A Web-Based, Pedometer-Mediated Intervention Increases Amount and Intensity of Physical Activity in COPD: A Randomized Controlled Trial

Patricia M Bamonti,1,2 Julia T Desiato,1 Reema Kadri,3 David R Gagnon,4,5 Marilyn L Moy1,6,71Research & Development Service, VA Boston Healthcare System, Boston, MA, USA; 2Department of Psychiatry, Harvard Medical School, Boston, MA, USA; 3Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA; 4Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA; 5Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA; 6Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, Boston, MA, USA; 7Department of Medicine, Harvard Medical School, Boston, MA, USACorrespondence: Marilyn L Moy, Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, 1400 VFW Parkway 111P, Boston, MA, 02132, USA, Email marilyn.moy@va.govIntroduction: Ground-based walking training is an aerobic exercise used in supervised pulmonary rehabilitation (PR). Physical activity (PA) interventions typically promote step counts, but it is unclear whether community-based walking intensity can be targeted as aerobic exercise. This randomized controlled trial evaluated a web-based, pedometer-mediated PA intervention designed to increase walking amount and intensity.Material and Methods: Participants with COPD who had never enrolled in PR were randomized 1:1 to control or intervention. The intervention included individualized step-count goals, iterative feedback, educational content, and an online community forum. The Fitbit Inspire Heart Rate objectively monitored daily step counts. Participants were instructed to achieve step-count goals with as many steps of moderate-intensity as possible guided by a modified Borg rating of 4– 5 for dyspnea. The primary outcome was change in PA measured as average daily step count at 12 weeks. Aerobic intensity was assessed by the Rapid Assessment of PA Questionnaire which uses self-reported moderate or vigorous PA to categorize responders as underactive or active. Linear mixed-effects models (PROC MIXED, SAS v9.4), adjusting for group, time, group*time, FEV1%predicted, enrollment season, and study modality (eg, in-person, virtual, hybrid), assessed between-group change.Results: Participants (57 intervention, 52 control) were 97% male, mean age 73± 7 years, and baseline FEV1 73± 23% predicted. Baseline daily steps were 4,222± 1,929 (intervention) and 4,851± 2,637 (control). Intervention participants increased average daily steps by 1,410 steps/day more than controls (p=0.005). The intervention group showed greater transitions from underactive to active intensity (between-group: p=0.025), with 20 (41%) moving to active status (within-group: p=0.001).Conclusion: Technology-mediated community-based walking increased PA amount and intensity. These findings support further evaluation of this intervention as a potential option for ground-based walking training with objective measurement of exercise intensity.Keywords: physical activity, technology, pedometer, moderate intensity exercise, behavior change, COPD