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Chronic Obstructive Pulmonary DiseaseNCT03749655

Physical Activity Promotion Added to Standard Care Pulmonary Rehabilitation and Cognitive Behavioural Therapy

A study testing Physical Activity Promotion in people with Chronic Obstructive Pulmonary Disease, run by Northumbria University at 1 site in United Kingdom.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

In patients with Chronic Obstructive Pulmonary Disease (COPD) daily physical activity is reduced compared to healthy age-matched individuals. Reduced levels of physical activity in patients with COPD are associated with increased risk for exacerbations, hospital admissions and mortality. Read more about this study

Who is it for?
Ages 40 to 75 years
Conditions the study is for
Chronic Obstructive Pulmonary Disease
What is being tested?
Physical Activity Promotion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
70 participants
Where
1 siteUnited Kingdom
Study dates
20 Nov 2018to 31 Aug 2021
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 40 to 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • COPD confirmed by obstructive spirometry
  • Clinically stable male or female COPD patients aged 40 years or older
  • Optimised medical therapy
  • Able to provide informed consent
  • HADS score of 8 and above

Who cannot join

  • Orthopaedic, neurological or other concomitant diseases that significantly impair normal biomechanical movement patterns, as judged by the investigator.
  • Moderate or severe COPD exacerbation (AECOPD) within 4 weeks.
  • Unstable ischaemic heart disease, including myocardial infarction within 6 weeks.
  • Moderate or severe aortic stenosis or hypertrophic obstructive cardiomyopathy.
  • Uncontrolled hypertension.
  • Another condition likely to limit life expectancy to less than one year (principally metastatic malignancy).

Trial locations and contacts

1 site in 1 country.

United Kingdom1 site
  • Newcastle upon Tyne NHS trust

    Newcastle upon Tyne, Tyne and Wear, NE18ST

Other trials in United Kingdom

About this study

Official title: A Feasibility Study Assessing the Inclusion of Physical Activity Promotion to Standard Care Pulmonary Rehabilitation and Cognitive Behavioural Therapy in Patients With COPD Who Are Anxious and Depressed

In patients with Chronic Obstructive Pulmonary Disease (COPD) daily physical activity is reduced compared to healthy age-matched individuals. Reduced levels of physical activity in patients with COPD are associated with increased risk for exacerbations, hospital admissions and mortality.

Pulmonary rehabilitation (PR) constitutes standard care for patients with COPD as it improves exercise capacity, quality of life and reduces the risk for exacerbation and hospitalisation. Participation in PR, however, does not necessarily translate into improved daily physical activity levels. It is currently uncertain whether addition of physical activity promotion strategies to standard PR programs induces an improvement in daily physical activity along with exercise capacity and quality of life compared to pulmonary rehabilitation alone.

Physical activity (PA) is a complex health behaviour that is modified by behavioural change interventions. PA promotion programs through the use of wearable monitors (i.e. pedometers, accelerometers) with goal setting and feedback, have shown to increase daily physical activity, but not exercise capacity or quality of life in COPD patients. Therefore, combination of both PR and PA promotion strategies is necessary to translate PR-induced improvements in functional capacity into improved daily physical activity level. The investigators propose to perform a feasibility study assessing patient adherence to PA promotion incorporated into a standard PR program. To enhance adherence to the PA promotion strategy, Cognitive Behavioural Modification Strategies (CBM) will be provided to patients undertaking PR. CBM strategies facilitate the goals of PR as they address several behavioural barriers including anxiety, depression and physical inactivity, and constitutes an important component in the management of COPD to improve engagement with PR and promote a physically active lifestyle. The investigators will divide patients into two programs: one including PR, PA promotion and CBM and the other comprising standard PR and CBM provision. The investigators will compare patients' adherence (16 sessions of PR) to both programs.

Read the detailed description

Chronic Obstructive Pulmonary Disease (COPD) is a debilitating and progressive disease, primarily affecting the respiratory system. In many patients, it also has adverse extra-pulmonary effects, such as skeletal muscle dysfunction and weakness (Maltais, et al. 2014). Pulmonary and skeletal muscle metabolic abnormalities enhance the ventilatory requirement during exercise, resulting in exercise-associated symptoms such as breathlessness and leg discomfort. These symptoms make every day physical activity an unpleasant experience, which many patients try to avoid (Troosters, et al. 2013). Physical activity levels are therefore remarkably lower in COPD patients than healthy age-matched individuals, presenting a major predictor of exacerbations, hospitalisations and mortality and in these patients (Pitta et al. 2005) \& (Garcia-Aymerich et al. 2006).

Implementation of exercise training as part of Pulmonary Rehabilitation aims to reverse the systemic consequences of COPD, in particular skeletal muscle dysfunction and weakness (Troosters, et al. 2013) . Currently pulmonary rehabilitation programs have shown substantial improvements in exercise capacity; however, these findings have not consistently progressed into improvements in daily levels of physical activity (Watz et al. 2014). One reason for this may link to physical activity in COPD being a complex health behaviour (Troosters, et al. 2013).

