Acceso usuarios
, Joaquin Gea Guiral (secret.) , Heleen Demeyer (voc.) Background: High levels of physical activity have been related to better prognosis in patients with chronic obstructive pulmonary disease (COPD). However, so far no interventions have proven effective to modify physical activity in COPD. The aims of this thesis are to design, validate and test a novel behavioral intervention (Urban Training) in the community to modify physical activity behavior in COPD patients at the long term.
Methods: We designed and validated walking trails of different intensities in public spaces of five seaside Catalan municipalities using a gas analyzer to measure physiological response to walking trails in 10 COPD patients and 10 healthy subjects. A total of 411 COPD patients recruited from 33 primary care centers and 5 tertiary hospitals were allocated 1:1 to Urban Training intervention or usual care. The intervention used behavioral strategies by combining motivational interviewing, walking trails, pedometers, calendars, website, pamphlets, phone text messages, walking groups and support phone number to increase physical activity. Patients were followed for 12 months.
Results: (1) The physiological response to and energy expenditure on unsupervised walking the Urban Training trails increased according to the predefined trails’ intensity and did not change across trails of the same intensity in different public space. (2) The Urban Training intervention improved physical activity after 12 months of follow-up only in patients adherent to the intervention. No effect of the intervention was found in hospital admissions, exercise capacity, body composition, health-related quality of life, anxiety, or depression. (3) Dog walking and grandparenting were associated with a higher amount and intensity of physical activity in COPD patients independent of airflow limitation and other psychological or biological parameters. Environmental characteristics of green or blue spaces surrounding patients' home were not associated with physical activity.
Conclusions: The present thesis highlights the importance of behavioral strategies and social determinants to design future interventions aiming to enhance physical activity in COPD patients.
