Top

BMC Medical Informatics and Decision Making

Published in:

Open Access 01-12-2018 | Research article

Promoting exercise training and physical activity in daily life: a feasibility study of a virtual group intervention for behaviour change in COPD

Authors: Tatjana M. Burkow, Lars K. Vognild, Elin Johnsen, Astrid Bratvold, Marijke Jongsma Risberg

Published in: BMC Medical Informatics and Decision Making | Issue 1/2018

Abstract

Background

Physical inactivity is associated with poor health outcomes in chronic obstructive pulmonary disease (COPD). It is therefore crucial for patients to have a physically active lifestyle. The aims of this feasibility study were to assess a tablet-based physical activity behavioural intervention in virtual groups for COPD regarding 1) patients’ acceptance 2) technology usability 3) patients’ exercise programme adherence and 4) changes in patients’ physical activity level.

Methods

We used an application with functionality for a virtual peer group, a digital exercise diary, a follow-along exercise video, and visual rewards on the home screen wallpaper. The exercise programme combined scheduled virtual group exercising (outdoor ground walking, indoor resistance and strength training) with self-chosen individual exercises. Ten participants with COPD were enrolled into two exercise training groups. Patients’ acceptance was assessed by semi-structured interviews, technology usability was assessed by the System Usability Scale, and exercise programme adherence and level of physical activity by self-reporting. The interviews were also used for the latter three aspects.

Results

The virtual peer group was experienced as motivating, helping participants to get started and be physically active. They updated their own activity status and kept track of the others’ status. Having a time schedule for the virtual group exercises helped them to avoid postponing the exercise training. All participants recorded individual exercises in the diary, the exercise video was well received and used, and most participants paid attention to the visual rewards. All participants found the technology easy both to learn and to use. The exercise programme adherence was good, with, on average, 77% attendance for the virtual group exercises, and all participants performed additional individual exercises. The average number of physical activity sessions per week was doubled from 2.9 (range 0–10, median 2) at baseline to 5.9 (range 3.3–10.33, median 4.8) during the intervention period.

Conclusion

The results indicate that the tablet-based intervention may be feasible in COPD, and that it was acceptable, encouraged a sense of peer support and fellowship in the group and motivated participants to physical activity and exercise training in daily life. Further assessment is needed on patient outcomes.

WHO. Chronic respiratory diseases, Burden of COPD. [https://www.who.int/respiratory/copd/burden/en]. Accessed 2017.

Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, Hill K, Holland AE, Lareau SC, Man WD, Pitta F, Sewell L, Raskin J, Bourbeau J, Crouch R, Franssen FM, Casaburi R, Vercoulen JH, Vogiatzis I, Gosselink R, Clini EM, Effing TW, Maltais F, van der Palen J, Troosters T, Janssen DJ, Collins E, Garcia-Aymerich J, Brooks D, Fahy BF, Puhan MA, Hoogendoorn M, Garrod R, Schols AM, Carlin B, Benzo R, Meek P, Morgan M, Rutten-van Mölken MP, Ries AL, Make B, Goldstein RS, Dowson CA, Brozek JL, Donner CF, Wouters EF. ATS/ERS task force on pulmonary rehabilitation. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013 Oct 15;188(8):e13-e64. doi:https://doi.org/10.1164/rccm.201309-1634ST. PubMed PMID: 24127811

Pitta F, Troosters T, Spruit MA, Probst VS, Decramer M, Gosselink R. Characteristics of physical activities in daily life in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005 May 1;171(9):972–7.CrossRef

Vorrink SNW, Kort HSM, Troosters T, Lammers J-WJ. Level of daily physical activity in individuals with COPD compared with healthy controls. Respir Res. 2011 Mar 22;12:33. https://doi.org/10.1186/1465-9921-12-33.CrossRefPubMedPubMedCentral

