eHealth to stimulate physical activity in patients with chronic obstructive pulmonary disease

Abstract

Persons with Chronic Obstructive Pulmonary Disease (COPD) demonstrate reduced physical activity (PA) levels compared to healthy age-matched controls. Regular PA is associated with positive health outcomes. Inactivity leads to deconditioning, which leads to increased symptoms and a further reduction of PA. This results in a downward spiral of deconditioning and inactivity.

Pulmonary rehabilitation (PR) is known to improve exercise capacity; however, these benefits decline to pre-rehabilitation values after 1-2 years when patients do not continue to exercise after completing the programme. Furthermore, the effect of PR on PA is less consistent, and positive effects disappear rather quickly.

The overall aim of the thesis was to improve and/or maintain PA in patients with COPD after PR.

In chapter 1 a literature review was performed showing that suffering from COPD has a substantial negative effect on the duration and amount of PA but less on the intensity. There seems to be a relation between PA and the severity of the disease (as classified by the GOLD criteria), but this correlation is moderate at most.

In chapter 2 the barriers and enablers to physical activity according to patients were studied. Fatigue, lack of motivation and weather conditions greatly influence engagement in PA in patients with COPD.

The thesis continues in chapter 3 with a study that looks at older adults in general and their ICT use. A computer and e-mail are often used by older adults, whereas the use of a smartphone or a tablet is conceivably lower. Increased age, a lower degree of education, being a non-Western immigrant, a lower income, less arthrosis of the hands, and a lower physical functioning significantly predicted lower ICT use in older adults. It appears that it is not the degree of physical restrictions but rather the degree of adaptability to these restrictions that influence the use of ICT.

Chapter 4 describes the development of an eHealth intervention to address the overall aim of this thesis. Several pilot studies were conducted to ensure usability and accuracy of the measurement. The final product consists of two components: 1) a smartphone application and 2) a website for the healthcare professional (HCP). The application provides feedback on PA measured by the accelerometer embedded in the smartphone. Patients are persuaded to obtain their personalized PA goal. The HCP can monitor their patients’ PA via the website and is able to adjust each patient’s PA goal and send motivating group or individual text messages.

In chapters 5 and 6 this intervention was evaluated through efficacy testing in a randomized controlled trial and by examining the experiences of those who received the intervention.

The eHealth intervention did not affect PA, physical capacity, health related quality of life, or BMI. PA, lung function, and mastery significantly decreased over time. Surprisingly, exercise capacity remained unchanged over the one-year duration of the study.

Not all prerequisites were met to ensure the usability and successful implementation of the intervention in practice. The thesis provides several recommendations for practice and future research to address this inefficacy.