TITLE: EFFECTIVENESS OF AN AUTOMATED WALKING PROGRAM TARGETING VETERANS WITH COPD Anticipated Impact: Chronic Obstructive Pulmonary Disease (COPD) is a common disabling chronic condition that is more prevalent in veterans than in the general population. Limitations in daily activities due to reduced exercise tolerance along with frequent hospitalizations for COPD exacerbations contribute to poor quality of life and increased health care costs. A low cost and widely disseminated intervention that improves quality of life and exercise tolerance while decreasing rates of hospitalization for veterans with COPD could significantly improve quality of care and decrease costs. This research program addresses three HRS&D priority areas: 1) Access / Rural Health, 2) Care of Complex Chronic Conditions, and 3) Healthcare Informatics. Project Background / Rationale: Individuals with COPD who undergo a facility-based, exercise-focused pulmonary rehabilitation program experience significant improvements in health related quality of life, dyspnea, and exercise tolerance as well as reduced rates of hospitalization. Unfortunately, only a small percent of individuals with COPD who could benefit from pulmonary rehabilitation have access to and participate in such programs. Moreover, the benefits of short-term pulmonary rehabilitation programs tend to diminish rapidly after the program ends. Rural veterans are less likely to have access to facility-based pulmonary rehabilitation than urban veterans. Health related quality of life in rural veterans with COPD is significantly worse than for veterans with COPD who live in urban areas. An internet-mediated self-management program for veterans with COPD that focuses on walking could be disseminated widely at low marginal cost to any veteran with COPD who has internet access. Stepping Up to Health is a fully automated internet-mediated walking program that has been studied and is effective in individuals with other chronic diseases including type 2 diabetes, coronary artery disease and obesity. The SUH program uses inexpensive, enhanced uploading pedometers and provides automated, individually tailored coaching with gradually incrementing step-count goals and feedback. SUH results in an average increase in walking of approximately 1 mile or 2000 steps per day in individuals with chronic disease. The effectiveness of SUH with respect to COPD relevant outcomes has not been tested. Project Objectives: The proposed research is designed to test the effectiveness of an automated internet-mediated walking program for veterans with COPD on improving health related quality of life and reducing days of hospitalization. Additionally, the proposed research will compare measures of intervention reach, participation and satisfaction between urban and rural veterans. Project Methods: The study is a two-arm randomized controlled trial of an automated internet- mediated walking program targeting veterans with COPD. The two arms are 1) SUH for COPD and 2) wait list control. All study procedures will be delivered remotely including recruitment, consent, medical clearance, intervention delivery and outcome assessment. Equal numbers of urban and rural veterans will be invited, allowing comparisons of intervention reach, participation and satisfaction between urban and rural veterans.
This randomized controlled trial will provide crucial data on the effectiveness of delivering an internet-mediated intervention to improve quality of life and exercise tolerance, and decrease hospitalizations in veterans with COPD. It will also measure the reach adherence for interventions delivered over the internet with a particular focus on differences in reach and adherence between rural and urban veterans.