Leveraging Technology to Address Access and Adherence to Conventional Hospital-Based Pulmonary Rehabilitation in Veterans with COPD

传统的肺康复（PR）计划非常有效， 慢性阻塞性肺疾病（COPD）患者。公共关系面临两个重要问题：（1）大多数 能从PR中获益的COPD患者无法获得PR，2）没有有效的长期策略 在完成PR后维持体力活动（PA）和益处。我们提出了一项随机对照试验 (RCT)测试技术介导的干预措施对增加COPD患者PA的有效性， 不能访问传统的，以医院为基础的公关。我们还提出了一个非随机研究，以探讨能力 PA干预，以维持PA和锻炼的坚持，扩大PR的好处，在人与 完成常规PR计划的COPD患者。COPD是美国第三大死亡原因 美国估计有1600万人患有COPD。尽管进行了最大限度的药物治疗， 典型的经历呼吸困难，这导致了久坐行为的螺旋式下降，身体 不活动、失调和功能性残疾。低体力活动与不良结局相关， COPD-急性加重、住院和死亡的风险增加，与肺功能无关。的 慢性阻塞性肺疾病全球倡议（GOLD）指南建议所有人定期PA COPD患者。常规的、有监督的公关项目明显减少了呼吸困难， 健康相关生活质量（HRQL）和运动能力。然而，公共关系项目面临重大挑战 of access访问and adherence遵守.我们开发了每一步都很重要（ESC），这是一种技术介导的干预措施 基于自我调节的行为理论，针对久坐行为，促进PA， 去适应ESC将网站与计步器结合起来，直接监控步数。网站 提供个性化的步数目标，迭代反馈，疾病自我管理教育， 动机和社会支持的在线社区。在两项针对COPD退伍军人的随机研究中，我们 证实了ESC增加PA的安全性、可行性和有效性。可通过互联网访问， 在家里的任何时候，ESC都可以成为解决传统PR局限性的理想低成本平台。 我们假设ESC可能是一种有效的策略，以促进许多患者的PA， 参加一个公关计划，并可能是一个选择，以保持参与PA后，患者完成 传统的公关计划。主要目标1：确定基于网络的干预措施ESC的有效性， 增加PA（直接用加速度计和评估强度的问卷测量）， 常规护理，在COPD患者中，被转诊到常规PR但无法获得它。 次要目的2：评估ESC干预对（a）运动坚持性，（B）运动自我- 疗效，（c）HRQL，（d）呼吸困难，（e）焦虑和抑郁，（f）运动能力，（g）急性 急性加重和COPD相关的住院治疗，与常规护理相比。探索性目标3：评估 ESC维持PA和锻炼依从性的能力，以及延长PR受益的能力， 已完成常规PR的COPD患者。

Conventional pulmonary rehabilitation (PR) programs are highly effective and the standard of care in patients with chronic obstructive pulmonary disease (COPD). PR faces two significant problems: (1) most patients with COPD who would benefit from PR cannot access it, and 2) there is no effective long-term strategy to maintain physical activity (PA) and benefits after completing PR. We propose a randomized controlled trial (RCT) to test the efficacy of a technology-mediated intervention to increase PA in persons with COPD who cannot access conventional, hospital-based PR. We also propose a non-randomized study to explore the ability of the PA intervention to maintain PA and exercise adherence, extending the benefits of PR, in persons with COPD who complete a conventional PR program. COPD is the third leading cause of death in the United States; an estimated 16 million Americans have COPD. Despite maximal medical therapy, patients with COPD characteristically experience breathlessness, which leads to a downward spiral of sedentary behavior, physical inactivity, deconditioning, and functional disability. Low physical activity is associated with poor outcomes in COPD--increased risk of acute exacerbations, hospitalizations, and death, independent of lung function. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend regular PA for all patients with COPD. Conventional, supervised PR programs clearly reduce breathlessness, and improve health-related quality of life (HRQL) and exercise capacity. However, PR programs face significant challenges of access and adherence. We developed Every Step Counts (ESC), a technology-mediated intervention based on the Behavioral Theory of Self-Regulation, to target sedentary behavior, promote PA, and alleviate deconditioning. ESC couples a website with a pedometer to directly monitor step counts. The website provides individualized step-count goals, iterative feedback, education on disease self-management, motivation, and an online community of social support. In two randomized studies in Veterans with COPD, we demonstrated ESC's safety, feasibility, and efficacy to increase PA. Accessible via the internet and available at any time from home, ESC could be an ideal low-cost platform to address the limitations of conventional PR. We hypothesize that ESC may be an efficacious strategy to promote PA in the many patients who cannot attend a PR program, and may be an option to maintain engagement in PA after patients complete a conventional PR program. Primary Aim 1: Determine the efficacy of a web-based intervention, ESC, to increase PA (measured directly with an accelerometer and a questionnaire that assesses intensity), compared to usual care, in persons with COPD who are referred to conventional PR but who cannot access it. Secondary Aim 2: Estimate the effect of the ESC intervention on (a) exercise adherence, (b) exercise self- efficacy, (c) HRQL, (d) dyspnea, (e) anxiety and depression, (f) exercise capacity, and (g) risk of acute exacerbations and COPD-related hospitalizations, compared to usual care. Exploratory Aim 3: Assess the ability of ESC to maintain PA and exercise adherence, and extend the benefits of PR, in participants with COPD who have completed conventional PR.