A99-02 A Web-based, Pedometer-mediated Intervention Increases Amount and Intensity of Daily Steps Counts in COPD: A Randomized Controlled Trial

Rationale Ground-based walking training can be an aerobic exercise used in conventional pulmonary rehabilitation (PR) programs with minimal equipment. We evaluated the efficacy of a web-based, pedometer-mediated intervention aimed at increasing walking amount and intensity in individuals with COPD. Methods This randomized controlled trial enrolled 146 participants with COPD who never attended PR and had Internet access. The trial was conducted in-person, remotely, or hybrid due to the COVID-19 pandemic. Participants were randomly assigned (1:1) to the intervention or control group for 12 weeks. The intervention included: 1) individualized step-count goals, 2) objective monitoring (Fitbit Inspire HR) and iterative feedback of daily step counts, 3) motivational messages and educational content, and 4) an online community forum. Participants were instructed to achieve their step-count goals with moderate intensity guided by a Borg rating of 4-5 for dyspnea. The primary outcome was change in average daily step count from baseline to 12 weeks. Secondary outcomes included self-reported physical activity (PA) intensity (Rapid Assessment of PA [RAPA]) and 4 walking items on the Community Healthy Activities Model Program for Seniors [CHAMPS] PA questionnaire. RAPA categorizes PA intensity as underactive or active based on exercise minutes at moderate or vigorous levels. Generalized linear models (PROC GLM, SAS v9.4, Cary, NC, USA) assessed between-group change from baseline to 12 weeks. Models adjusted for forced expiratory volume in 1 second (FEV1) %predicted, season, and study mode. Results Ninety-nine participants (54 intervention, 45 control) with >1 follow-up time point at 6 or 12 weeks were included in the analysis. Mean age was 73±7 years, with 98% male participants, and mean FEV1 %predicted was 75±22%. Baseline daily step count was 4,289±1,876 and 5,043±2,651 in the intervention and control group, respectively. Intervention participants increased average daily step count by 1,604 [95% CI:513;2,696] steps/day more than the control group (p = 0.005) (Figure). The intervention group had a significant number of participants transition from underactive to active PA intensity, compared to control (p = 0.042). Within the intervention group, 20 (41%) participants moved from underactive to active (p = 0.001). The number of transitions to active was not significant in the control group (p = 0.564). Compared to control, the intervention group demonstrated significant increases in CHAMPS weekly walk frequency (p = 0.002) and duration (p = 0.041). Conclusion A technology-mediated intervention focused on walking amount and intensity is efficacious for individuals with COPD who never participated in PR. This intervention can potentially be used by PR programs to provide ground-based walking training. This abstract is funded by: VA Office of Research and Development Merit Award I01 RX002855