Pilot study of a cell phone-based exercise persistence intervention post-rehabilitation for COPD

Figures & data

Figure 1 Sample flow.

Abbreviation: MOBILE, Mobilizing Support for Long-term Exercise.

Table 1 Baseline sample characteristics

	MOBILE-SM (n =8)	MOBILE-C (n = 9)
Demographics
Age	64 ±12	72 ± 9
Female (%)	5 (63%)	6 (67%)
College educated or higher	7 (88%)	6 (67%)
Race/ethnicity
Caucasian	6 (75%)	8 (89%)
African-American	2 (25%)	1 (11%)
Married/partnered	3 (38%)	2 (22%)
Computer user	8 (100%)	7 (78%)
Clinical status
BMI	25.0 ±7.8	26.3 ±5.5
FEV1/FVC	0.39 ±0.12	0.48 ±0.10
FEV1% predicted	34.4 ±15	46.7 ±18.7
GOLD
Stage 2	2 (25%)	3 (33%)
Stages 3 and 4	6 (75%)	6 (67%)
BODE Index (↓0–10)	3.7 ±1.3	3.0 ±2.4
Comorbidities (≥1)	5 (63%)	6 (67%)
Supplemental oxygen	5 (63%)	5 (56%)
Beliefs and attitudes towards exercise and self-care
Satisfaction with rehab on overall health (0–5↑)	3.0 ±1.8	3.0 ±1.2
Expectations that continued exercise will help maintain overall health (0–5↑)	4.4 ±0.7	4.3 ±0.5
Importance of continuing exercise (0–10↑)	8.9 ±1.0	9.2 ±2.0
Motivation to continue exercise (0–10↑)	7.8 ±1.3	8.7 ±1.9
Confidence to continue exercise (0–10 ↑)	7.1 ±2.8	8.7 ±1.3
Self-Regulation Questionnaire-Exercise (0–36↑)	20.1 ±4.5	21.0 ±8.4
Patient Activation Measure (↓13–52)	20.5 ±4.4	20.9 ±4.7
Resources and support for exercise
Home exercise equipment (cycle or treadmill)	2 (25%)	3 (33%)
Has access to a local exercise facility	3 (38%)	4 (44%)
Enacted support for exercise from family (13–65↑)	19.7 ±5.8	22.6 ±4.3
Enacted support for exercise from friends (13–65↑)	20.1 ±4.5	21.0 ±8.4
Overall perceived support for exercise (1–5↑)	2.9 ±1.5	4.0 ±1.1

Notes: Mean ±SD or count (percentage); ↑ or ↓ indicate better ratings.

Abbreviations: BMI, body mass index; FEV₁, forced expiratory volume in one second; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease; MOBILE, Mobilizing Support for Long-term Exercise; MOBILE-C, MOBILE-Coached; MOBILE-SM, MOBILE-Self-Monitored; SD, standard deviation.

Table 2 Usability of study-issued cell phones and daily log entries

	MOBILE-SM (n =8)	MOBILE-C (n = 9)
Usability
Easy to submit exercise data	1.7 ±0.5	1.4 ±0.5
Easy to submit symptom data	1.7 ±0.5	1.5 ±0.5
Time needed to submit data was just right	1.9 ±0.9	1.6 ±0.5
Keeping track of exercise kept me going	1.6 ±0.5	1.4 ±0.5
Easy to read text messages from nurse	N/A	1.9 ±0.8
Easy to send text messages to nurse	N/A	1.9 ±0.8
Text messages from nurse helped me stick with my exercise	N/A	1.8 ±0.7
Helpful that I could send text message to the nurse anytime	N/A	1.9 ±0.6
Recommend MOBILE program to other rehab graduates	1.2 ±0.4	1.0 ±0
Daily log entries
Total exercise entries (mean entries per participant; range)	947 (118; 28–176)	1390 (154; 79–180)
Total symptom entries (mean entries per participant; range)	996 (125; 28–176)	1404 (156; 85–180)

Notes: Mean ±SD; Usability response scale: 1: strongly agree, 2: agree; 3: disagree; 4: strongly disagree; all between group comparisons, p > 0.05.

Abbreviations: MOBILE, Mobilizing Support for Long-term Exercise; MOBILE-C, MOBILE-Coached; MOBILE-SM, MOBILE-Self-Monitored.

Table 3 Changes in exercise performance and physical activity at three and six months post-pulmonary rehabilitation

	MOBILE-SM (n =8)	MOBILE-C (n =9)	Group × Time p value
Incremental cycle test (watts)
Baseline	47.9 ± 8.9	54.4 ± 7.9	0.29
6 months	49.2 ± 9.6	48.9 ± 7.9
Six minute walk (feet)
Baseline	1200 ± 133	1240 ± 125	0.12
3 months	1222 ± 134	1206 ± 127
6 months	1268 ± 136	1194 ± 125
Total steps/day
Baseline	5229 ± 1068	6692 ± 1007	0.04
3 months	4452 ± 1082	5879 ± 1016
6 months	5838 ± 1096	5675 ± 1007
% Time inactive
Baseline	68.9 ± 4.3	67.7 ± 4.1	0.71
3 months	73.8 ± 4.3	70.0 ± 4.1
6 months	69.3 ± 4.4	69.5 ± 4.1
% Active time at moderate–high activity
Baseline	19.1 ± 2.7	27.1 ± 2.6	0.003
3 months	18.6 ± 2.8	24.2 ± 2.6
6 months	23.5 ± 2.9	23.6 ± 2.6
Peak performance
Baseline	61.2 ± 5.4	68.4 ± 5.0	0.002
3 months	59.0 ± 5.6	59.0 ± 5.2
6 months	68.2 ± 5.8	56.6 ± 5.0

* Notes: Adjusted mean ± SE; % time inactive: time during waking hours without any steps; moderate activity (31–80 steps/min); high activity (>80 steps/min); peak performance: average steps/minute of the best 30 minutes of the day.

Abbreviations: MOBILE, Mobilizing Support for Long-term Exercise; MOBILE-C, MOBILE-Coached; MOBILE-SM, MOBILE-Self-Monitored; SE, standard error.

Table 4 Changes in health-related quality of life (HRQL) at three and six months post-pulmonary rehabilitation

Questionnaire	MOBILE-SM (n = 8)	MOBILE-C (n =9)	Group × Time p value
St George’s respiratory total score (SGRQ, ↓ 0–100)
Baseline	50.7 ± 5.0	38.3 ±4.7	0.15
3 months	54.4 ± 5.0	39.0 ± 4.7
6 months	45.2 ± 5.2	41.7 ± 4.7
SF-36 Composite physical functioning (0–100↑)
Baseline	31.4 ± 2.4	32.8 ± 2.3	0.51
3 months	27.5 ± 2.4	32.9 ± 2.3
6 months	30.3 ± 2.5	33.8 ± 2.3
SF-36 Composite mental functioning (0–100↑)
Baseline	54.2 ± 4.1	50.6 ± 3.8	0.38
3 months	48.4 ± 4.1	48.5 ± 3.8
6 months	55.2 ± 4.2	46.9 ± 3.8

* Notes: Adjusted mean ±SE.

Abbreviations: MOBILE, Mobilizing Support for Long-term Exercise; MOBILE-C, MOBILE-Coached; MOBILE-SM, MOBILE-Self-Monitored; SE, standard error.