Watz H, Waschki B, Meyer T, Magnussen H. Physical activity in patients with COPD. Eur Respir J. 2009 Feb;33(2):262–72. https://doi.org/10.1183/09031936.00024608.CrossRefPubMed

Watz H, Pitta F, Rochester CL, Garcia-Aymerich J, ZuWallack R, Troosters T, Vaes AW, Puhan MA, Jehn M, Polkey MI, Vogiatzis I, Clini EM, Toth M, Gimeno-Santos E, Waschki B, Esteban C, Hayot M, Casaburi R, Porszasz J, McAuley E, Singh SJ, Langer D, Wouters EF, Magnussen H, Spruit MA. An official European Respiratory Society statement on physical activity in COPD. Eur Respir J. 2014 Dec;44(6):1521–37. https://doi.org/10.1183/09031936.00046814.CrossRefPubMed

WHO. Global Strategy on Diet, Physical Activity and Health, [https://www.who.int/dietphysicalactivity/pa/en] accessed 2017.

Nici L, Donner C, Wouters E, Zuwallack R, Ambrosino N, Bourbeau J, Carone M, Celli B, Engelen M, Fahy B, Garvey C, Goldstein R, Gosselink R, Lareau S, MacIntyre N, Maltais F, Morgan M, O'Donnell D, Prefault C, Reardon J, Rochester C, Schols A, Singh S. Troosters T; ATS/ERS pulmonary rehabilitation writing committee. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med. 2006;173(12):1390–413 PMID: 16760357.CrossRef

Ries AL, Bauldoff GS, Carlin BW, Casaburi R, Emery CF, Mahler DA, Make B, Rochester CL, Zuwallack R, Herrerias C. Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based clinical practice guidelines. Chest. 2007;131(5 Suppl):4S–42S PMID: 17494825.CrossRef

10.

McCarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2015 Feb 23;2:CD003793. https://doi.org/10.1002/14651858.CD003793.pub3.CrossRef

11.

Wilson JJ, O’Neill B, Collins EG, Bradley J. Interventions to increase physical activity in patients with COPD: a comprehensive review. COPD. 2015 Jun;12(3):332–43. https://doi.org/10.3109/15412555.2014.948992.CrossRefPubMed

12.

Keating A, Lee A, Holland AE. What prevents people with chronic obstructive pulmonary disease from attending pulmonary rehabilitation? A systematic review. Chron Respir Dis. 2011;8(2):89–99 PMID: 21596892.CrossRef

13.

Keating A, Lee AL, Holland AE. Lack of perceived benefit and inadequate transport influence uptake and completion of pulmonary rehabilitation in people with chronic obstructive pulmonary disease: a qualitative study. J Physiother. 2011;57(3):183–90 PMID: 21843834.CrossRef

14.

Hogg L, Grant A, Garrod R, Fiddler H. People with COPD perceive ongoing, structured and socially supportive exercise opportunities to be important for maintaining an active lifestyle following pulmonary rehabilitation: a qualitative study. J Physiother. 2012;58(3):189–95. https://doi.org/10.1016/S1836-9553(12)70110-8.CrossRefPubMed

15.

Stewart KF, Meis JJ, van de Bool C, Janssen DJ, Kremers SP, Schols AM. Maintenance of a physically active lifestyle after pulmonary rehabilitation in patients with COPD: a qualitative study toward motivational factors. J Am Med Dir Assoc. 2014 Sep;15(9):655–64. https://doi.org/10.1016/j.jamda.2014.05.003.CrossRefPubMed

16.

Johnsen E, Burkow TM, Vognild LK. Den sosiale gruppa som motivasjon til fysisk trening [The social group as motivation to exercise training]. In: Tjora A, editor. Helsesosiologi: Analyser av helse, sykdom og behandling: Gyldendal Akademisk ISBN 978–82–05-42414-2; 2012. p. 325–46.

17.

