Impact of step exercises as an early intervention during COPD exacerbation

Hospital admissions due acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have a negative effect on physical activity since the latter is reduced both during hospitalization and for a relatively prolonged period after discharge. To prevent the effects of deconditioning we conducted a randomized clinical trial ( NCT01871025 ) using a step exercise protocol from the third day of hospital admission until one month after discharge. We recruited 22 consecutive patients hospitalized with AECOPD, who were randomized to an early intervention with step exercises (Chester Step Test) (intervention group, IG) or usual care (physiotherapy techniques for airway clearance, etc.) (n=11 in each group). The primary outcome was the level of physical activity four weeks after discharge. Patients had [mean (SD)] 67 (8) yrs. and were mostly male (82%), former smokers (70%) and frequent exacerbators (31%). FEV 1 was 33(11) % pred. and CAT reached 24(8) points. The median length of hospital stay was similar in both groups (6 days). One month after discharge, the time spent sitting per day was only significantly reduced in the IG (13 to 7 hours/day, p=0.007). In addition, the percentage of patients doing moderate to vigorous activity (>3 MET) more than 150 minutes/week was significantly higher in the IG compared with the usual care group (56 vs. 12%, p=0.04). Moreover, the number of steps per day showed a trend to also be higher in the former group (4282 vs. 2835, respectively). In conclusion, the use of an early intervention with step exercises during hospital admission and the recovery period improved the level of daily physical activities in patients with AECOPD one month after discharge.