Home-based Physical Activity Coaching, Physical Activity, and Health Care Utilization in Chronic Obstructive Pulmonary Disease. Chronic Obstructive Pulmonary Disease Self-Management Activation Research Trial Secondary Outcomes

• Published in: Annals of the American Thoracic Society Vol. 15; no. 4; pp. 470 - 478
• Main Authors: Coultas, David B, Jackson, Bradford E, Russo, Rennie, Peoples, Jennifer, Singh, Karan P, Sloan, John, Uhm, Minyong, Ashmore, Jamile A, Blair, Steven N, Bae, Sejong
• Format: Journal Article
• Language: English
• Published: United States American Thoracic Society 01.04.2018
• Subjects: Aged; Behavior modification; Chronic illnesses; Chronic obstructive pulmonary disease; Clinical trials; Confidence intervals; Disease Progression; Education; Exercise; Female; Forced Expiratory Volume; Health services utilization; Humans; Intervention; Lifestyles; Lung - physiopathology; Male; Medicare; Mentoring - methods; Middle Aged; Original Research; Outcome Assessment, Health Care; Patient Acceptance of Health Care - statistics & numerical data; Patients; Physical fitness; Prevention; Pulmonary Disease, Chronic Obstructive - rehabilitation; Quality of Life; Rehabilitation; Self Report; Self-Management - methods; Spirometry; Time Factors; United States > US; health care utilization; behavior change; self-management; physical inactivity
• ISSN: 2329-6933; 2325-6621
• DOI: 10.1513/AnnalsATS.201704-308OC

Physical inactivity among patients with chronic obstructive pulmonary disease is associated with exacerbations requiring high-cost health care utilization including urgent, emergent, and hospital care. To examine the effectiveness of a behavioral lifestyle physical activity intervention combined with chronic obstructive pulmonary disease self-management education to prevent high-cost health care utilization. This was an analysis of secondary outcomes of the Chronic Obstructive Pulmonary Disease Self-Management Activation Research Trial, a two-arm randomized trial of stable adult outpatients with chronic obstructive pulmonary disease recruited from primary care and pulmonary clinics. Following a 6-week self-management education run-in period, participants were randomized to usual care or to a telephone-delivered home-based health coaching intervention over 20 weeks. Secondary outcomes of physical activity and health care utilization were determined by self-report 6, 12, and 18 months after randomization. Associations between treatment allocation arm and these secondary outcomes were examined using log-binomial and Poisson regression models. A total of 325 outpatients with stable chronic obstructive pulmonary disease were enrolled in the trial. Their average age was 70.3 years (standard deviation, 9.5), and 50.5% were female; 156 were randomized to usual care and 149 to the intervention. A greater proportion of participants reported being persistently active over the 18-month follow-up period in the intervention group (73.6%) compared with the usual care group (57.8%) (mean difference, 15.8%; 95% confidence interval, 4.0-27.7%). This association varied by severity of forced expiratory volume in 1 second impairment (P for interaction = 0.09). Those in the intervention group with moderate impairment (forced expiratory volume in 1 second, 50-70% predicted), more frequently reported being persistently active compared with the usual care (86.0 vs. 65.1%; mean difference, 20.9%; 95% confidence interval, 5.7-36.1%). Patients with severe and very severe forced expiratory volume in 1 second impairment (forced expiratory volume in 1 second < 50% predicted) in the intervention group also reported being persistently active more frequently compared with usual care (63.3 vs. 50.8%; mean difference, 12.6%; 95% confidence interval, -4.7 to 29.8). The intervention was associated with a lower rate of lung-related utilization (adjusted rate ratio, 0.38; 95% confidence interval, 0.23-0.63) only among participants with severe spirometric impairment. Our results demonstrate that a feasible and generalizable home-based coaching intervention may decrease sedentary behavior and increase physical activity levels. In those with severe chronic obstructive pulmonary disease, this intervention may reduce lung disease-related health care utilization. Clinical trial registered with www.clinicaltrials.gov (NCT01108991).