Williams G, Hamm MP, Shulhan J, Vandermeer B, Hartling L. Social media interventions for diet and exercise behaviours: a systematic review and meta-analysis of randomised controlled trials. BMJ Open. 2014:4e003926. https://doi.org/10.1136/bmjopen-2013-003926.

18.

Valle CG, Tate DF, Mayer DK. A randomized trial of a Facebook-based physical activity intervention for young adult cancer survivors. J. Cancer Surviv. 2013:355–68. https://doi.org/10.1007/s11764-013-0279-5.

19.

Cavallo DN, Tate DF, DeVellis RF, Ammerman AS. A social media-based physical activity intervention: a randomized controlled trial. Am J Prev Med. 2012 Nov;43(5):527–32. https://doi.org/10.1016/j.amepre.2012.07.019.CrossRefPubMedPubMedCentral

20.

Baez M, Far K, Ibarra F, Ferron M, Didino D, Casati F. Effects of online group exercises for older adults on physical, psychological and social wellbeing: a randomized pilot trial. PeerJ. 2017;5:e3150. https://doi.org/10.7717/peerj.3150.CrossRefPubMedPubMedCentral

21.

Burkow TM, Vognild LK, Krogstad T, Borch N, Ostengen G, Bratvold A, Risberg MJ. An easy to use and affordable home-based personal eHealth system for chronic disease management based on free open source software. Stud Health Technol Inform. 2008;136:83–8 PMID: 18487712.PubMed

22.

Vognild LK, Burkow TM, Luque LF. The MyHealthService approach for chronic disease management based on free open source software and low cost components. In Conf Proc IEEE Eng Med Biol Soc. 2009;2009:1234–7 PMID: 19963996.

23.

Johnsen E, Burkow TM, Vognild LK. In: Tjora og Sandaunet, editor. Digitalt pasientfellesskap som sosial ressurs og tilfredse pasienter som sosiologisk problem [Digital patient community as a social resource and satisfied patients as a sociological challenge]. Gyldendal: Akademisk; 2010. p. 163–89. ISBN-978820539909.

24.

Burkow TM, Vognild LK, Østengen G, Johnsen E, Risberg MJ, Bratvold A, Hagen T, Brattvoll M, Krogstad T, Hjalmarsen A. Internet-enabled pulmonary rehabilitation and diabetes education in group settings at home: a preliminary study of patient acceptability. BMC Med Inform Decis Mak. 2013;5(13):33. https://doi.org/10.1186/1472-6947-13-33 PMID: 23496829.CrossRef

25.

Burkow TM, Vognild LK, Johnsen E, Risberg MJ, Bratvold A, Breivik E, Krogstad T, Hjalmarsen A. Comprehensive pulmonary rehabilitation in home-based online groups: a mixed method pilot study in COPD. BMC Res Notes. 2015 Dec 10;8:766. https://doi.org/10.1186/s13104-015-1713-8.CrossRefPubMedPubMedCentral

26.

Taylor A, Aitken A, Godden D, Colligan J. Group pulmonary rehabilitation delivered to the home via the Internet: feasibility and patient perception. In: Proceedings of the 2011 annual conference on human factors in computing systems (CHI ‘11). ACM, New York, NY, USA, p. 3083–92. doi:https://doi.org/10.1145/1978942.1979398.

27.

Taylor A, Godden D, Aitken A, Colligan J, Wilson R. Delivering group-based services to the home via the Internet: maximising clinical and social benefit. In: Proceedings of the 5th international conference on pervasive computing technologies for healthcare (pervasive health), Dublin, Ireland, 23–26 May 2011, p. 384–8. Print ISBN: 978–1–61284-767-2. INSPEC Accession Number: 12304791.

28.

Tsai LL, McNamara RJ, Moddel C, Alison JA, McKenzie D, McKeough ZJ. Home-based telerehabilitation via real-time videoconferencing improves endurance exercise capacity in patients with COPD: the randomized controlled TeleR study. Respirology. 2017;22(4):699–707. https://doi.org/10.1111/resp.12966 Epub 2016 Dec 19.CrossRefPubMed

29.

