Are Physical Activity and Benefits Maintained After Long-Term Telerehabilitation in COPD?

Hanne Hoaas, Bente Morseth, Anne E. Holland, Paolo Zanaboni


This study investigated whether physical activity levels and other outcomes were maintained at 1-year from completion of a 2-year telerehabilitation intervention in COPD. During the post-intervention year, nine patients with COPD (FEV1 % of pred. 42.4±19.8%; age 58.1±6 years) were encouraged to exercise on a treadmill at home and monitor daily symptoms and training sessions on a webpage as during the intervention. Participants were not provided supervision or motivational support. Physical activity levels decreased from 3,806 steps/day to 2,817 steps/day (p= 0.039). There was a decline in time spent on light physical activity (p=0.009), but not on moderate-to-vigorous activity (p=0.053). Adherence to registration of symptoms and training sessions decreased significantly. Other outcomes including health status, quality of life, anxiety and depression, self-efficacy, and healthcare utilization did not change significantly. In conclusion, provision of equipment for self-management and unsupervised home exercise might not be enough to maintain physical activity levels.


Andersson, M., Janson, C., & Emtner, M. (2014). Accuracy of three activity monitors in patients with chronic obstructive pulmonary disease: A comparison with video recordings. COPD: Journal of Chronic Obstructive Pulmonary Disease, 11, 560-567.

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77-101.

Brooks, D., Krip, B., Mangovski-Alzamora, S., & Goldstein, R. S. (2002). The effect of postrehabilitation programmes among individuals with chronic obstructive pulmonary disease. European Respiratory Journal, 20, 20-29.

Burtin, C., Langer, D., van Remoortel, H., Demeyer, H., Gosselink, R., Decramer, M., . . . Troosters, T. (2015). Physical Activity Counselling during Pulmonary Rehabilitation in Patients with COPD: A Randomised Controlled Trial. PloS One, 10(12), e0144989. doi:10.1371/journal.pone.0144989

Byrom, B., & Rowe, D. A. (2016). Measuring free-living physical activity in COPD patients: deriving methodology standards for clinical trials through a review of research studies. Contemporary Clinical Trials, 47, 172-184.

Cavalheri, V., Donária, L., Ferreira, T., Finatti, M., Camillo, C. A., Ramos, E. M. C., & Pitta, F. (2011). Energy expenditure during daily activities as measured by two motion sensors in patients with COPD. Respiratory Medicine, 105, 922-929.

Demeyer, H., Burtin, C., Hornikx, M., Camillo, C. A., Van Remoortel, H., Langer, D., . . . Troosters, T. (2016). The minimal important difference in physical activity in patients with COPD. PloS One, 11(4), e0154587.

Demeyer, H., Burtin, C., Van Remoortel, H., Hornikx, M., Langer, D., Decramer, M., . . . Troosters, T. (2014). Standardizing the analysis of physical activity in patients with COPD following a pulmonary rehabilitation program. Chest, 146, 318-327. doi:10.1378/chest.13-1968

Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I.-M., . . . Swain, D. P. (2011). Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Medicine and Science in Sports and Exercise, 43, 1334-1359.

Garcia-Aymerich, J., Lange, P., Benet, M., Schnohr, P., & Antó, J. M. (2006). Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study. Thorax, 61, 772-778.

García-Polo, C., Alcázar-Navarrete, B., Ruiz-Iturriaga, L. A., Herrejón, A., Ros-Lucas, J. A., García-Sidro, P., . . . Miravitlles, M. (2012). Factors associated with high healthcare resource utilisation among COPD patients. Respiratory Medicine, 106, 1734-1742. doi:

Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2016). Global strategy for the diagnosis, management and prevention of COPD. Retrieved from

Hellem, E., Bruusgaard, K. A., & Bergland, A. (2012). Exercise maintenance: COPD patients' perception and perspectives on elements of success in sustaining long-term exercise. Physiother Theory Pract, 28, 206-220.

Hoaas, H., Andreassen, H., Lien, L., Hjalmarsen, A., & Zanaboni, P. (2016). Adherence and factors affecting satisfaction in long-term telerehabilitation for patients with chronic obstructive pulmonary disease: a mixed methods study. BMC Medical Informatics and Decision Making, 16, 26.

