Effects of a brief, pedometer-based behavioral intervention for individuals with COPD during inpatient pulmonary rehabilitation on 6-week and 6-month objectively measured physical activity: study protocol for a randomized controlled trial

Effects of whey protein complex combined with low-intensity exercise in elderly inpatients with COPD at a stable stage

BACKGROUND AND OBJECTIVES

Previous literature mostly has demonstrated the efficacy of pulmonary rehabilitation (PR) combined with whole nutrition powder in patients with chronic obstructive pulmonary disease (COPD). However, the benefits of whey protein as an oral nutritional supplement (ONS) during PR are not clear.

METHODS AND STUDY DESIGN

It took 12 weeks to complete the trial, we divided 90 elderly patients with stable-stage COPD into a low-intensity exercise group (n= 30, PR group), PR plus whey proteins complex group (n= 30, PRWP group), and a control group (n= 30) randomly, and assessed index such as exercise capacity, mental health status, lung function, and body composition. Eventually, 84 people persisted until the end of the trial.

RESULTS

Compared with the control group, hand grip strength (HGS)(1.4 ± 0.6 kg, and 1.0 ± 0.2 kg respectively, p< 0.05) in the PRWP and PR group, 6 minutes of walking distance (6MWD)(14.1 ± 3.8m, p< 0.05) in PRWP group improved. Furthermore, compared with the PR group, Medical Research Council Dyspnea Scale (MRC)(-0.2 ± 0.1, p< 0.01), anxiety score (-1.2 ± 0.4, p< 0.01), and body weight (2.0 ± 0.8kg, p< 0.05) improved in the PRWP group. There were no inter-group differences in a fat-free mass index or appendicular skeletal muscle mass index.

CONCLUSIONS

Muscle strength could be enhanced in both intervention models. Adding whey protein complex was additionally successful in rectifying dyspnea, anxiety, and weight loss caused by exercise. This rehabilitation pattern might be valuable in elderly patients with COPD.

The Effectiveness of Interventions to Reduce Sedentary Time in Different Target Groups and Settings in Germany: Systematic Review, Meta-Analysis and Recommendations on Interventions

BACKGROUND

Sedentary behavior is an important risk factor for several chronic diseases and is associated with an increased risk of mortality. We assessed the effectiveness of interventions to reduce sedentary time in Germany and provide recommendations on interventions to reduce sedentary time in children and adults.

METHODS

We comprehensively searched PubMed, Web of Science and the German Clinical Trials Register up to April 2022 for intervention studies targeting sedentary behavior in Germany. We performed a systematic review and qualitative synthesis of the interventions and a meta-analysis in children.

RESULTS

We included 15 studies comprising data from 4588 participants. The results of included primary studies in adults and children showed inconsistent evidence regarding change in sedentary time, with a majority of studies reporting non-significant intervention effects. The meta-analysis in children showed an increase in sedentary time for children in the control and intervention groups.

CONCLUSION

We found inconsistent evidence regarding the effectiveness of interventions to reduce time spent sedentary and our meta-analysis showed an increase in sedentary time in children. For children, we recommend physical and social environment interventions with an active involvement of families. For adults, we recommend physical environment interventions, such as height-adjustable desks at work.

The Relevance of Competences for a Healthy, Physically Active Lifestyle in Persons with Multiple Sclerosis: a Path Analytical Approach

To promote health and counteract the decline associated with the disease, persons with multiple sclerosis (pwMS) are advised to lead healthy, physically active lifestyles. The physical activity-related health competence (PAHCO) model posits that individuals must meet three integrated, person-related requirements for the adoption of such a lifestyle: movement competence, control competence, and self-regulation competence. To gain insights into the needs and challenges of pwMS, the goal of the present study was to empirically examine the roles of these competences within this target group. A total of 475 pwMS underwent a multidimensional, online-based assessment of PAHCO. These participants self-reported their amount of physical activity (PA), health status, disease-related, and sociodemographic information. We used a series of path analyses to investigate the relevance of the three competence areas for each individual's PA level and subjective health. Stepwise multivariate analyses revealed that self-regulation competence was significantly associated with overall PA volume. In contrast, movement competence did not contribute to this prediction. Control competence was also not related to PA level. However, in accordance with the PAHCO model, this factor exerted an independent, qualitative effect on participant health. In summary, self-regulation competence appears to play a crucial role with regard to PA volume. Specifically, control competence appears to be key for the qualitative aspect of PA promotion, characterizing the individual's application of an appropriate stimulus for the achievement of health. Integrating the promotion of self-regulation and control competences into rehabilitation practices can help to foster healthy, physically active lifestyles in pwMS.Supplemental data for this article is available online at https://doi.org/10.1080/08964289.2021.1935437 .