Recently, physical activity coaching, including weekly targets and feedback, has shown to be effective in patients with COPD in terms of improving daily steps over a period of three months (Lahham et al. 2016). Accordingly, activity coaching may be added to standard pulmonary rehabilitation to facilitate the rehabilitation-induced improvements in exercise capacity to progress into improvements in physical activity (Lahham et al. 2016).

Alongside the physical barriers influencing daily physical activity, the distressing nature of COPD has a significant impact on patients' psychological well-being. Major focusing points for COPD patients are the sense of feeling unwell, the inability to perform everyday activities and the emotional consequences of the condition. These symptoms can promote anxiety and depression, which are prevalent in patients with COPD, are associated with poorer treatment outcomes, and reduced survival (Ng, T-P et al. 2007).

Cognitive Behavioural Modification (CBM) strategies constitute an intervention that focuses on understanding how experiences are interpreted. It provides an understanding of the interaction between thoughts, mood, behaviour and physical sensations, which are intrinsically linked [8]. Techniques used for anxiety include education on anxiety and COPD, planning/pacing, distraction techniques, breathing control, relaxation and managing worry. These techniques help to break the vicious cycle of anxiety and can reduce patients' distress (Heslop \& Foley. 2009).

Similar techniques for patients suffering mainly from depression include education about depression and physical inactivity and planning and recording activities each day, while rating these for achievement or pleasure. These techniques help to break patient inactivity, which can lead to low mood and poor physical condition. A key treatment for depression can involve encouragement to increase activities within the patients' physical capabilities. A study found clinical and statistically significant improvements in anxiety and depression scores and a statistically significant reduction in hospital admissions following CBM. CBM is therefore an important approach to incorporate into COPD management to improve engagement with both pulmonary rehabilitation and the physical activity promotion programme Heslop \& Foley. 2009.

The efficacy of incorporating a physical activity promotion program to standard care pulmonary rehabilitation along with CBM strategies is still unknown. Accordingly, it is proposed to study patient compliance with the physical activity promotion programme comprising weekly goals in terms of daily step counts measured by a commercially available step counter. Compliance to the intervention is defined as at least 4 days per week (> 8 hours/day) with valid step count data (>70 steps/day) ensuring that patients use the step counter on a daily basis. Over the 8-week program patients should have a minimum of 6 weeks (75%) compliance with the physical activity intervention. If patients adhere adequately to this programme, a randomised controlled trial will be designed to study the long-term effects of adding physical activity promotion to Pulmonary Rehabilitation (including exercise training, education, physical activity promotion and behavioural modification strategies) on the risk for COPD exacerbations and hospitalisations.

Being tested
Physical Activity Promotion
Keywords
Pulmonary Rehabilitation, Physical activity, Anxiety and depression
Medical subject headings
Pulmonary Disease, Chronic Obstructive, Motor Activity, Anxiety Disorders, Depression

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Physical Activity PromotionBehavioural

    The physical activity (PA) promotion intervention will be provided only to the intervention group, and will include: 1) a step-counter with a digital display, 2) an interview discussing motivational issues, favourite daily activities and strategies to become more physically active; and 3) a tailored physical activity coaching plan including an Individualised activity goal (in steps/day) revised twice weekly through consultation sessions (16 sessions in total). Patients' targets will be revised twice weekly during the consultation sessions which will be incorporated into the Pulmonary rehabilitation sessions. The aim is to increase physical activity by 10% each week. The goal can be altered if required.

Study groups in NCT03749655
Study groupRoleWhat they receive
PR+CBTNo interventionStandard care Pulmonary rehabilitation will be given alongside cognitive behavioural therapy
PR+CBT+PA Promotion.ExperimentalStandard care Pulmonary rehabilitation will be given alongside cognitive behavioural therapy and physical activity promotion.
Receives: Behavioral: Physical Activity Promotion

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Patient compliance with the physical activity promotion intervention

    Whether patients use the step counter for an 8 week period of physical activity promotion while undertaking pulmonary rehabilitation. Compliance to the intervention is defined as at least 4 days per week with valid step count data (>70 steps/day). Over the 8-week program patients should have a minimum of 6 weeks (75%) compliance with the physical activity intervention.

    Measured: 8 weeks (16 sessions)

  2. Patient Experience of Physical Activity

    Measured using the innovative Clinical Visit of COPD Questionnaire (C-PPAC)

    Measured: Measured 1 week prior and 1 week post rehabilitation

Secondary outcomes (5)
  1. Change in daily physical activity.

    Measured via steps/day using a triaxial accelerometer

    Measured: Measured 1 week prior and 1 week post rehabilitation

  2. Change in symptoms of anxiety and depression.

    Assessed using the Hospital Anxiety and Depression Scale (HADS) questionnaire. Scale measures for Anxiety and Depression are both out of 21. Scoring is grouped as: Normal= 0-7, Borderline abnormal= 8-10, 11-21= Abnormal.

    For the investigators study a score for Anxiety and/or depression of >8 is required at inclusion.

