Results Summary

What was the research about?

Patients with chronic obstructive pulmonary disease, or COPD, can have breathing problems and chronic cough. Being active may help people with COPD breathe more easily.

In this study, the research team wanted to learn if a physical activity program called Walk On! improved the health of patients with COPD when added to usual care. The program includes

  • Education about physical activity and COPD
  • A daily step-count goal and wearable step counter
  • Four phone calls from a coach
  • Check-in phone calls as needed over 11 months
  • Monthly group visits for peer support

Usual care included services covered by a patient’s health insurance, but no additional support for physical activity.

The research team first compared all patients assigned to Walk On! with patients who received usual care alone. The team then compared the smaller group of patients who actively took part in Walk On! with patients receiving usual care alone.

What were the results?

During the study, patients assigned to Walk On! and patients who received usual care alone had similar rates of emergency room visits and hospital stays. They also had similar rates of death for any reason.

After 10 months, patients who were in the group that actively took part in Walk On! had a lower risk of a short hospital stay compared with patients who received usual care alone. These patients were also more likely to report getting some physical activity and as much physical activity as recommended. After six months, these patients reported improved quality of life related to physical health and less time sitting compared with those receiving only usual care. But these changes were no longer present after one year.

Who was in the study?

The study included 2,707 patients ages 40 or older who went to the hospital because of COPD in the past year. All received care at Kaiser Permanente in Southern California. Of the patients, 74 percent were white, 14 percent were African American, 5 percent were Asian, 1 percent were Hawaiian or Pacific Islander, and 5 percent were other or unknown race. The average age was 72, and 54 percent were women.

What did the research team do?

The research team assigned patients by chance to Walk On! plus usual care or usual care alone. The team reviewed patients’ health records to look at use of health care, reported activity levels, and number of deaths. Patients completed surveys on quality of life and physical activity when the study began and again 6 and 12 months later.

Patients with COPD, caregivers, COPD advocacy groups, clinicians, and health system leaders gave input during the study.

What were the limits of the study?

Only 24 percent of the patients invited to join Walk On! did so. Patients who took part in Walk On! may differ from those who didn’t. Patients in the study reported their own physical activity. It’s possible those reports weren’t always correct.

Future studies could look at other ways to support physical activity among patients with COPD.

How can people use the results?

Health systems can use the results when considering how to help patients with COPD increase their physical activity.

Final Research Report

View this project's final research report.

Engagement Resources

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • The reviewers expressed concern about the considerable amount of missing data, given the attrition of 75 percent of those participating in the coaching intervention. The researchers agreed that the level of participation was suboptimal and revised the results to better describe the level of participation. They also noted that patients could still receive the coaching intervention but not use the activity sensors or not upload activity data at 12 months. This may have led to an underestimate of patients’ physical activity, especially compared to self-reported physical activity. The researchers did, however, reflect on how missing data in activity monitoring and multiple comparisons may have overestimated the effectiveness of the coaching intervention.
  • The reviewers cautioned the researchers to consider the heterogeneity in intervention delivery in their limitations section. The researchers acknowledged that there was variability in the type of activity monitor used and how patients used them, and that patients had the option of not attending some of the intervention sessions. They stated, however, that these aspects of the study illustrate the pragmatic nature of the study design, allowing patients to take advantage of the intervention based on their enthusiasm and preferences.
  • The reviewers noted that there were clinical differences between patients who completed and did not complete the six-month data collection. The researchers acknowledged that patients who completed the six-month data collection tended to have fewer comorbid conditions but worse airflow obstruction. The same patients were also more likely to be white, partnered, and physically active at baseline. However, these differences were the same for both treatment groups so there does not appear to be a treatment-related reason for the difference.
  • The reviewers questioned the value of self-reported measures of physical activity. The researchers agreed that self-reported physical activity data is less valuable than directly measured data but said it would be unrealistic to require objective measures of physical activity in such a large study sample. They also noted that restricting the study to only subjects who would wear a device would have created biases in the findings.

Conflict of Interest Disclosures

Project Information

Huong Q. Nguyen, PhD, RN
Kaiser Foundation Research Institute
$3,948,021
10.25302/08.2020.IHS-1403-14117
Patient-Centered Physical Activity Coaching to Improve Outcomes in COPD: A Pragmatic Trial

Key Dates

September 2014
January 2020
2014
2019

Study Registration Information

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Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
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Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
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Last updated: January 25, 2023