NHS Glos. CCG: Pulmonary Conditions

Kirstie Tew, MSc., Abby Barton, BSc., & Sophie Middleton

Executive Summary

Background

Regular physical activity improves breathing and can reduce other symptoms of pulmonary conditions, such as Chronic Obstructive Pulmonary Disease (COPD) and Asthma, as well as benefiting mental and physical wellbeing and quality of life (QoL). Many people actually find that the benefits of being active exceed those of inhaled drugs (British Lung Foundation, 2019). NHS Gloucestershire Commissioners felt that KiActiv® Health could be a valuable tool to support individuals who have been diagnosed with a pulmonary condition, in order to better self-manage their condition and reduce the likelihood of exacerbations which could lead to hospital admission.

Innovation

KiActiv® Health is a personalised and guided online behaviour change service that empowers participants to optimise everyday physical activity in the context of their condition.  KiActiv®’s patented technology evaluates minute-by-minute physical activity data from a validated wearable monitor, which is displayed instantly in the user’s personalised online dashboard, and is available 24/7 to provide meaningful and actionable feedback. Patients are also supported remotely by phone calls with a dedicated KiActiv® Mentor at 6 key time points during the 12-week programme, to help them build an understanding of the value of their daily activities and the confidence to plan, monitor and improve. At the end of the 12-weeks, the patients retain access to their personal dashboard and activity monitor, enabling them to continue their self-management using the technology if desired.

Purpose/objective

To provide an accessible service to enable patients diagnosed with various pulmonary conditions to improve self-care through the optimisation of their everyday physical activity.

Methodology

Eligible patients were invited to participate in KiActiv® Health via a letter sent out by their GP practice. Enrolled patients were sent a wearable activity monitor, before participating in the 12-week KiActiv® Health programme. They were supported at key time points throughout by a trained KiActiv® Mentor. Data was analysed from a range of sources: the KiActiv® Health platform, KiActiv® Mentor calls, and a self-administered online questionnaire. 

Key Findings

  • Demographics: 139 patients started KiActiv® Health (84 females, 55 males), average age = 66 years, average body mass index (BMI) = 29.0kg/m2.
  • Completion: 87 patients (62.6%) (49 females, 38 males) have completed the 12-week programme. 23 patients (16.5%) are currently within the 12-weeks.
  • Engagement: The use of the technology was excellent and included 89% of days being classed as having complete data sets.
  • PROMS: A self-administered online questionnaire was completed on completion of the 12-weeks of KiActiv® Health.
    • 84.4% of respondents felt that their understanding of physical activity had improved as a result of participation in KiActiv® Health.
    • 81.3% of respondents felt confident that they could manage their physical activity for their overall health now and in the future.
    • 81.3% of patients felt that KiActiv® Health had benefitted them in some way.
    • 90.6% of patients stated that they would recommend KiActiv® Health to a family member or friend.
    • Patient reported benefits included:
      • Improved pulmonary symptoms
      • Benefits to other aspects of lifestyle such as improved sleep, reduced anxiety, healthier eating habits, and feeling more energised during the day.
      • An increased awareness of all movement, not just exercise.
      • Understanding the accessibility of everyday physical activity, and finding more enjoyment in daily activities.
      • The ability to plan, self-manage, and improve daily physical activities.
      • A sense of control around how everyday physical activities affect their health and wellbeing, which has led to an improvement in physical and mental health, as well as overall QoL.
      • Increased confidence when engaging with technology.
  • Physical Activity Data: In their 2020 Cochrane Review, Burge and colleagues found that, in comparison to no intervention, the mean difference in time spent in moderate to vigorous intensity physical activity following pulmonary rehabilitation was 4-minutes per day. On average, KiActiv® Health participants increased in the same dimension by a total of 13-hours 16-minutes over 66 complete days, which is equivalent to 12-minutes per day of the intervention.
    • 100% of patients improved their physical activity in 1+ dimensions.
    • 100% of patients improved their physical activity in 3+ dimensions.
    • 78% of patients improved their physical activity in 4+ dimensions.
    • The average increases in physical activity from baseline (i.e., physical activity dose) across an average of 66 complete days were:
      • Non-Sedentary Time: +31hrs 33mins (+18%)
      • Moderate Activity: +13hrs 16mins (+583%)
      • Moderate Bouts: +8hrs 14mins (+1,163%)
      • Calorie Burn: +6,460kcals (+3%)

Conclusion

Previous research with COPD patients indicates that without an intervention, physical activity levels over a 16-week period remain stable in less severe stages (GOLD A, B and C; Agarwal et al., 2012) and declined in those with the most severe COPD (Global Initiative for Chronic Obstructive Lung Disease 2011 Group [GOLD] D). When observed over a period of 18 months to 3 years, physical activity has been shown to substantially decrease across all severity stages of COPD (Durheim et al., 2015; Waschki et al., 2015).

KiActiv® Health increased self-management skills and participants received person-centered care along with tailored individual advice on managing their daily activity to best support their respiratory diagnosis. The remote nature of KiActiv® Health overcomes the travel barrier; ensuring participants are supported from the safety of their own homes. Not only is this particularly pertinent due to ongoing COVID-19 restrictions, reducing our reliance on transport to receive care will also reduce carbon emissions, supporting the vision for a healthier planet.

29th November 2021