title: Long-Term Effects of an Internet-Mediated Pedometer-Based Walking Program for Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial.
abstract: Regular physical activity (PA) is recommended for persons with chronic obstructive pulmonary disease (COPD). Interventions that promote PA and sustain long-term adherence to PA are needed.
  
  
  
  We examined the effects of an Internet-mediated, pedometer-based walking intervention, called Taking Healthy Steps, at 12 months.
  
  
  
  Veterans with COPD (N=239) were randomized in a 2:1 ratio to the intervention or wait-list control. During the first 4 months, participants in the intervention group were instructed to wear the pedometer every day, upload daily step counts at least once a week, and were provided access to a website with four key components: individualized goal setting, iterative feedback, educational and motivational content, and an online community forum. The subsequent 8-month maintenance phase was the same except that participants no longer received new educational content. Participants randomized to the wait-list control group were instructed to wear the pedometer, but they did not receive step-count goals or instructions to increase PA. The primary outcome was health-related quality of life (HRQL) assessed by the St George's Respiratory Questionnaire Total Score (SGRQ-TS); the secondary outcome was daily step count. Linear mixed-effect models assessed the effect of intervention over time. One participant was excluded from the analysis because he was an outlier. Within the intervention group, we assessed pedometer adherence and website engagement by examining percent of days with valid step-count data, number of log-ins to the website each month, use of the online community forum, and responses to a structured survey.
  
  
  
  Participants were 93.7% male (223/238) with a mean age of 67 (SD 9) years. At 12 months, there were no significant between-group differences in SGRQ-TS or daily step count. Between-group difference in daily step count was maximal and statistically significant at month 4 (P<.001), but approached zero in months 8-12. Within the intervention group, mean 76.7% (SD 29.5) of 366 days had valid step-count data, which decreased over the months of study (P<.001). Mean number of log-ins to the website each month also significantly decreased over the months of study (P<.001). The online community forum was used at least once during the study by 83.8% (129/154) of participants. Responses to questions assessing participants' goal commitment and intervention engagement were not significantly different at 12 months compared to 4 months.
  
  
  
  An Internet-mediated, pedometer-based PA intervention, although efficacious at 4 months, does not maintain improvements in HRQL and daily step counts at 12 months. Waning pedometer adherence and website engagement by the intervention group were observed. Future efforts should focus on improving features of PA interventions to promote long-term behavior change and sustain engagement in PA.
  
  
  
  Clinicaltrials.gov NCT01102777; https://clinicaltrials.gov/ct2/show/NCT01102777 (Archived by WebCite at http://www.webcitation.org/6iyNP9KUC).
authors: Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, Boston, MA, United States.
authors: Marilyn L
authors: 0000-0002-2471-9218
authors: ML
authors: Moy
authors: Carlos H
authors: 0000-0003-2070-4091
authors: CH
authors: Martinez
authors: Reema
authors: 0000-0003-0935-3761
authors: R
authors: Kadri
authors: Pia
authors: 0000-0002-6190-4666
authors: P
authors: Roman
authors: Robert G
authors: 0000-0003-2300-1842
authors: RG
authors: Holleman
authors: Hyungjin Myra
authors: 0000-0002-0604-8027
authors: HM
authors: Kim
authors: Huong Q
authors: 0000-0002-3650-3705
authors: HQ
authors: Nguyen
authors: Miriam D
authors: 0000-0002-8551-0741
authors: MD
authors: Cohen
authors: David E
authors: 0000-0003-3232-2189
authors: DE
authors: Goodrich
authors: Nicholas D
authors: 0000-0002-5026-3859
authors: ND
authors: Giardino
authors: Caroline R
authors: 0000-0002-1945-6046
authors: CR
authors: Richardson
mesh_terms: D061725:Accelerometry; D000368:Aged; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009042:Motivation; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013995:Time; D016896:Treatment Outcome; D014728:Veterans; D014850:Waiting Lists; D016138:Walking
keywords: Internet; bronchitis, chronic; emphysema; exercise; motor activity; pulmonary disease, chronic obstructive; quality of life