Walking Engagement in Mexican Americans Who Participated in a Community-Wide Step Challenge in El Paso, TX

In the United States, the Latinx population has the highest prevalence of physical inactivity compared with other ethnicities. Research shows that work-based physical activity interventions have been widely implemented in the non-Latinx population and effectively increase physical activity in the non-Latinx population. In an effort to improve physical activity and reduce obesity among the Latinx population, we conducted 10,000 Steps for 100 Days, an employer-based walking challenge campaign, to increase walking engagement among Latinx employees located in El Paso, Texas. Participants reported their number of steps using a pedometer or smartphone. Step counts were collected at baseline, 2 weeks post challenge, and 6 months post challenge. Screenshots of the tracking device were uploaded to an online tracker. Regression analysis was conducted to identify covariates associated with baseline and 2-week and 6-month average daily steps. Generalized estimating equations (GEE) were performed to predict steps over time by demographic characteristics. Participation in the 10,000 Steps for 100 Days walking challenge was associated with a sustained increase in average daily steps. Participants with less than 7000 steps per day demonstrated the greatest increase in average daily steps (921 steps at 2 weeks; 1002.4 steps at 6 months). Demographic characteristics were not significant predictors of average steps, except that married participants had higher average steps. Participants with 10,000 or more daily steps had a 51% (p = 0.031) higher chance of having a professional occupation than a non-professional one compared to those with 7000 or fewer daily steps. We provided initial evidence that the walking challenge is an effective approach for improving physical activity in the Latinx population.

The "can do, do do" concept in individuals with chronic obstructive pulmonary disease: an exploration of psychological mechanisms

Background

The “can do, do do” concept aims at identifying subgroups among persons with chronic obstructive pulmonary disease (COPD). Following a two-dimensional categorization, individuals are binarily classified with respect to their levels of physical capacity (“can’t do” or “can do”) and physical activity (“don’t do” or “do do”), resulting in four disjunct quadrants. The approach has been debated recently and the latest articles have concluded that the quadrants should be specifically examined in terms of psychological aspects of physical activity. Therefore, the goal of the present study was to explore the role of psychological variables in physical activity in the context of the “can do, do do” quadrant concept.

Methods

Within the scope of secondary data analyses of the “Stay Active After Rehabilitation” (STAR) randomized controlled trial, a total of 298 COPD rehabilitants of an inpatient pulmonary rehabilitation program were grouped into the suggested quadrants. We set fixed cut-offs at 70% of relative 6-min walking test performances for healthy individuals (physical capacity dimension) and 5.000 steps per day (physical activity dimension). Univariate and multivariate logistic regression analyses served to analyze whether depression scores, fear avoidance behaviors, disease-specific anxiety, self-concordance for physical activity, and five indicators of physical activity-related health competence (PAHCO) effectively discriminated between the “don’t do” and “do do” groups.

Results

Among persons with lower relative physical capacity, depression scores, fear avoidance behaviors, and disease-specific anxiety (univariate case) significantly differentiated between the more and the less active. Among persons with higher relative physical capacity, fear avoidance behaviors, disease-specific anxiety, as well as three PAHCO indicators (physical activity-specific self-efficacy, self-control, and affect regulation) significantly separated the more and the less active. In multivariate analyses, only fear avoidance behaviors and affect regulation discriminated among individuals with better relative physical capacity.

Conclusion

The findings identified important psychological and competence-oriented variables that explain discrepancies in the quadrant concept. Based on this, we discuss implications for physical activity promotion in individuals with COPD. Respiratory research can benefit from future studies complementing the quadrant concept through further behavioral analyses.

Trial registration Clinicaltrials.gov, ID: NCT02966561. Registered 17 November, 2016, https://clinicaltrials.gov/ct2/show/NCT02966561.

