Mobile-phone-based Home Exercise in Chronic Obstructive Pulmonary Disease
Condition: Moderate to Severe COPD Receiving Home Exercise Training
MeSH terms: Pulmonary Disease, Chronic Obstructive
Study type: Interventional
Phase: Phase 2

Summary: 
      Background: Moderate-intensity exercise training improves skeletal muscle aerobic capacity
      and increased oxidative enzyme activity, as well as exercise tolerance in Chronic Obstructive
      Pulmonary Disease (COPD) patients.

      Design: To investigate the home-based exercise training program can reduce inflammatory
      biomarkers in COPD.

      Setting: Conducted from January 2007 to December 2007 at a tertiary medical center, Chang
      Gung Memorial Hospital, Taiwan.

      Patients: Moderate to severe COPD receiving home exercise training, 12 using mobile phone
      assistance and 14 with free walk, were assessed for 6 months.

      Measurements: Incremental shuttle walk test (ISWT), spirometry, strength of limb muscles,
      C-reactive protein (CRP) and inflammatory cytokines.
    

Detailed description: 
      Exercise training is the cornerstone of comprehensive rehabilitation programs in patients
      with COPD. Exercise training improves skeletal muscle oxidative capacity and efficiency that
      leads to a less alveolar ventilation at a given work rate. Patients can tolerate a heavier
      work load with less dyspnea under exercise. To date, it remains unclear whether and to what
      extent markers of low-grade systemic inflammation may affect trainability in clinically
      stable patients. Although specific exercise modalities can be applied to reverse muscle
      dysfunction, exercise intolerance, and reduced health-related quality of life, there is a
      substantial heterogeneity in the response to exercise training among patients with clinically
      stable COPD. Endurance exercise training has been reported to have consistently high clinical
      efficacy. Most pulmonary rehabilitation programs are hospital based and ask patients with
      regular supervision and monitoring in order to achieve persistent and optimal physiological
      benefits. However, compliance and time consuming with regular visits to the hospital or
      clinics are major stumbling blocks to the success of these programs. Recently, the
      investigators have developed a home-based exercise training program for stable COPD patients
      by asking them to walk at a speed controlled by the tempo of music from a program installed
      in a mobile phone. The tempo of music was set to keep the same walking speed at the intended
      level for endurance exercise training for all patients. Our mobile phone-based system
      provides an efficient home endurance exercise training program with good compliance and
      clinical outcomes in patients with moderate-to-severe COPD. This study was therefore designed
      to further explore whether the circulating level of inflammatory markers, such as CRP, IL-6,
      TNF-α, and IL-8, will be reduced in patients with COPD undergoing a mobile-phone assisted
      home-based exercise training program
    

Intervention name(s): Mobile-phone-based Home Exercise Training Program; Home Exercise Training Program
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Patients in the mobile phone group were asked to perform daily endurance exercise training under mobile phone guidance, and the adherence was reported back to the central server. The level of endurance walking was re-assessed and re-adjusted initially on regular clinical visits every four weeks during the first three months. During this period of time, the adherence to protocol was reinforced by telephone from health professionals whenever patients missed one day of their walking training detected by the central system. Patients were asked to continue their exercise program at home at a fixed walking speed, and return to the clinic at 1, 2, 3 and 6 months.; all the subjects were assessed by an incremental shuttle walking test (ISWT) (24) for estimation of exercise endurance. Baseline spirometry and body mass index (BMI) were recorded. The adherence and compliance of the home-based exercise training program was assessed by monitoring the frequency of performance and the duration of the endurance walking program recorded on the central system every week. Patients were asked to continue their exercise program at home at a fixed walking speed, and return to the clinic at 1, 2, 3 and 6 months.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Chronic Obstructive Pulmonary Disease; Pulmonary Rehabilitation; Mobile phone; Biomarker