title: An Internet-Mediated Pedometer-Based Program Improves Health-Related Quality-of-Life Domains and Daily Step Counts in COPD: A Randomized Controlled Trial.
abstract: BACKGROUND
  Low levels of physical activity (PA) are associated with poor outcomes in people with COPD. Interventions to increase PA could improve outcomes.
  
  
  METHODS
  We tested the efficacy of a novel Internet-mediated, pedometer-based exercise intervention. Veterans with COPD (N = 239) were randomized in a 2:1 ratio to the (1) intervention group (Omron HJ-720 ITC pedometer and Internet-mediated program) or (2) wait-list control group (pedometer). The primary outcome was health-related quality of life (HRQL), assessed by the St. George's Respiratory Questionnaire (SGRQ), at 4 months. We examined the SGRQ total score (SGRQ-TS) and three domain scores: Symptoms, Activities, and Impact. The secondary outcome was daily step counts. Linear regression models assessed the effect of intervention on outcomes.
  
  
  RESULTS
  Participants had a mean age of 67 ± 9 years, and 94% were men. There was no significant between-group difference in mean 4-month SGRQ-TS (2.3 units, P = .14). Nevertheless, a significantly greater proportion of intervention participants than control subjects had at least a 4-unit improvement in SGRQ-TS, the minimum clinically important difference (53% vs 39%, respectively, P = .05). For domain scores, the intervention group had a lower (reflecting better HRQL) mean than the control group by 4.6 units for Symptoms (P = .046) and by 3.3 units for Impact (P = .049). There was no significant difference in Activities score between the two groups. Compared with the control subjects, intervention participants walked 779 more steps per day at 4 months (P = .005).
  
  
  CONCLUSIONS
  An Internet-mediated, pedometer-based walking program can improve domains of HRQL and daily step counts at 4 months in people with COPD.
  
  
  BACKGROUND
  Clinical Trials.gov; No.: NCT01102777; URL: www.clinicaltrials.gov.
authors: Department of Veterans Affairs, Rehabilitation Research and Development Service, and the Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, Harvard Medical School, Boston, MA.
authors: Marilyn L
authors: ML
authors: Moy
authors: University of Michigan Medical School, Ann Arbor, MI.
authors: Riley J
authors: RJ
authors: Collins
authors: Pulmonary and Critical Care Division, University of Michigan Health System, Ann Arbor, MI.
authors: Carlos H
authors: CH
authors: Martinez
authors: VA Center for Clinical Management Research, Health Services Research and Development Center of Innovation, VA Ann Arbor Healthcare System, Ann Arbor, MI.
authors: Reema
authors: R
authors: Kadri
authors: VA Center for Clinical Management Research, Health Services Research and Development Center of Innovation, VA Ann Arbor Healthcare System, Ann Arbor, MI.
authors: Pia
authors: P
authors: Roman
authors: VA Center for Clinical Management Research, Health Services Research and Development Center of Innovation, VA Ann Arbor Healthcare System, Ann Arbor, MI.
authors: Robert G
authors: RG
authors: Holleman
authors: VA Center for Clinical Management Research, Health Services Research and Development Center of Innovation, VA Ann Arbor Healthcare System, Ann Arbor, MI; University of Michigan School of Public Health, Ann Arbor, MI.
authors: Hyungjin Myra
authors: HM
authors: Kim
authors: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
authors: Huong Q
authors: HQ
authors: Nguyen
authors: VA New York Harbor, Brooklyn, NY.
authors: Miriam D
authors: MD
authors: Cohen
authors: VA Center for Clinical Management Research, Health Services Research and Development Center of Innovation, VA Ann Arbor Healthcare System, Ann Arbor, MI.
authors: David E
authors: DE
authors: Goodrich
authors: Department of Psychiatry, University of Michigan, Ann Arbor, MI.
authors: Nicholas D
authors: ND
authors: Giardino
authors: VA Center for Clinical Management Research, Health Services Research and Development Center of Innovation, VA Ann Arbor Healthcare System, Ann Arbor, MI; Department of Family Medicine, University of Michigan, Ann Arbor, MI. Electronic address: caroli@umich.edu.
authors: Caroline R
authors: CR
authors: Richardson
mesh_terms: D056044:Actigraphy / Q000295:instrumentation; D000368:Aged; D004417:Dyspnea / Q000209:etiology / Q000517:prevention & control; D030141:Feedback, Psychological; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*; D011788:Quality of Life; D012648:Self Care; D012944:Social Support; D011795:Surveys and Questionnaires; D014728:Veterans; D016138:Walking