    Measured: Measured 1 week prior and 1 week post rehabilitation

  3. Change in functional capacity

    Assessed by the 6-min walk test

    Measured: Measured 1 week prior and 1 week post rehabilitation

  4. Change in quality of life

    Assessed using COPD Assessment Test (COPD)

    Measured: Measured 1 week prior and 1 week post rehabilitation

  5. Change in quality of life

    Assessed using the clinical COPD questionnaire (CCQ). The total CCQ score is calculated by adding the scores of the ten items and dividing that number by 10. The scale varies between 0 (very good health) to 6 (extremely poor health status).

    Measured: Measured 1 week prior and 1 week post rehabilitation

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted21 Nov 2018
  2. Study start20 Nov 2018
  3. Primary completion1 Apr 2021
  4. Study completion31 Aug 2021

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Other
Allocation
Randomised
Intervention model
Parallel groups
Model description
Single centre feasibility, single blind, parallel, randomised controlled study.
Masking
None (open label)
Enrolment
70 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03749655
Sponsor's protocol ID
08968
Status last verified
Apr 2022
First submitted
14 Nov 2018
Last updated
5 Apr 2022
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Maltais F, Decramer M, Casaburi R, Barreiro E, Burelle Y, Debigare R, Dekhuijzen PN, Franssen F, Gayan-Ramirez G, Gea J, Gosker HR, Gosselink R, Hayot M, Hussain SN, Janssens W, Polkey MI, Roca J, Saey D, Schols AM, Spruit MA, Steiner M, Taivassalo T, Troosters T, Vogiatzis I, Wagner PD; ATS/ERS Ad Hoc Committee on Limb Muscle Dysfunction in COPD. An official American Thoracic Society/European Respiratory Society statement: update on limb muscle dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2014 May 1;189(9):e15-62. doi: 10.1164/rccm.201402-0373ST.

    PubMed 24787074
  • Troosters T, van der Molen T, Polkey M, Rabinovich RA, Vogiatzis I, Weisman I, Kulich K. Improving physical activity in COPD: towards a new paradigm. Respir Res. 2013 Oct 30;14(1):115. doi: 10.1186/1465-9921-14-115.

    PubMed 24229341
  • Pitta F, Troosters T, Spruit MA, Probst VS, Decramer M, Gosselink R. Characteristics of physical activities in daily life in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005 May 1;171(9):972-7. doi: 10.1164/rccm.200407-855OC. Epub 2005 Jan 21.

    PubMed 15665324
  • Garcia-Aymerich J, Lange P, Benet M, Schnohr P, Anto JM. Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study. Thorax. 2006 Sep;61(9):772-8. doi: 10.1136/thx.2006.060145. Epub 2006 May 31.

    PubMed 16738033
  • Watz H, Pitta F, Rochester CL, Garcia-Aymerich J, ZuWallack R, Troosters T, Vaes AW, Puhan MA, Jehn M, Polkey MI, Vogiatzis I, Clini EM, Toth M, Gimeno-Santos E, Waschki B, Esteban C, Hayot M, Casaburi R, Porszasz J, McAuley E, Singh SJ, Langer D, Wouters EF, Magnussen H, Spruit MA. An official European Respiratory Society statement on physical activity in COPD. Eur Respir J. 2014 Dec;44(6):1521-37. doi: 10.1183/09031936.00046814. Epub 2014 Oct 30.

    PubMed 25359358
  • Lahham A, McDonald CF, Holland AE. Exercise training alone or with the addition of activity counseling improves physical activity levels in COPD: a systematic review and meta-analysis of randomized controlled trials. Int J Chron Obstruct Pulmon Dis. 2016 Dec 8;11:3121-3136. doi: 10.2147/COPD.S121263. eCollection 2016.

    PubMed 27994451
  • Ng TP, Niti M, Tan WC, Cao Z, Ong KC, Eng P. Depressive symptoms and chronic obstructive pulmonary disease: effect on mortality, hospital readmission, symptom burden, functional status, and quality of life. Arch Intern Med. 2007 Jan 8;167(1):60-7. doi: 10.1001/archinte.167.1.60.

    PubMed 17210879
  • Heslop K, Foley T. Using cognitive behavioural therapy to address the psychological needs of patients with COPD. Nurs Times. 2009 Sep 29-Oct 5;105(38):18-9.

    PubMed 19860064
  • Armstrong M, Hume E, McNeillie L, Chambers F, Wakenshaw L, Burns G, Marshall KH, Vogiatzis I. Behavioural modification interventions alongside pulmonary rehabilitation improve COPD patients' experiences of physical activity. Respir Med. 2021 Apr-May;180:106353. doi: 10.1016/j.rmed.2021.106353. Epub 2021 Mar 9.

    PubMed 33735798

Questions about this trial

What is this clinical trial studying?

A study testing Physical Activity Promotion in people with Chronic Obstructive Pulmonary Disease, run by Northumbria University at 1 site in United Kingdom.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 5 Apr 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Patient compliance with the physical activity promotion intervention (time frame: 8 weeks (16 sessions)). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03749655, which also lists 9 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 5 Apr 2022.

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