A randomized controlled trial of telephone-mentoring with home-based walking preceding rehabilitation in COPD.
OBJECTIVE
With the limited reach of pulmonary rehabilitation (PR) and low levels of daily physical activity in chronic obstructive pulmonary disease (COPD), a need exists to increase daily exercise. This study evaluated telephone health-mentoring targeting home-based walking (tele-rehab) compared to usual waiting time (usual care) followed by group PR.


METHODS
People with COPD were randomized to tele-rehab (intervention) or usual care (controls). Tele-rehab delivered by trained nurse health-mentors supported participants' home-based walking over 8-12 weeks. PR, delivered to both groups simultaneously, included 8 weeks of once-weekly education and self-management skills, with separate supervised exercise. Data were collected at three time-points: baseline (TP1), before (TP2), and after (TP3) PR. The primary outcome was change in physical capacity measured by 6-minute walk distance (6MWD) with two tests performed at each time-point. Secondary outcomes included changes in self-reported home-based walking, health-related quality of life, and health behaviors.


RESULTS
Of 65 recruits, 25 withdrew before completing PR. Forty attended a median of 6 (4) education sessions. Seventeen attended supervised exercise (5±2 sessions). Between TP1 and TP2, there was a statistically significant increase in the median 6MWD of 12 (39.1) m in controls, but no change in the tele-rehab group. There were no significant changes in 6MWD between other time-points or groups, or significant change in any secondary outcomes. Participants attending supervised exercise showed a nonsignificant improvement in 6MWD, 12.3 (71) m, while others showed no change, 0 (33) m. The mean 6MWD was significantly greater, but not clinically meaningful, for the second test compared to the first at all time-points.


CONCLUSIONS
Telephone-mentoring for home-based walking demonstrated no benefit to exercise capacity. Two 6-minute walking tests at each time-point may not be necessary. Supervised exercise seems essential in PR. The challenge of incorporating exercise into daily life in COPD is substantial.
Centre of Research Excellence for Chronic Respiratory Disease and Lung Aging, School of Medicine.
Helen Laura
HL
Cameron-Tucker
Centre of Research Excellence for Chronic Respiratory Disease and Lung Aging, School of Medicine.
Richard
R
Wood-Baker
Centre of Research Excellence for Chronic Respiratory Disease and Lung Aging, School of Medicine.
Lyn
L
Joseph
Centre of Research Excellence for Chronic Respiratory Disease and Lung Aging, School of Medicine.
Julia A
JA
Walters
School of Health Sciences, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia.
Natalie
N
Schüz
Centre of Research Excellence for Chronic Respiratory Disease and Lung Aging, School of Medicine.
E Haydn
EH
Walters
D000368:Aged; D005081:Exercise Therapy / Q000379:methods* / Q000451:nursing; D017079:Exercise Tolerance; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D018575:Home Care Services, Hospital-Based; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008611:Mentors; D008875:Middle Aged; D010353:Patient Education as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000451:nursing / Q000503:physiopathology / Q000534:rehabilitation*; D011788:Quality of Life; D020127:Recovery of Function; D012138:Respiratory Therapy / Q000379:methods* / Q000451:nursing; D012648:Self Care; D013648:Tasmania; D017216:Telemedicine / Q000379:methods*; D013689:Telephone; D013997:Time Factors; D016896:Treatment Outcome; D000070857:Walk Test; D016138:Walking
exercise; physical capacity; pulmonary rehabilitation; self-reported walking; structured self-management-based education