Physical Activity after COPD Exacerbations

Background: Although pulmonary rehabilitation after hospital discharge improves outcomes in Chronic Obstructive Pulmonary Disease (COPD) patients, its impact is limited due to poor reach and adoption. The study’s objectives were to evaluate the feasibility of conducting a physical activity promotion program for recently hospitalized patients with COPD and to evaluate time-related changes in functional capacity, objectively measured physical activity parameters, and patient-generated outcomes in these patient population. Methods: This 12-week prospective cohort study involved recently discharged (≤4 weeks) patients with COPD exacerbations. Additional eligibility criteria include airflow obstruction by spirometry, inability to attend pulmonary rehabilitation (PR) and no medical contraindications to participation, as determined by the patient’s physician. Patients are enrolled while hospitalized or during outpatient clinic follow-up appointments, attend 5 in-person outpatient study visits (eligibility/baseline visit, and visits on week 1, 2, 4 and 12) and are asked to carry pedometers for physical activity monitoring. Daily physical activity (step counts) was analyzed as mean daily step counts over 7 days. At each visit participants also completed standardized questionnaires regarding their mental, physical and social health (Patient-Reported Outcomes Measurement Information System, PROMIS). To reduce participant burden, visits are scheduled around the time of clinical appointments and participants receive monetary compensation. Results: Fifty participants were enrolled in the study, however only twenty-two patients discharged a mean (standard deviation, SD) of 21(19) days prior to enrollment participated in the study past the enrollment visit. Several study modifications were implemented to improve recruitment and retention, including implementing a more flexible eligibility criteria and decreasing the burden of study procedures. Participants were predominantly younger (mean age [SD] 63.8[7.1] years), women (68%), African American (90%), and had high school education or less (72%). Comorbidities were common, with 45% of patients reporting at least one comorbidity associated with chronic pain (e.g., osteoarthritis) and 68% had a body mass index ≥30 kg/m2. Participants also had limited functional capacity, with a median (interquartile range, IQR) incremental shuttle walk test of 110 (30 – 210), and PROMIS physical function, ability to participate in social roles and activities, and satisfaction with participation roles and activities T-scores at least one standard deviation lower than the national mean. The median daily step count (IQR) on enrollment was 3,101 (1,144 - 5,330) steps. There was a high within-person correlation in week-to-week daily physical activity over the course of the study (R>0.8). There was no significant change in mean PROMIS T-scores at week 12 compared to enrollment (p>0.05). Discussion: There are multiple challenges to enrolling participants in practice-based research involving physical activity promotion following a hospitalization for COPD. There is a wide range of daily physical activity between patients with COPD recently discharged from the hospital. However, we found limited within-person time-related change in daily physical activity and patient-reported outcomes during the observation period. Future real-world studies of interventions for COPD patients will require more tailored recruitment strategies, a more flexible enrollment criteria and minimization of study burden on participants.