann Arbor, MI , USA 2 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital , Boston , USA 3 Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System , 1400 VFW Parkway, 02132 West Roxbury, MA , USA 4 Pulmonary & Critical Care Division, University of Michigan Health System , 3916 Taubman Center, Box 0360, 1500 E. Medical Center Drive, 48104 Ann Arbor, MI , USA 5 School of Public Health, University of Michigan , 915 E. Washington, 48109-2399 Ann Arbor, MI , USA 6 Patient Services , VA New York Harbor 800 Poly Place, 11209 Brooklyn, NY , USA 7 Department of Research and Evaluation, Kaiser Permanente Southern California , 100 S. Los Robles Ave, 91102 Pasadena, CA , USA 8 Department of Psychiatry, University of Michigan , 2215 Fuller Rd, 48109-2399 Ann Arbor, MI , USA Background: Low levels of physical activity are common in patients with chronic obstructive pulmonary disease (COPD), and a sedentary lifestyle is associated with poor outcomes including increased mortality, frequent hospitalizations, and poor health-related quality of life. Internet-mediated physical activity interventions may increase physical activity and improve health outcomes in persons with COPD. Methods/Design: This manuscript describes the design and rationale of a randomized controlled trial that tests the effectiveness of Taking Healthy Steps, an Internet-mediated walking program for Veterans with COPD. Taking Healthy Steps includes an uploading pedometer, a website, and an online community. Eligible and consented patients wear a pedometer to obtain one week of baseline data and then are randomized on a 2:1 ratio to Taking Healthy Steps or to a wait list control. The intervention arm receives iterative step-count feedback; individualized step-count goals, motivational and informational messages, and access to an online community. Wait list controls are notified that they are enrolled, but that their intervention will start in one year; however, they keep the pedometer and have access to a static webpage. Discussion: Participants include 239 Veterans (mean age 66.7 years, 93.7% male) with 155 randomized to Taking Healthy Steps and 84 to the wait list control arm; rural-living (45.2%); ever-smokers (93.3%); and current smokers (25.1%). Baseline mean St. George's Respiratory Questionnaire Total Score was 46.0; 30.5% reported severe dyspnea; and the average number of comorbid conditions was 4.9. Mean baseline daily step counts was 3497 (+/ 2220). Veterans with COPD can be recruited to participate in an online walking program. We successfully recruited a cohort of older Veterans with a significant level of disability including Veterans who live in rural areas using a remote national recruitment strategy. Trial registration: Clinical Trials.gov NCT01102777 - Background Burden and management of COPD Chronic Obstructive Pulmonary Disease (COPD) is a significant problem worldwide, affecting 9-10% of the population 40 years of age or older [1,2]. In the U.S., COPD is currently the third cause of mortality [3] and affects 5.1% of the population. Among Veterans the prevalence is 8.2% [4] with those afflicted by the disease accumulating more emergency room and outpatient visits to physicians when compared to persons without COPD. COPD is characterized by acute exacerbations (AECOPD), which are responsible for 70% of the total cost generated by the disease. AECOPD accelerate the rate of decline of lung function [5] and negatively impact health-related quality of life (HRQL); nearly 50% of the patients will continue to need help with their activities of daily living six months after hospital discharge for an AECOPD [6]. AECOPD are part of a downward spiral in functionality and HRQL and are also the main risk factor for new or recurrent exacerbations [7]. The principles of COPD management include control of symptoms, prevention of AECOPD, and improving HRQL. Strategies include smoking cessation, pharmacological therapy with short- and long-acting bronchodilators and anti-inflammatory inhaled medications, oxygen supplementation, and early recognition of symptoms. Almost all available therapeutic options have been proven to reduce symptoms, decrease the frequency of exacerbations, and improve HRQL [8-11], but none of the available pharmacologic interventions modifies the progressive loss of pulmonary function [12]. The recognition of a high frequency of cardiovascular disease as cause of death in COPD patients [13] and the role of comorbid conditions as risk factors for recurrent exace (...truncated)


This is a preview of a remote PDF: http://www.biomedcentral.com/content/pdf/1471-2466-14-12.pdf

Carlos H Martinez, Marilyn L Moy, Huong Q Nguyen, Miriam Cohen, Reema Kadri, Pia Roman, Robert G Holleman, Hyungjin Kim, David E Goodrich, Nicholas D Giardino, Caroline R Richardson. Taking Healthy Steps: rationale, design and baseline characteristics of a randomized trial of a pedometer-based internet-mediated walking program in veterans with chronic obstructive pulmonary disease, BMC Pulmonary Medicine, 2014, pp. 12, 14, DOI: 10.1186/1471-2466-14-12