Competencies for a Healthy Physically Active Lifestyle-Validation of an Integrative Model

Purpose: The model of physical activity-related health competence (PAHCO) provides an integrative and interdisciplinary view on competencies that are necessary when people want to lead a healthy, physically active lifestyle. Given the need to accumulate potential further evidence on the validity of this model through the development of an assessment tool, the goal of the present study was to extend first measurement models on PAHCO. Method: In Study 1, a measurement model with five predictors on PAHCO was tested with 341 COPD patients undergoing inpatient rehabilitation. In Study 2, data from 745 apprentices were used to create an extended eight-factor measurement model. We undertook reliability analysis, confirmatory factor analysis (CFA), and structural equation modeling (SEM) to assess the validity of the models. Results: The analyses showed good results for the reliability and discriminant validity of the factors. Accordingly, the CFA demonstrated satisfactory overall fits for the five-factor as well as for the extended eight-factor measurement model. The associations with physical activity and physical health parameters indicated criterion validity for seven of the eight PAHCO factors. The explained variance of the multivariate models lay between 9.8% and 10.4% in Study 1 and between 9.5% and 21.3% in Study 2. Conclusion: In the present study, it was possible to extract a well-fitting, eight-factor measurement model and accumulate further evidence on the validity of the PAHCO model. Future research should strive for a cross-validation of the measurement model and more deeply investigate the internal structure of the eight factors.

Long-Term Benefits of Adding a Pedometer to Pulmonary Rehabilitation for COPD: The Randomized Controlled STAR Trial

Purpose

This Stay Active after Rehabilitation (STAR) study examined the effects of a pedometer-based behavioral intervention for individuals with COPD during three weeks of inpatient pulmonary rehabilitation (PR) on patients' physical activity levels six weeks and six months after PR, including steps (primary outcome), moderate-intensity physical activity, and sedentary time as well as patient quality of life, symptoms, and other psychological and clinical variables.

Patients and Methods

Rehabilitation patients with COPD wore a triaxial accelerometer (ActiGraph wGT3X) for seven days two weeks before (T0) as well as six weeks (T3) and six months (T4) after PR. In addition to the three-week inpatient PR (control group, CG), the randomly allocated intervention group (IG) received a brief pedometer-based behavioral intervention with the application of the following behavior-change techniques: performing the behavior, individual goal-setting, self-monitoring, and feedback. The effects were analyzed using analysis of covariance with an intention-to-treat approach.

Results

A total of 327 patients (69% male, age: 58 years, FEV₁ (%): 53.5, six-minute walk distance: 447.8 m) were randomly allocated to either the IG (n = 167) or CG (n = 160). Although both groups increased their daily steps after PR (IG: M_T3-T0 = 1152, CG: M_T3-T0 = 745; IG: M_T4-T0 = 795, CG: M_T4-T0 = 300), the slightly higher increases in daily steps in the IG compared to the CG at T3 (Δ388 steps, d = 0.16) and T4 (Δ458 steps, d = 0.15) were not statistically significant (p > 0.05 for all). Patients in both groups showed moderate to high pre-post-changes in terms of secondary outcomes, but no advantage favoring the IG was found.

Conclusion

The results show that adding a pedometer-based behavioral intervention to standard German three-week inpatient PR for COPD patients did not result in more physical activity in terms of steps and moderate-intensity physical activity or less sedentary time. However, both groups (IG and CG) showed remarkably enhanced physical activity levels six weeks and six months after PR, as well as improvements in other secondary outcomes (eg, quality of life).

What About the Environment? How the Physical Activity-Related Health Competence Model Can Benefit From Health Literacy Research

Research cultivates a multitude of frameworks, models, and theories with different determinants internal and/or external to the individual contributing to the understanding and explaining of physical activity levels. The physical activity–related health competence (PAHCO) model can be located at the interface between research of health literacy and physical activity. Because of its primary person orientation, however, the model has not yet undergone discussions on the relevance of the environment. Encouraged by the developments in the area of health literacy, the goal of the present perspective article was to stimulate some initial reflections on potential solutions for the competence–environment relationship within the PAHCO model. We extracted three potential solutions for this issue. Dubbed the solution of integration, we first discussed that the PAHCO model could be placed into overarching, more holistic, and abstract models of health-enhancing physical activity, such as the capability approach or the socioecological model. Applying a solution of elaboration, researchers could second substantiate existing components of the PAHCO model, such as control competence or self-regulation competence, by further explanations. Characterizing the solution of extension, it would third be possible to introduce (a) separate competence component(s) that highlight(s) the manageability of the environment, for instance, by establishing a (socio)ecological competence. The article concludes with a short overview of potential empirical approaches, given their potential to assist researchers in identifying preferences for the theoretical advancement and to put the development on a stronger evidence base.