Moy ML, Martinez CH, Kadri R, Roman P, Holleman RG, Kim HM, Nguyen HQ, Cohen MD, Goodrich DE, Giardino ND, Richardson CR. Long-term effects of an internet-mediated pedometer-based walking program for chronic obstructive pulmonary disease: randomized controlled trial. J Med Internet Res. 2016 Aug 8;18(8):e215. https://doi.org/10.2196/jmir.5622.CrossRefPubMedPubMedCentral

30.

Lee AL, Holland AE. Time to adapt exercise training regimes in pulmonary rehabilitation – a review of the literature. Int J Chron Obstruct Pulmon Dis. 2014;9:1275–88. https://doi.org/10.2147/COPD.S54925 eCollection 2014.CrossRefPubMedPubMedCentral

31.

Wotton SL, Ng LW, McKeough ZJ, Jenkins S, Hill K, Eastwood PR, Hillman DR, Cecins N, Spencer LM, Jenkins C, Alison JA. Ground-based walking training improves quality of life and exercise capacity in COPD. Eur Respir J. 2014 Oct;44(4):885–94. https://doi.org/10.1183/09031936.00078014.CrossRef

32.

Leung RW, Alison JA, McKeough ZJ, Peters MJ. Ground walk training improves functional exercise capacity more than cycle training in people with chronic obstructive pulmonary disease (COPD): a randomised trial. J Phys. 2010;56(2):105–12.

33.

Breyer MK, Breyer-Konansal R, Funk GC, Dornhofer N, Spruit MA, Wouters EF, Burghuber OC, Hartl S. Nordic walking improves daily physical activities in COPD: a randomised controlled trial. Respir Res. 2010 Aug 22;11:112. https://doi.org/10.1186/1465-9921-11-112.CrossRefPubMedPubMedCentral

34.

Liu WT, Wang CH, Lin HC, Lin SM, Lee KY, Lo YL, Hung SH, Chang YM, Chung KF, Kuo HP. Efficacy of a cell phone-based exercise programme for COPD. Eur Respir J. 2008;32(3):651–9 Epub 2008 May 28. PMID: 18508824.CrossRef

35.

Ramos EM, de Toledo-Arruda AC, Fosco LC, Bonfim R, Bertolini GN, Guarnier FA, Cecchini R, Pastre CM, Langer D, Gosselink R, Ramos D. The effects of elastic tubing-based resistance training compared with conventional resistance training in patients with moderate chronic obstructive pulmonary disease: a randomized clinical trial. Clin Rehabil. 2014 Nov;28(11):1096–106. https://doi.org/10.1177/0269215514527842.CrossRefPubMed

36.

Deterding S, Dixon D, Khaled R, Nacke L. From game design elements to gamefulness: defining "gamification". In Proceedings of the 15th International Academic MindTrek Conference: Envisioning Future Media Environments (MindTrek '11). 2011. ACM, new York, NY, USA, 9–15. doi:https://doi.org/10.1145/2181037.2181040.

37.

Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, Eccles MP, Cane J, Wood CE. The behaviour change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behaviour change intervention. Ann Behav Med. 2013 Aug;46(1):81–95. https://doi.org/10.1007/s12160-013-9486-6.CrossRef

38.

Norvic G. Is there a Bias against telephone interviews in qualitative research? Res Nurs Health. 2008 Aug;31(4):391–8. https://doi.org/10.1002/nur.20259.CrossRef

39.

Lamont M. Money, morals, and manners. The culture of the French and the American upper-middle class. Chicago: University of Chicago Press; 1992.CrossRef

40.

Maxwell JA. Understanding and validity in qualitative research. Harv Educ Rev. 1992;62(3):279–300.CrossRef

41.

Weiss RS. Learning from strangers: the art and method of qualitative interview studies. Newsbury Park, CA: Sage; 1990.

42.

