functional improvement in osa and copd with a telehealth lifestyle and exercise intervention

Conditions: Chronic Obstructive Pulmonary Disease; Obstructive Sleep Apnea; Overweight and Obesity

Summary: the investigators will conduct a type i hybrid effectiveness-implementation study to test an integrated telehealth intervention among 400 overweight and obese patients with chronic obstructive pulmonary disease (copd) and obstructive sleep apnea (osa). the investigators will include eligible participants receiving primary care at one of five department of veterans affairs (va) medical centers and their community-based outpatient clinics. the investigators will randomize patients in a 1:1 ratio to the multi-component intervention or "enhanced" usual care, stratifying by age (≥65 vs. \< 65) and site. participants randomized to the intervention will receive an integrated, telehealth-delivered intervention composed of a self-directed lifestyle program and supervised pulmonary rehabilitation. at the end of 3 months, the investigators will offer to enter a recommendation for weight management medications on behalf of eligible intervention participants. in the post-core period (months 4-12), participants will continue to have as-needed access to the lifestyle coach. for participants randomized to the "enhanced" usual care group, study staff will prompt the patient's primary care provider to refer them to existing weight loss management and pulmonary rehabilitation programs. follow-up will occur at virtual visits at 3 and 12 months. the primary effectiveness outcome at 1-year is quality of life measured by the sf-12 physical component summary score. secondary effectiveness outcomes will include other measures of quality of life (including sleep related impairment), sleep disturbance, disease severity (copd exacerbations and respiratory event index for osa), depression, social support, weight loss and cardiovascular risk. in addition to assessing effectiveness, investigators will also conduct a concurrent implementation process evaluation using the re-aim framework.


Eligibility criteria:
inclusion criteria: * copd: defined by presence of airflow obstruction (fev1/fvc \< 0.70) on post-bronchodilator spirometry * ≥10 pack year history of tobacco use * self-reported clinician diagnosis of osa (or presence of osa on research hsat) * bmi ≥ 25 kg/m2 * symptoms of dyspnea defined by mmrc score of ≥2 exclusion criteria: * self-report of weight change \>15 lbs. during prior 3 months * current active weight loss treatment, including: 1) research-based commercial weight loss programs (e.g., weight watchers, jenny craig, hmr, omada, tops, move!); 2) other weight loss or related behavioral health or wellness programs led by trained personnel (professional or lay) in the local community; 3) prescription weight loss medication within last 3 months; and scheduled bariatric surgery. * severe illness from any cause * diagnosis of bulimia or history of purging behavior * active enrollment in pulmonary rehabilitation * safety and/or adherence concerns due to severe physical or mental health issues or life expectancy \< 12 months. these include but may not be limited to: unstable cardiac arrhythmias, active or recent (within one month) myocardial infarction, active or recent (within one month) copd exacerbation, angina not well-controlled with medication, significant musculoskeletal comorbidities or physical infirmities that preclude participation in an exercise program, and the need for supplemental oxygen ≥ 5 lpm at rest or with exertion. * pregnant, lactating, or planning to become pregnant during the study period * participation in other intervention studies. * prisoner * unable to complete surveys in english