Incorporating Internal and External Training Load Measurements in Clinical Decision Making After ACL Reconstruction: A Clinical Commentary

BACKGROUND AND PURPOSE

Poor outcomes after anterior cruciate ligament reconstruction (ACLr), including the relatively high risk of suffering a subsequent ACL injury, suggest the need to optimize rehabilitation and return-to-sport testing. The purpose of this commentary is to introduce clinicians to the concept of monitoring training load during rehabilitation, to review methods of quantifying internal and external loads, and to suggest ways that these technologies can be incorporated into rehabilitation progressions and return-to-sport decisions after anterior ACLr.

DESCRIPTION OF TOPIC WITH RELATED EVIDENCE

Quantifying and identifying the effects of training load variables, external (distance, impacts, decelerations) and internal (heart rate, heart rate variability) workload, during rehabilitation can indicate both positive (improved physical, physiological, or psychological capacity) or negative (heightened risk for injury or illness) adaptations and allow for the ideal progression of exercise prescription. When used during return-to-sport testing, wearable technology can provide robust measures of movement quality, readiness, and asymmetry not identified during performance-based testing.

DISCUSSION / RELATION TO CLINICAL PRACTICE

Researchers have reported the actual in-game demands of men and women of various ages and competition levels during multi-directional sport. Wearable technology can provide similar variables during rehabilitation, home exercise programs, and during on-field transition back to sport to ensure patients have met the expected fitness capacity of their sport. Additionally, clinicians can use internal load measures to objectively monitor patient's physiological responses to rehabilitation progressions and recovery rather than relying on subjective patient-reported data.

LEVEL OF EVIDENCE

5.

Towards a better understanding of physical activity in people with COPD: predicting physical activity after pulmonary rehabilitation using an integrative competence model

The integrative Physical Activity-related Health Competence (PAHCO) model specifies competences (movement competence, control competence, and self-regulation competence) that enable people to lead a physically active lifestyle. This longitudinal study analyses the predictive quality of a multidimensional PAHCO assessment for levels of physical activity (PA) and their relevance for quality of life in COPD patients after pulmonary rehabilitation. At the end of an inpatient pulmonary rehabilitation (T2), 350 COPD patients participating in the Stay Active after Rehabilitation (STAR) study underwent assessments, including a six-factor measurement of PAHCO. PA (triaxial accelerometry) and quality of life (Saint George's Respiratory Questionnaire) were recorded 6 weeks (T3) and 6 months (T4) after rehabilitation. Structural equation modelling (SEM) was used to regress the PAHCO assessment on PA, which should, in turn, influence quality of life. In univariable analysis, five and six factors of the PAHCO model were related to PA and quality of life, respectively. Multivariate modelling showed that the predictive analyses for the PA level were dominated by the 6-minute walking test representing movement competence (0.562 ≤ |β| ≤ 0.599). Affect regulation as an indicator of control competence co-predicted quality of life at T3 and levels of PA at T4. The PA level was, in turn, significantly associated with patients' quality of life (0.306 ≤ |β| ≤ 0.388). The integrative PAHCO model may be used as a theoretical framework for predicting PA in COPD patients following pulmonary rehabilitation. The results improve our understanding of PA behaviour in COPD patients and bear implications for person-oriented PA promotion.

Competencies for a Healthy Physically Active Lifestyle: Second-Order Analysis and Multidimensional Scaling

