# Exercise as it relates to Disease/The use of pedometers to enhance physical activity with COPD patients

This wiki-book aims to critique the study Pedometers to enhance physical activity in COPD: a randomised controlled trial by Laura Mendoza.
This article critique is conducted for assessment for the "Health, Disease and Exercise (8340)" unit at the University of Canberra.

## What is the Background to this Research?

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that obstructs airflow from the lungs. Physical activity is a key issue in COPD patients. Despite patients with COPD still needing to complete the recommended 30 minutes of exercise per day, there is a decrease in physical activity for these patients. There is an increased risk of hospital admissions and mortality for patients with COPD, which outlines the importance of following the physical activity guidelines. This research paper aims to determine if pedometers can help enhance the physical activity levels of patients living with COPD.

## Where is the Research From?

The research took place in Santiago, Chile, at the Hospital Clinic, University of Chile. The author of the paper, Laura Mendoza, is from the pulmonary section, department of medicine, at the University of Chile Clinical Hospital. The author also has another research paper titled Use of simulator models such as teaching methodology for the career of Medicine and has declared no conflict of interest, and the study received funding from Chile's national fund for research and development in health.

## What Kind of Research is this?

This research is a randomised control trial, which is a form of a scientific experiment that can be used to control factors that are not under the direct control of the experiment. Randomised control studies can effectively measure new interventions and treatments as the differences between the groups are attributed to the outcome of the study and the randomisation balances the participation characteristics.

## What did the Research Involve?

Patients who were included in the study:
* Patients diagnosed with COPD according to the 2006 Global Initiative for COPD
* Patients who had a smoking history and had quit 2 months before the study
* Patients who have not had exacerbations in the 4 weeks preceding the study
Patients were recruited from outpatient clinics at private and public hospitals and primary health centres in Santiago. Patients were excluded from the study if they had any other chronic conditions that significantly impacted their ability to walk or had participated in any rehabilitation programs in the previous year. Patients attended monthly appointments with their physicians and physiotherapists for 30 minutes for 3 months. There was no follow-up recorded in the study.
Participants in the control group:
* 47 participants in the control group.
* Received counselling to increase their physical activity level and were advised to walk at least 30 minutes per day.
* Given a diary to record information related to their condition and were told to fill it out daily. This data entry is self-reported data.
Participants in the pedometer group:
* 50 participants in the pedometer group.
* Participants in this group received a pedometer and were taught how to use it.
* Given the same diary as the control group, but with an added step count column. The patients could record the step count in the provided diary and record information related to their condition daily.
* Self-reported data bias may occur as the participants in the first two months could visualise the step count. In the third month, the step count was taped over and there were no signs of tampering of tape tampering. The step counts remained high for the third month.

### Limitations

* There was no follow-up recorded in the study. Follow-ups are important after intervention-based studies, as it is beneficial to know if the intervention impacted behaviour change in the long term.
* The data was self-reported. Self-reported data bias may occur as the participants could add more or less physical activity to the diary, even if it was or wasn't accomplished. Participants can be influenced by external causes, which is why self-reported data can be bias.
* The participants in the pedometer group didn't have the results of the pedometer hidden until the third month of the study. This can affect the results of the study due to the external bias of self-reported data.

## What were the Basic Results?

Participants in the pedometer group had a larger degree of compliance as well as significantly greater physical activity improvements and health improvements than the control group. Health improvements were measured with a 6-minute walk test and a COPD assessment test score. The pedometer group followed all the instructions from the researchers in the monthly follow-ups, which shows greater compliance with the exercise intervention.
The control group had a total of 5 missing days of data from the baseline and a total of 9 missing days from the follow-up month.

### What were the Researcher's Conclusions?

A higher degree of compliance is suggested with the pedometer group, as the group showed a progressive increase in average daily steps throughout the study. The most substantial increases were in the first and second month follow-ups. The researchers concluded that a pedometer-based program can increase physical activity levels for patients with early COPD, which can increase the quality of life for those patients.

## What Conclusions Can We Take from this Research?

Pedometers can increase physical activity for patients with COPD. Having visual devices such as pedometers can help motivate patients with COPD to meet the physical activity guidelines. The use of pedometers can help increase physical activity levels in both the long and the short term. Physical activity recommendations from healthcare professionals don't seem to help patients achieve the guidelines.

## Practical Advice

* Pedometers are a visual way to improve physical activity for certain demographic groups. Seeing the results of the steps taken throughout the day is a good motivator to get in the recommended daily physical activity.
* COPD patients increasing physical activity and completing the recommended daily guidelines can increase their quality of life.

## Further Reading

Australia's physical activity guidelines - The physical activity guidelines that are recommended for Australians
COPD health information - Symptoms and signs of COPD
List of the recommended pedometers - Top pedometers of 2022

## References

* 1 2 3 Mendoza L, Horta P, Espinoza J, Aguilera M, Balmaceda N, Castro A, et al. Pedometers to enhance physical activity in COPD: a randomised controlled trial. European Respiratory Journal. 2015;45(2):347-54.
* ↑ mayoclinic.org, COPD, by Mayo Foundation for Medical Education and Research (MFMER)
* ↑ Esteban C, Garcia-Gutierrez S, Legarreta MJ, Anton-Ladislao A, Gonzalez N, Lafuente I, Fernandez de Larrea N, Vidal S, Bare M, Quintana JM, -COPD group IR. One-year mortality in COPD after an exacerbation: the effect of physical activity changes during the event. COPD: Journal of Chronic Obstructive Pulmonary Disease. 2016 Nov 1;13(6):718-25.
* ↑ Donaire-Gonzalez D, Gimeno-Santos E, Balcells E, Rodríguez DA, Farrero E, de Batlle J, Benet M, Ferrer A, Barberà JA, Gea J, Rodriguez-Roisin R. Physical activity in COPD patients: patterns and bouts. European Respiratory Journal. 2013 Oct 1;42(4):993-1002.
* ↑ Mendoza L, Herskovic P, Vásquez A, Quevedo F. Uso de modelos simuladores como metodología docente para la carrera de Medicina. Rev. Hosp. Clin. Univ. Chile. 2009;20(4):355-8.
* ↑ Hariton E, Locascio JJ. Randomised controlled trials—the gold standard for effectiveness research. BJOG: an international journal of obstetrics and gynaecology. 2018 Dec;125(13):1716
* 1 2 Rosenman R, Tennekoon V, Hill LG. Measuring bias in self-reported data. International journal of behavioural & healthcare research. 2011 Oct;2(4):320.
* ↑ Kwasnicka D, Dombrowski SU, White M, Sniehotta F. Theoretical explanations for maintenance of behaviour change: a systematic review of behaviour theories. Health psychology review. 2016 Jul 2;10(3):277-96.
* 1 2 Althubaiti A. Information bias in health research: definition, pitfalls, and adjustment methods. Journal of multidisciplinary healthcare. 2016;9:211.
* ↑ Chaudhry UA, Wahlich C, Fortescue R, Cook DG, Knightly R, Harris T. The effects of step-count monitoring interventions on physical activity: systematic review and meta-analysis of community-based randomised controlled trials in adults. International Journal of Behavioral Nutrition and Physical Activity. 2020 Dec;17(1):1-6.