Pattons MQ. Qualitative evaluation and research methods. Newsbury Park, CA: Sage; 1990.

43.

Brooke J. SUS: a “quick and dirty” usability scale. In: Jordan PW, Thomas B, Weerdmeester BA, McClelland AL, editors. Usability evaluation in industry. London: Taylor and Francis; 1996.

44.

Bangor A, Kortum P, Miller J. Determining what individual SUS scores mean: adding an adjective rating scale. J Usabil Stud. 2009;4(3):114–23.

45.

From the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD 2017). Available from: [https://goldcopd.org].

46.

Hospes G, Bossenbroek L, ten Hacken NH, van Hengel P, de Greef MH. Enhancement of daily physical activity increases physical fitness of outclinic COPD patients: results of an exercise counseling programme. Patient Educ Couns. 2009 May;75(2):274–8. https://doi.org/10.1016/j.pec.2008.10.005.CrossRefPubMed

47.

Pomidori L, Contoli M, Mandolesi G, Cogo A. A simple method for home exercise training in patients with chronic obstructive pulmonary disease: one-year study. J Cardiopulm Rehabil Prev. 2012 Jan-Feb;32(1):53–7. https://doi.org/10.1097/HCR.0b013e31823be0ce.CrossRefPubMed

48.

Tabak M, Brusse-Keizer M, van der Valk P, Mermens H, Vollenbroed-Hutten M. A telehealth program for self-management of COPD exacerbations and promotion of an active lifestyle: a pilot randomized controlled trial. Int J Chron Obstruct Pulmon Dis. 2014 Sep 9;9:935–44. https://doi.org/10.2147/COPD.S60179.CrossRefPubMedPubMedCentral

49.

Minet LR, Hansen LW, Pedersen CD, Titlestad IL, Christensen JK, Kidholm K, Rayce K, Bowes A, Møllegård L. Early telemedicine training and counselling after hospitalization in patients with severe chronic obstructive pulmonary disease: a feasibility study. BMC Med Inform Decis Mak. 2015 Feb 7;15:3. https://doi.org/10.1186/s12911-014-0124-4.CrossRef

50.

Hoaas H, Andreassen HK, Lien LA, Hjalmarsen A, Zanoboni P. Adherence and factors affecting satisfaction in long-term telerehabilitation for patients with chronic obstructive pulmonary disease: a mixed method study. BMC Med Inform Decis Mak. 2016 Feb 25;16:26. https://doi.org/10.1186/s12911-016-0264-9.CrossRefPubMedPubMedCentral

51.

Demeyer H, Louvaris Z, Frey A, et al. Physical activity is increased by a 12-week semiautomated telecoaching programme in patients with COPD: a multicentre randomised controlled trial. Thorax. 2017 May;72(5):415–23. https://doi.org/10.1136/thoraxjnl-2016-209026.CrossRefPubMedPubMedCentral

52.

Voncken-Brewster V, Tange H, de Vries H, Nagykaldi Z, Winkens B, van der Weijden T. A randomised controlled trial testing a web-based, computer-tailored self-management intervention for people with or at risk for chronic obstructive pulmonary disease: a study protocol. BMC Public Health. 2013;13:557. https://doi.org/10.1186/1471-2458-13-557.CrossRefPubMedPubMedCentral

53.

Albores J, Marolda C, Haggerty M, Gerstenhaber B, ZuWallack R. The use of a home exercise program based on a computer system in patients with chronic obstructive disease. Journal of Cardiopulmonary Rehabilitation and Prevention. 2013;33(1):47–52.CrossRef

54.

Moorhouse N, Jung T, Shi X, Newsham J, McCall S, Amin F. Pulmonary rehabilitation in virtual reality for patients with chronic obstructive pulmonary disease (COPD). The 4th International AR & VR Conference in Manchester, Manchester Metropolitan University's Business School, 21st and 22nd June 2018.

55.