The physical activity-related health competence (PAHCO) model assumes that individuals require movement competence, control competence, and self-regulation competence to lead a healthy, physically active lifestyle. Although previous research has already established some measurement factors (n = 8) of the three dimensions, no attempts have so far been made to statistically aggregate them on the sub-competence level. Therefore, the goal of the present study was to test two additional factors for PAHCO and subsequently model the second-order structure with two samples from the fields of rehabilitation and prevention. We conducted two questionnaire surveys with persons with multiple sclerosis (n = 475) and teaching students undergoing a basic qualification course in physical education (n = 502). After performing exploratory items analysis, we used second-order confirmatory factor analysis (CFA) and multidimensional scaling to investigate whether the scales could be bundled in accordance with the PAHCO model. The CFAs with 10 factors (42 items) demonstrated a good model fit. In contrast, the second-order analysis with a simple loading structure on the three sub-competencies revealed an unacceptable model fit. Instead, a second-order model variant was preferred [comparative fit index (CFI) = 0.926, root mean square error of approximation (RMSEA) = 0.048, standardized root mean square residual (SRMR) = 0.065] in which body awareness and self-efficacy had theory-conform cross-loadings. The results of multidimensional scaling (two-dimensional solution) were in line with the extracted second-order structure. The present results suggested that the extension of the measurement instrument to 10 first-order factors was psychometrically justified for the two populations. The results from the second-order analyses provided the basis for the creation of sum scores, representing manifest indicators of movement competence, control competence, and self-regulation competence. Future studies are needed that cross-validate the extended measurement model with other populations and that relate the sub-competencies of PAHCO to indicators of health-enhancing physical activity.

An ORBIT Phase 1: Design study of a citywide employer-based walking challenges in a predominantly Mexican American metropolitan area

Most Mexican-Americans do not meet current physical activity recommendations. This paper uses the ORBIT model of obesity intervention development as a framework to outline the process of establishing three employer-based walking challenges in El Paso, Texas, a predominantly Mexican American community. The walking challenges were planned and implemented through the Border Coalition for Fitness and participating partnering organizations. Over 2000 participants and several employers took part in the walking challenges. Results from this ORBIT Phase 1 design intervention suggest that walking challenges are a feasible approach to increase physical activity in Mexican-Americans.

Competencies for a Healthy Physically Active Lifestyle-Reflections on the Model of Physical Activity-Related Health Competence

BACKGROUND

The World Health Organization's Global Action Plan on Physical Activity 2018-2030 states that physical activity interventions should strengthen peoples' competencies for health. Yet, frameworks that bundle pivotal competencies for a healthy and physically active lifestyle have not been extensively discussed in the past.

RESULTS

In the present article, the authors therefore present the model of Physical Activity-related Health Competence (PAHCO), an integrative structure model including the 3 areas of movement competence, control competence, and self-regulation competence. After providing a rationale for the use of the competence concept, the authors focus on implications from the PAHCO model to guide interventions for the promotion of a healthy and physically active lifestyle. The authors argue that the PAHCO model is located at the interface between health literacy and physical literacy, research areas that have gained increasing scholarly attention in recent years. In addition, PAHCO appears to be compatible with the concept of health capability because it can represent the important aspect of agency.

CONCLUSIONS

The article concludes with a scientific positioning of model components and some empirical results that have been accumulated so far.

Interventions for promoting physical activity in people with chronic obstructive pulmonary disease (COPD)

BACKGROUND

Escalating awareness of the magnitude of the challenge posed by low levels of physical activity in people with chronic obstructive pulmonary disease (COPD) highlights the need for interventions to increase physical activity participation. The widely-accepted benefits of physical activity, coupled with the increasing availability of wearable monitoring devices to objectively measure participation, has led to a dramatic rise in the number and variety of studies that aimed to improve the physical activity of people with COPD. However, little was known about the relative efficacy of interventions tested so far.

OBJECTIVES

In people with COPD, which interventions are effective at improving objectively-assessed physical activity?

SEARCH METHODS

We identified trials from the Cochrane Airways Trials Register Register, which contains records identified from bibliographic databases including the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, AMED, and PsycINFO. We also searched PEDro, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform portal and the Australian New Zealand Clinical Trials Registry (from inception to June 2019). We checked reference lists of all primary studies and review articles for additional references, as well as respiratory journals and respiratory meeting abstracts, to identify relevant studies.

SELECTION CRITERIA

We included randomised controlled trials of interventions that used objective measures for the assessment of physical activity in people with COPD. Trials compared an intervention with no intervention or a sham/placebo intervention, an intervention in addition to another standard intervention common to both groups, or two different interventions.

DATA COLLECTION AND ANALYSIS

We used standard methods recommended by Cochrane. Subgroup analyses were possible for supervised compared to unsupervised pulmonary rehabilitation programmes in clinically-stable COPD for a range of physical activity outcomes. Secondary outcomes were health-related quality of life, exercise capacity, adverse events and adherence. Insufficient data were available to perform prespecified subgroup analyses by duration of intervention or disease severity. We undertook sensitivity analyses by removing studies that were at high or unclear risk of bias for the domains of blinding and incomplete outcome data.

