A randomized controlled trial of telephone-mentoring with home-based walking preceding rehabilitation in COPD

Abstract

Purpose: With the limited reach of pulmonary rehabilitation (PR) and low levels of daily physical activity in chronic obstructive pulmonary disease (COPD), a need exists to increase daily exercise.This study evaluated telephone health-mentoring targeting home-based walking (tele-rehab) compared to usual waiting time (usual care) followed by group PR.Patients and methods: People with COPD were randomized to tele-rehab (intervention) or usual care (controls).Tele-rehab delivered by trained nurse health-mentors supported participants’ home-based walking over 8-12 weeks.PR, delivered to both groups simultaneously, included 8 weeks of once-weekly education and self-management skills, with separate supervised exercise.Data were collected at three time-points: baseline (TP1), before (TP2), and after (TP3) PR.The primary outcome was change in physical capacity measured by 6-minute walk distance (6MWD) with two tests performed at each time-point.Secondary outcomes included changes in self-reported home-based walking, health-related quality of life, and health behaviors.Results: Of 65 recruits, 25 withdrew before completing PR.Forty attended a median of 6 (4) education sessions.Seventeen attended supervised exercise (5±2 sessions).Between TP1 and TP2, there was a statistically significant increase in the median 6MWD of 12 (39.1) m in controls, but no change in the tele-rehab group.There were no significant changes in 6MWD between other time-points or groups, or significant change in any secondary outcomes.Participants attending supervised exercise showed a nonsignificant improvement in 6MWD, 12.3 (71) m, while others showed no change, 0 (33) m.The mean 6MWD was significantly greater, but not clinically meaningful, for the second test compared to the first at all time-points.Conclusion: Telephone-mentoring for home-based walking demonstrated no benefit to exercise capacity.Two 6-minute walking tests at each time-point may not be necessary.Supervised exercise seems essential in PR.The challenge of incorporating exercise into daily life in COPD is substantial.