Hurst, H., & Bolton, J. (2004). Assessing the clinical significance of change scores recorded on subjective outcome measures. Journal of Manipulative and Physiological Therapeutics, 27(1), 26-35. doi:10.1016/j.jmpt.2003.11.003

Kon, S. S. C., Canavan, J. L., Jones, S. E., Nolan, C. M., Clark, A. L., Dickson, M. J., . . . Man, W. D. C. (2014). Minimum clinically important difference for the COPD Assessment Test: a prospective analysis. The Lancet Respiratory Medicine, 2, 195-203. doi:10.1016/S2213-2600(14)70001-3

Lundell, S., Holmner, Å., Rehn, B., Nyberg, A., & Wadell, K. (2015). Telehealthcare in COPD: A systematic review and meta-analysis on physical outcomes and dyspnea. Respiratory Medicine, 109, 11-26.

Marquis, N., Larivée, P., Dubois, M.-F., & Tousignant, M. (2014). Are improvements maintained after in-home pulmonary telerehabilitation for patients with chronic obstructive pulmonary disease? International Journal of Telerehabilitation, 6(2), 21-30.

Norton, K., Norton, L., & Sadgrove, D. (2010). Position statement on physical activity and exercise intensity terminology. Journal of Science and Medicine in Sport, 13, 496-502. doi:10.1016/j.jsams.2009.09.008

Patel, S. A., Benzo, R. P., Slivka, W. A., & Sciurba, F. C. (2007).

Activity monitoring and energy expenditure in COPD patients: A validation study. COPD: Journal of Chronic Obstructive Pulmonary Disease, 4, 107-112.

Ries, A. L., Kaplan, R. M., Myers, R., & Prewitt, L. M. (2003). Maintenance after pulmonary rehabilitation in chronic lung disease: A randomized trial. American Journal of Respiratory and Critical Care Medicine, 167, 880-888.

Spruit, M. A., Singh, S., Garvey, C., Zuwallack, R., Nici, L., Rochester, C., . . . Wouters, E. F. M. (2013). An official American Thoracic Society/European Respiratory Society Statement: Key concepts and advances in pulmonary rehabilitation. American Journal of Respiratory and Critical Care Medicine, 188(8), e13-e64.

Spruit, M. A., & Singh, S. J. (2013). Maintenance programs after pulmonary rehabilitation: How may we advance this field? Chest, 144, 1091-1093.

Suissa, S., Dell'Aniello, S., & Ernst, P. (2012). Long-term natural history of chronic obstructive pulmonary disease: Severe exacerbations and mortality. Thorax, 67, 957-963.

Troosters, T., van der Molen, T., Polkey, M., Rabinovich, R. A., Vogiatzis, I., Weisman, I., & Kulich, K. (2013). Improving physical activity in COPD: Towards a new paradigm. Respiratory Research, 14, 115.

Tudor-Locke, C., Craig, C. L., Brown, W. J., Clemes, S. A., De Cocker, K., Giles-Corti, B., . . . Blair, S. N. (2011). How many steps/day are enough? for adults. International Journal of Behavioral Nutrition and Physical Activity, 8(1), 1-17. doi:10.1186/1479-5868-8-79

Tudor-Locke, C., Washington, T. L., & Hart, T. L. (2009). Expected values for steps/day in special populations. Preventive Medicine, 49(1), 3-11. doi:

Van Remoortel, H., Hornikx, M., Demeyer, H., Langer, D., Burtin, C., Decramer, M., . . . Troosters, T. (2013). Daily physical activity in subjects with newly diagnosed COPD. Thorax, 68, 962-963.

Vassilev, I., Rowsell, A., Pope, C., Kennedy, A., O’Cathain, A., Salisbury, C., & Rogers, A. (2015). Assessing the implementability of telehealth interventions for self-management support: a realist review. Implementation Science, 10(1), 59. doi: 10.1186/s13012-015-0238-9

Waschki, B., Kirsten, A., Holz, O., Müller, K.-C., Meyer, T., Watz, H., & Magnussen, H. (2011). Physical activity is the strongest predictor of all-cause mortality in patients with COPD: A prospective cohort study. CHEST Journal, 140, 331-342.

Watz, H., Pitta, F., Rochester, C. L., Garcia-Aymerich, J., ZuWallack, R., Troosters, T., . . . Polkey, M. I. (2014). An official European Respiratory Society statement on physical activity in COPD. European Respiratory Journal, 44, 1521-1537.

Zanaboni, P., Hoaas, H., Lien, L. A., Hjalmarsen, A., & Wootton, R. (2016). Long-term exercise maintenance in COPD via telerehabilitation: A two-year pilot study. Journal of Telemedicine and Telecare, 0(0), 1-9.

Zanaboni, P., Lien, L. A., Hjalmarsen, A., & Wootton, R. (2013). Long-term telerehabilitation of COPD patients in their homes: Interim results from a pilot study in Northern Norway. Journal of Telemedicine and Telecare, 19, 425-429.




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