MAIN RESULTS

We included 76 studies with 8018 participants. Most studies were funded by government bodies, although some were sponsored by equipment or drug manufacturers. Only 38 studies had physical activity as a primary outcome. A diverse range of interventions have been assessed, primarily in single studies, but improvements have not been systematically demonstrated following any particular interventions. Where improvements were demonstrated, results were confined to single studies, or data for maintained improvement were not provided. Step count was the most frequently reported outcome, but it was commonly assessed using devices with documented inaccuracy for this variable. Compared to no intervention, the mean difference (MD) in time in moderate- to vigorous-intensity physical activity (MVPA) following pulmonary rehabilitation was four minutes per day (95% confidence interval (CI) -2 to 9; 3 studies, 190 participants; low-certainty evidence). An improvement was demonstrated following high-intensity interval exercise training (6 minutes per day, 95% CI 4 to 8; 2 studies, 275 participants; moderate-certainty evidence). One study demonstrated an improvement following six months of physical activity counselling (MD 11 minutes per day, 95% CI 7 to 15; 1 study, 280 participants; moderate-certainty evidence), but we found mixed results for the addition of physical activity counselling to pulmonary rehabilitation. There was an improvement following three to four weeks of pharmacological treatment with long-acting muscarinic antagonist and long-acting beta2-agonist (LAMA/LABA) compared to placebo (MD 10 minutes per day, 95% CI 4 to 15; 2 studies, 423 participants; high-certainty evidence). These interventions also demonstrated improvements in other measures of physical activity. Other interventions included self-management strategies, nutritional supplementation, supplemental oxygen, endobronchial valve surgery, non-invasive ventilation, neuromuscular electrical stimulation and inspiratory muscle training.

AUTHORS' CONCLUSIONS

A diverse range of interventions have been assessed, primarily in single studies. Improvements in physical activity have not been systematically demonstrated following any particular intervention. There was limited evidence for improvement in physical activity with strategies including exercise training, physical activity counselling and pharmacological management. The optimal timing, components, duration and models for interventions are still unclear. Assessment of quality was limited by a lack of methodological detail. There was scant evidence for a continued effect over time following completion of interventions, a likely requirement for meaningful health benefits for people with COPD.

Patterns of physical activity-related health competence: stability over time and associations with subjective health indicators

Objective

If individuals want to integrate health-enhancing physical activity in their everyday life, they need specific competences. This person-oriented study aimed to: 1) Identify patterns of physical activity-related health competence, 2) examine how structurally and individually stable these patterns are over 4 months and 3) test how changes in patterns are associated with changes in subjective health indicators.

Materials and methods

A total of 769 individuals (82% women, Mage = 27 years) were recruited from exercise courses offered by university sport. Four facets of physical activity-related health competence (control competence for physical training, physical activity-specific affect regulation, self-determined motivation for exercise, physical activity-specific self-control) and subjective health (subjective vitality and perceived fitness) were measured twice. Patterns were identified using latent profile analysis. Their stability and associations with subjective health changes were examined with latent transition analyses and a configural frequency analysis.

Results

Seven patterns of physical activity-related health competence were identified. Besides three level patterns, four shape patterns were found with differing ratings across the studied variables (e.g. average values for control competence for physical training, self-determined motivation and physical activity-specific self-control, but a high level in physical activity affect regulation). These patterns proved to be structurally stable over time. In all, 72% of the individuals stayed in the same pattern, whereas 20% moved to a more and 8% to a less competent pattern. Changes in patterns are linked to change in subjective vitality and perceived fitness.

Conclusion

The results presented here demonstrate the added value of using a person-oriented approach to investigate development of physical activity-related health competence. Furthermore, they generate knowledge for designing tailored interventions.