Consolvo S, McDonald DW, Toscos T, Chen MY, Froehlich J, Harrison B, Klasnja P, LaMarca A, LeGrand L, Libby R, Smith I, Landay JA. Activity sensing in the wild: a field trial of ubifit garden. In Proceeding of the twenty-sixth annual SIGCHI conference on Human factors in computing systems (CHI '08). ACM, New York, NY, USA, 1797–1806. https://doi.org/10.1145/1357054.1357335.

56.

Bourne S, DeVos R, North M, Chauhan A, Green B, Brown T, Cornelius V, Wilkson T. Online versus face-to-face pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: randomised controlled trial. BMJ Open. 2017;7:e014580. https://doi.org/10.1136/bmjopen-2016-014580.CrossRefPubMedPubMedCentral

57.

Robinson H, Williams V, Curtis F, Bridle C, Jones AW. Facilitators and barriers to physical activity following pulmonary rehabilitation in COPD: a systematic review of qualitative studies. NPJ primary care respiratory medicine. 2018;28(1):19.CrossRef

58.

Godin G. Commentary. The Godin-Shephard Leisure-Time Physical Activity Questionnaire. Health and Fitness Journal of Canada. Volume 4, No 1, March 1, 2011.

59.

Pitta F, Troosters T, Probst VS, Spruit MA, Decramer M, Gosselink R. Quantifying physical activity in daily life with questionnaires and motion sensors in COPD. Eur Respir J. 2006 May;27(5):1040–55.CrossRef

60.

Bandura A. Self-efficacy: towards a unifying theory of behaviour change. Psychol Rev. 1977;84(2):191–215.CrossRef

61.

Davis FD. Perceived usefulness, perceived ease of use, and user acceptance of information technology, MIS quarterly 1989, vol 13, No 3, 319–340, https://doi.org/10.2307/249008.

62.

Davis FD, Bagozzi RP, Warshaw PR. User acceptance of computer technology: A comparison of two theoretical models. Management Science, vol 35, no 8 aug 1989, pp. 982–1003, https://doi.org/10.1287/mnsc.35.8.982.

63.

Venkatesh V, Morris MG, Davis GB, Davis FD. User acceptance of information technology: towards a unified view. MIS Q. 2003;27(3):425–78.CrossRef

64.

Bogazzi PR. The legacy of the technology acceptance model and a proposal for a paradigm shift. J Assoc Inf Syst, Vol 8, Issue 4, pp 244–254 April 2007.

65.

Lowry PB, Hammer B, Gaskin JE, Roberts TL, Twyman NW. Taking “fun and games” seriously: proposing the hedonic-motivation system adaption model (HMSAM). J Assoc Inf Syst Volume 14 Issue 11 pp 617–671, November 2013.

Title: Promoting exercise training and physical activity in daily life: a feasibility study of a virtual group intervention for behaviour change in COPD
Authors: Tatjana M. Burkow
Lars K. Vognild
Elin Johnsen
Astrid Bratvold
Marijke Jongsma Risberg
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Medical Informatics and Decision Making / Issue 1/2018
Electronic ISSN: 1472-6947
DOI: https://doi.org/10.1186/s12911-018-0721-8

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Promoting exercise training and physical activity in daily life: a feasibility study of a virtual group intervention for behaviour change in COPD

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2018

Comparative analysis of predictive methods for early assessment of compliance with continuous positive airway pressure therapy

Logistics management information system performance for program drugs in public health facilities of East Wollega Zone, Oromia regional state, Ethiopia

Continuance compliance of privacy policy of electronic medical records: the roles of both motivation and habit

Does Computerized Physician Order Entry Benefit from Dynamic Structured Data Entry? A Quasi-Experimental Study

Effect of clinical decision rules, patient cost and malpractice information on clinician brain CT image ordering: a randomized controlled trial

Patient portal adoption and use by hospitalized cancer patients: a retrospective study of its impact on adverse events, utilization, and patient satisfaction