Home-based coaching can help COPD patients get moving, avoid hospitalization

As healthcare evolves, there is a greater push for providing care to patients where they want it, and a new study supports the benefits of this kind of care.

A study published in the Annals of the American Thoracic Society in December 2017 found that patients with chronic obstructive pulmonary disease (COPD) were more active when prompted a health coach’s phone call.

David B. Coultas, MD, of Oregon Health & Science University, led the study which placed more than 300 patients with COPD in a six-week education program on self-management. Following the conclusion of that program, about half the patients returned to their normal daily care patterns while the other half received 20 weeks of home-based health coaching services by phone. In the 18 months researchers studied the two groups, they found the group receiving home-based coaching was persistently more active than the group not coached.

The study measured efficacy of the interventions in improving health by assessing the first second of forced expiratory volume (FEV1), Coultas said.

“On average, adopting an increase in lifestyle physical activity prevented decline in functional capacity over 18 months, measured by the six-minute walking distance (a common pulmonary test) among patients with moderate impairment (FEV1 50% to 70% predicted),” Coultas told Medical Economics. “The six-minute walking distance declined among patients in the control group with moderate impairment and all patients with severe impairment (FEV1 <50% predicted). However, patients with severe impairment had a reduced rate of COPD-related emergency room visits and hospitalizations.”

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The study measured different subsets of the study groups based on their level of impairment, with researchers cautioning that activities promoted in the home-based coaching must be feasible and generalizable. However, when these goals are met, the research team found that they were successful in increasing activity with the hope of decreasing the utilization of healthcare services for issues like COPD exacerbations. Physical inactivity in COPD patients is associated with more exacerbations, which have high healthcare costs, the study noted.

“Because of difficulty breathing, patients with COPD are limited in their capacity to exert themselves, which contributes to lower levels of physical activity and higher levels of sedentary behavior. This in-turn contributes to deconditioning and a viscous cycle of further worsening of their symptom,” Coultas said. “Clinicians need to recognize this problem and advise patients to participate in regular lifestyle physical activity, such as walking, at least 30 minutes per day, five days per week. Don’t sit for longer than 30 minutes, and even short bouts of movement throughout the day that total 30 minutes per day provide health benefits.”

Changing sedentary behaviors takes time, though, he added, but clinicians can help by offering support through new advances in telemedicine and home-based monitoring. Health coaches are trained in behavior change methods, he said, and they are in regular contact with patients over a long period of time with ongoing support to maintain the changes.

What doesn’t work, Coultas said, is simply telling patients to increase activity without some form of coaching or support and not recognizing and tailoring coaching to meet a patient’s needs. Patients have different levels of motivation and confidence that must be addressed in order to elicit the changes and increase activity, he said.

Coultas said he hopes his findings will increase awareness of the adverse effects of sedentary behavior and low-levels of physical activity on patients with COPD, as well as the benefits of health coaching for improving health outcomes by increasing physical activity.