The Impact of Underlying Behavioral Mechanisms on a Home-Based Pulmonary Rehabilitation Program

PROJECT SUMMARY/ABSTRACT Chronic Obstructive Pulmonary Disease (COPD) is one of the top five causes of disability among middle-aged US adults. Exercise-based pulmonary rehabilitation (PR) programs are often recommended for COPD patients to alleviate symptoms of breathlessness, fatigue, physical function, and overall quality of life. However, the benefits of physical activity-based interventions are typically not sustained over a long period of time in COPD, and adherence to physical activity interventions is poor. In addition, few longitudinal studies on physical activity of COPD patients use objective measures of physical activity. Symptoms of COPD can lead to increased sleep disturbances resulting in increased daily fatigue, lower physical activity, and negative mood, which in turn worsen COPD symptoms. We recently demonstrated the effectiveness of our novel home-based PR program consisting of 12 weeks of weekly health coaching calls and objective remote monitoring to increase the physical activity of COPD patients. However, the underlying behavioral mechanisms that contribute to a higher likelihood of successful and sustainable increases in daily physical activity in COPD patients participating in such programs are not understood. With COPD prevalence and its’ associated co-morbidities quickly accelerating in the aging population, it is critical to understand the underlying mechanisms responsible for improving health outcomes, and to translate that knowledge into clinical practice. It is our overarching hypothesis that modifiable habitual behavioral patterns play a significant mitigating role in slowing the progression of COPD symptoms. The proposed project will bridge these mechanistic gaps in knowledge and allow us to better refine and individualize our novel PR program to optimize improvements in physical activity and subsequent health benefits across the COPD population. The goal of this study is to investigate how patterns of physical activity, sedentary behavior, sleep and cognitive components of mood and self-efficacy affect the physical activity outcomes produced by our home-based physical activity intervention (R01 HL140486, PI: Benzo) by applying algorithms to a wrist-worn accelerometer (developed in R21 AR66643, PI: Fortune) in combination with daily survey-based measurements. The following steps will be taken to address this important need: we will determine the associations of the underlying (1) patterns of physical activity and sedentary behavior with changes in physical activity elicited through PR, (2) patterns of sleep behaviors with changes in physical activity, fatigue and mood elicited through PR, and (3) behavioral processes with changes in physical activity elicited through PR. This project is innovative in its approach of utilizing our novel wearable sensor-based algorithms, and survey measurements combined with our novel home-based PR intervention to further the understanding of the mechanistic interplay of multi-factorial behavioral aspects that lead to increased likelihood of successful outcomes from participation in our novel PR program. Our results may critically inform the optimization of PR programs for this prevalent condition.