Promoting Activity After COPD Exacerbations, Aim 2

Deconditioning is common in patients with chronic obstructive pulmonary disease (COPD) and
has been associated with poor outcomes (e.g. difficulty breathing). Pulmonary rehabilitation
(PR) initiated shortly after hospital discharge following a COPD exacerbation has been shown
to improve some of these outcomes. However, for many patients, access to PR programs is
limited due to environmental, physical, and psycho-social reasons. Home-based physical
activity promotion, combined with education and social support, could help to overcome some
barriers to access and have been shown to be effective in populations with mild to moderate
COPD. However, home-based interventions have not been tested in patients recovering from COPD
exacerbations, a group for whom solutions to safely promote physical activity are urgently
needed. In PACE2 up to 64 adult participants with a physician diagnosis of COPD will be
enrolled and randomized to one of two groups: physical activity promotion intervention or
enhanced usual care. Participants will be enrolled while hospitalized and randomization will
occur approximately 7 days after hospital discharge. All participants will be provided
self-management educational materials and community resources both prior to hospital
discharge and during a home visit shortly after hospital discharge. For the participants
randomized to the intervention group, physical activity promotion will start following
randomization and continue for 12 weeks. These participants will also receive a personalized
plan to attend pulmonary rehabilitation, a guideline-recommended program for patients with
COPD recovering from exacerbations. The primary endpoint will be the change in physical
activity (mean daily step counts over 1 week) over time using repeated measures over the 12
weeks of the study.

Inclusion Criteria:

1. Age 18 years or older;

2. Physician diagnosis of COPD;

3. Hospitalized as an inpatient, 23-hour observation, or clinical decision unit

4. Admitting respiratory conditions sensitive to the Centers for Medicare and Medicaid
Services Hospital Readmission Reduction Program as listed below:

- COPD exacerbation

- Asthma/COPD overlap

- Decompensated heart failure

- Pneumonia

- Chronic Airway Disease

Exclusion Criteria:

1. Physical inability to participate in a walking program;

2. Oxygen saturation <90% by pulse oximetry refractory to supplemental oxygen, or in a
patient unable or unwilling to use supplemental oxygen;

3. Fall in the previous 6 months;

4. Resting electrocardiogram (ECG) with new ST changes or tachyarrhythmia;

5. Planned discharge home to hospice or to long term care facility/skilled nursing
facility;

6. Life expectancy <3 months;

7. Medical contraindication to participating in a physical activity promotion program as
determined by the inpatient treating clinician;

8. Unable to communicate in English;

9. Unable or declines to provide informed consent.