Long-Term Benefits of Adding a Pedometer to Pulmonary Rehabilitation for COPD: The Randomized Controlled STAR Trial

Wolfgang Geidl,1 Johannes Carl,1 Michael Schuler,2,3 Eriselda Mino,1 Nicola Lehbert,4 Michael Wittmann,4 Klaus Pfeifer,1 Konrad Schultz4 1Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany; 2Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany; 3Department of Applied Heath Sciences, Hochschule für Gesundheit, University of Applied Sciences, Bochum, Germany; 4Klinik Bad Reichenhall, Centre for Rehabilitation, Pulmonology, and Orthopaedics, Bad Reichenhall, GermanyCorrespondence: Wolfgang GeidlDepartment of Sport Science and Sport, Gebbertstrasse 123b, Erlangen, 91058, GermanyTel +49 9131 85 25457Fax +49 9131 85 25467Email wolfgang.geidl@fau.dePurpose: This Stay Active after Rehabilitation (STAR) study examined the effects of a pedometer-based behavioral intervention for individuals with COPD during three weeks of inpatient pulmonary rehabilitation (PR) on patients’ physical activity levels six weeks and six months after PR, including steps (primary outcome), moderate-intensity physical activity, and sedentary time as well as patient quality of life, symptoms, and other psychological and clinical variables.Patients and Methods: Rehabilitation patients with COPD wore a triaxial accelerometer (ActiGraph wGT3X) for seven days two weeks before (T0) as well as six weeks (T3) and six months (T4) after PR. In addition to the three-week inpatient PR (control group, CG), the randomly allocated intervention group (IG) received a brief pedometer-based behavioral intervention with the application of the following behavior-change techniques: performing the behavior, individual goal-setting, self-monitoring, and feedback. The effects were analyzed using analysis of covariance with an intention-to-treat approach.Results: A total of 327 patients (69% male, age: 58 years, FEV1 (%): 53.5, six-minute walk distance: 447.8 m) were randomly allocated to either the IG (n = 167) or CG (n = 160). Although both groups increased their daily steps after PR (IG: MT3-T0 = 1152, CG: MT3-T0 = 745; IG: MT4-T0 = 795, CG: MT4-T0 = 300), the slightly higher increases in daily steps in the IG compared to the CG at T3 (Δ 388 steps, d = 0.16) and T4 (Δ 458 steps, d = 0.15) were not statistically significant (p > 0.05 for all). Patients in both groups showed moderate to high pre-post-changes in terms of secondary outcomes, but no advantage favoring the IG was found.Conclusion: The results show that adding a pedometer-based behavioral intervention to standard German three-week inpatient PR for COPD patients did not result in more physical activity in terms of steps and moderate-intensity physical activity or less sedentary time. However, both groups (IG and CG) showed remarkably enhanced physical activity levels six weeks and six months after PR, as well as improvements in other secondary outcomes (eg, quality of life).Keywords: physical activity, exercise, physical activity promotion, behavior change, long-term follow-u