Physical Activity Promotion for Apprentices in Nursing Care and Automotive Mechatronics-Competence Counts More than Volume

Apprentices in the area of nursing care and automotive mechatronics are exposed to increased health risks. In this context, the promotion of physical activity (PA) is considered an effective strategy for the assurance of work ability. The goal of the PArC-AVE study was therefore to better understand the role of PA for apprentices employed in these two sectors. In an exploratory study, 55 apprentices wore an ActiGraph accelerometer over seven consecutive days and were subject to activity analysis. The objective accelerometer data (18,979 ± 3780 steps/day; 471.00 ± 159.75 min of moderate-to-vigorous PA/week), complemented by questionnaire data, indicated that most met the volume-based PA recommendations. Subsequently, we conducted a multicenter study comprising 745 apprentices from six vocational education institutions. Path analyses showed that competencies for health-enhancing PA were significantly related to indicators of work ability (0.180 ≤ b ≤ 0.452) and psychophysical health (0.139 ≤ b ≤ 0.347), whereas mere volume of PA was not (-0.048 ≤ b ≤ 0.080). In summary, apprentices of nursing care and automotive mechatronics showed high levels of PA. However, the results highlight the importance of competencies for health-enhancing PA. The PAHCO model could provide a useful framework for the conceptualization of effective interventions.

Impact of Disease-Specific Fears on Pulmonary Rehabilitation Trajectories in Patients with COPD

Disease-specific fears predict health status in chronic obstructive pulmonary disease (COPD), but their role in pulmonary rehabilitation (PR) remains poorly understood and especially longer-term evaluations are lacking. We therefore investigated changes in disease-specific fears over the course of PR and six months after PR, and investigated associations with PR outcomes (COPD assessment test (CAT) and St. Georges respiratory questionnaire (SGRQ)) in a subset of patients with COPD (n = 146) undergoing a 3-week inpatient PR program as part of the STAR study (Clinicaltrials.gov, ID: NCT02966561). Disease-specific fears as measured with the COPD anxiety questionnaire improved after PR. For fear of dyspnea, fear of physical activity and fear of disease progression, improvements remained significant at six-month follow-up. Patients with higher disease-specific fears at baseline showed elevated symptom burden (CAT and SGRQ Symptom scores), which persisted after PR and at follow-up. Elevated disease-specific fears also resulted in reduced improvements in Quality of Life (SGRQ activity and impact scales) after PR and at follow-up. Finally, improvement in disease-specific fears was associated with improvement in symptom burden and quality of life. Adjustment for potential confounding variables (sex, smoking status, age, lung function, and depressive symptoms) resulted in comparable effects. These findings show the role of disease-specific fears in patients with COPD during PR and highlight the need to target disease-specific fears to further improve the effects of PR.

Physical Activity and Sedentary Behaviour Patterns in 326 Persons with COPD before Starting a Pulmonary Rehabilitation: A Cluster Analysis

This study applies a cluster analysis to identify typical physical activity (PA) and sedentary behaviour (SB) patterns in people with chronic obstructive pulmonary disease (COPD) before starting pulmonary rehabilitation (PR). We implemented an observational design which assessed baseline data of objectively measured PA and SB from the STAR (Stay Active after Rehabilitation) study. A total of 355 persons wore an accelerometer (Actigraph wGT3X) for seven days before the start of their PR. Sociodemographic and disease-related parameters were assessed at the start of PR. We applied cluster analysis and compared clusters applying univariate variance analyses. Data was available for 326 persons (31.6% women; age ø = 58 years). Cluster analysis revealed four movement clusters with distinct PA and SB patterns: Sedentary non-movers (28.5%), sedentary occasional movers (41.7%), sedentary movers (19.6%), and sedentary exercisers (10.1%). The four clusters displayed varying levels of moderate PA before rehabilitation (Ø daily min: 9; 28; 38; 70). Notably, all four clusters displayed considerably long average sedentary time per day (Ø daily minutes: 644; 561; 490; 446). The clusters differed significantly in disease-related parameters of GOLD severity, FEV1, CAT, and 6-Min-Walk-Test. In addition to PA promotion, PR programs should consider the reduction of sedentary behaviour as a valuable goal.

Measurement of physical activity in clinical practice and research: advances in cancer and chronic respiratory disease

PURPOSE OF REVIEW

Physical activity has emerged as an important health outcome and its assessment, in particular with objective monitors, has proliferated in recent years. This review considers recent advances in physical activity measurement and clinical trials in cancer and chronic respiratory diseases where physical activity was a primary or key secondary outcome focusing on methodological learning points.

