Volume 89, Issue 3 , Pages 404-412, March 2008
A Randomized Clinical Trial of an Activity and Exercise Adherence Intervention in Chronic Pulmonary Disease
Abstract
Steele BG, Belza B, Cain KC, Coppersmith J, Lakshminarayan S, Howard J, Haselkorn JK. A randomized clinical trial of an activity and exercise adherence intervention in chronic pulmonary disease.
Objectives
To evaluate the effectiveness of an exercise adherence intervention to maintain daily activity, adherence to exercise, and exercise capacity over 1 year after completion of an outpatient pulmonary rehabilitation program.
Design
A 2-group, experimental design was used with randomization into intervention and usual care groups.
Setting
Outpatient pulmonary rehabilitation program in a university-affiliated medical center.
Participants
One hundred six subjects (98 men; 98 with chronic obstructive pulmonary disease) with a mean age of 67 years and chronic lung disease.
Intervention
Twelve-week adherence intervention (weekly phone calls and home visit) including counseling on establishing, monitoring, and problem-solving in maintaining a home exercise program.
Main Outcome Measures
Primary outcomes included daily activity (accelerometer), exercise adherence (exercise diary), and exercise capacity (six-minute walk test). All measures were performed at baseline, after the pulmonary rehabilitation program (8wk), after the adherence intervention (20wk), and at 1 year.
Results
A rank-based analysis of covariance showed less decline at 20 weeks in exercise adherence (intervention mean, +3min; control mean, −13min; P=.015) and exercise capacity (intervention mean, −10.7m; control mean, −35.4m; P=.023). There were no differences in daily activity at 20 weeks or any differences in any primary variable at 1 year.
Conclusions
The intervention enhanced exercise adherence and exercise capacity in the short term but produced no long-term benefit. These findings are in part attributed to the disappointing measurement characteristics of the accelerometer used to measure daily activity. The intervention was acceptable to participants. Further study is needed to fashion interventions that have more persistent benefit.
Key Words: Behavior therapy, Exercise therapy, Health status, Patient compliance, Quality of life, Rehabilitation
Supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service (grant no. NRI 98-194) and the University of Washington School of Nursing (research and intramural funding grant).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.
PII: S0003-9993(07)01746-7
doi:10.1016/j.apmr.2007.11.003
© 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
Volume 89, Issue 3 , Pages 404-412, March 2008
