Internet-Based Self-Monitoring of Physical Activity (PA) in COPD Patients: a Study of the Usability of Activity Monitors and Patient’s Preferences

Background: In patients with COPD being physically active is considered of great importance in adequate disease management. However, it is difficult for the majority of COPD patients to meet the recommended amount of Physical Activity (PA). Pulmonary rehabilitation programs have been shown to improve PA in COPD patients. However, these programs are rather extensive and expensive, and not appropriate to all patients. Therefore, other methods of support (e.g. internet-based self-monitoring of PA using simple equipment) should be considered to help COPD patients in enhancing their PA. Objective: In the context of self-management of physical activity of COPD patients, 1) to assess the usability of two inexpensive and commercially available internet enabled accelerometers and 2) to gain insight into patients’ preferences with regard to the representation of the information on PA from the monitoring devices. Methods: A cross-over design study was conducted in COPD-patients from a Rehabilitation Centre, and who had never used a PA device before in order to assess the usability of two internet accelerometers: Fitbit (Fitbit Inc., San Francisco, CA) and PAM Physical Activity Monitor AM300 (PAM B.V. Doorwerth, NL). Participants (n=16, GOLD stage 1-4) were asked to wear both the Fitbit and PAM for seven consecutive days only during daytime. They were instructed to attach the devices to their waistband close to the hip (PAM) or pocket (FB), immediately after waking up and to continue to wear the device until going to sleep. Block-randomization determined the order in which activity monitors were worn (PAM – Fitbit or Fitbit-PAM). After each seven-day period patients were asked to indicate to what extend they agreed with seventeen statements regarding usability and user-friendliness of the corresponding activity monitor using a seven point Likert scale. A semi-structured focus group (n=5, GOLD stage 2-3) was organized. Issues such as presentation of the patients’ physical activity, providing feedback and advice, rewarding as well as planning for future physical activities were addressed. Various ways to present data gathered by the monitoring devices were presented to the participants. Results: Both devices scored well on the following aspects: in general pleasant to wear, and patients are willing to wear it for a longer period (>12 weeks) with average scores ranging from 4.9 - 5.9. There were no statistical differences between the Fitbit and the PAM. In general no negative sentiments (frightening, frustrating) towards wearing the device was reported. The focus group indicated that with respect to the presentation of the PA information, the patients were open to receive information about their physical activities via the internet, but they tended to be reluctant to get feedback (giving a feeling of being judged). The information also needed to be concise and easy to understand. Conclusions The two inexpensive and commercially available internet enabled accelerometers were both found to have good usability properties. Therefore, internet enabled self-monitoring of PA in COPD patients is a feasible and affordable solution to provide patients with the information and feedback needed to improve their PA as part of internet-based self-management support. []