RECENT FINDINGS

There is growing data on (i) the validity of commercial 'consumer' physical activity monitors, e.g. FitBit, and (ii) the role of hybrid physical activity assessments; combining objective and subjective measures to understand physical activity quantity and quality. In both cases, adherence is challenging and can be optimized using short monitoring protocols, e.g., 3-4 days, and by providing clear instructions and support materials to participants. Studies in cancer and chronic respiratory disease have found mixed effects from physical activity interventions based on pedometers, behavior change techniques, online resources, and/or therapeutic nutrition. The most responsive physical activity outcomes and minimum clinically important differences are still to be understood.

SUMMARY

Physical activity measures provide an opportunity to detect changes in health behavior. However, measuring physical activity as a trial endpoint is challenging and focusing effort to ensure optimal participant compliance is important.

The impact of disease-specific fears on outcome measures of pulmonary rehabilitation in patients with COPD

Anxiety is a highly prevalent psychological comorbidity in patients with chronic obstructive pulmonary disease (COPD) and has detrimental effects on pulmonary rehabilitation (PR) outcomes. It has been suggested that disease-specific fears could play an even more important role in COPD patients' disease progression. However, little is known about how different disease-specific fears impact COPD. This study examined how different disease-specific fears relate to different PR outcome measures in COPD patients and how these relationships evolve over the course of PR. Before and after a 3-week inpatient PR program, COPD patients (N = 104) underwent a 6-min walking test to measure functional exercise capacity. Disease-specific fears (fear of physical activity, fear of dyspnea, fear of disease progression, fear of social exclusion) were assessed with the COPD-Anxiety-Questionnaire-Revised. Health-related quality of life (HQoL), COPD health status, dyspnea in daily life, depression, and anxiety were measured using validated questionnaires. Multiple regression showed that greater disease-specific fears at the start of PR were associated with worse functional exercise capacity, HQoL, health status, and depression at the start and end of PR (controlling for age, sex, lung function, smoking status, and general anxiety). Patients who showed a stronger decrease in disease-specific fears improved more in PR outcome measures over the course of PR. Furthermore, different disease-specific fears were related to different PR outcome measures. The results show that disease-specific fears are associated with treatment outcome measures, both cross-sectionally and prospectively. Therefore, disease-specific fears should be addressed in COPD patients as they might play a significant role in disease progression.

A pedometer-based walking intervention with and without email counseling in general practice: a pilot randomized controlled trial

BACKGROUND

General practitioners play a fundamental role in combatting the current epidemic of physical inactivity, and pedometer-based walking interventions are able to increase physical activity levels of their patients. Supplementing these interventions with email counseling driven by feedback from the pedometer has the potential to further improve their effectiveness but it has to be yet confirmed in clinical trials. Therefore, the aim of our pilot randomized controlled trial is to evaluate the feasibility and potential efficacy of future trials designed to assess the additional benefit of email counseling added to a pedometer-based intervention in a primary care setting.

METHODS

Physically inactive patients were opportunistically recruited from four general practices and randomized to a 12-week pedometer-based intervention with or without email counseling. To explore the feasibility of future trials, we assessed the speed and efficiency of recruitment, adherence to wearing the pedometer, and engagement with email counseling. To evaluate the potential efficacy, daily step-count was the primary outcome and blood pressure, waist and hip circumference, and body mass were the secondary outcomes. Additionally, we conducted a qualitative analysis of structured interviews with the participating general practitioners.

RESULTS

The opportunistic recruitment has been shown to be feasible and acceptable, but relatively slow and inefficient; moreover, general practitioners selectively recruited overweight and obese patients. Patients manifested high adherence, wearing the pedometer on 83% (± 20) of days. All patients from the counseling group actively participated in email communication and responded to 46% (± 22) of the emails they received. Both groups significantly increased their daily step-count (pedometer-plus-email, + 2119, p = 0.002; pedometer-alone, + 1336, p = 0.03), but the difference between groups was not significant (p = 0.18). When analyzing both groups combined, there was a significant decrease in body mass (- 0.68 kg, p = 0.04), waist circumference (- 1.73 cm, p = 0.03), and systolic blood pressure (- 3.48 mmHg, p = 0.045).

CONCLUSIONS

This study demonstrates that adding email counseling to a pedometer-based intervention in a primary care setting is feasible and might have the potential to increase the efficacy of such an intervention in increasing physical activity levels.

TRIAL REGISTRATION

The trial was retrospectively registered at ClinicalTrials.gov (ID: NCT03135561 , date: April 26, 2017).