INTRODUCTION:Low physical activity (PA) levels have a negative impact on the health status of patients with Chronic Obstructive Pulmonary Disease (COPD). Smartphone applications (apps) focused on PA promotion may mitigate this problem; however, their effectiveness depends on patient adherence, which can be influenced by the technological features of the apps. This systematic review identified the technological features of smartphone apps aiming to promote PA in patients with COPD. METHODS:A literature search was performed in the databases ACM Digital Library, IEEE Xplore, PubMed, Scopus and Web of Science. Papers including the description of a smartphone app for PA promotion in patients with COPD were included. Two researchers independently selected studies and scored the apps features based on a previously developed framework (38 possible features). RESULTS:Twenty-three studies were included and 19 apps identified, with an average of 10 technological features implemented. Eight apps could be connected to wearables to collect data. The categories 'Measuring and monitoring' and 'Support and Feedback' were present in all apps. Overall, the most implemented features were 'progress in visual format' (n = 13), 'advice on PA' (n = 14) and 'data in visual format' (n = 10). Only three apps included social features, and two included a web-based version of the app. CONCLUSIONS:The existing smartphone apps include a relatively small number of features to promote PA, which are mostly related to monitoring and providing feedback. Further research is warranted to explore the relationship between the presence/absence of specific features and the impact of interventions on patients' PA levels.

Rationale: Patients present a wide range of respiratory symptoms and different clinical expressions of body composition and, according to current dietary recommendations from European Comission, a greater number and frequency of meals has been highlighted for patients with Chronic Obstructive Pulmonary Disease (COPD) in different european countries. There are no studies that relate the meals pattern and eating frequency with the body composition and symptoms of these patients.

People with COPD present inactive lifestyles and physical activity (PA) promotion is a major recommendation in disease management. Technology-based interventions may be useful, especially if tailored to the target population to improve adherence. We assessed the usability of the OnTRACK platform to promote PA through individualised goal setting and feedback: mobile application (app) for patients and web app for health professionals (HP). Patients and HP were asked to complete 9 and 10 tasks, respectively, and rate how easy completing each task was, from 1 (I couldn't complete it) to 5 (I completed it easily). Suggestions were recorded. In the end, participants completed the System Usability Scale (SUS; 10 questions, score 0-100%, higher scores indicate better usability). 15 patients with COPD (68±6 years, 80% male; 80% used smartphone, 80% internet, 20% wearables) and 22 HP (40±10 years, 86% female; all used computer, smartphone and internet; 64% wearables) participated. The easiness of task completion was 3.9±0.3 for patients and 4.6±0.3 for HP. The SUS score was 66±22 for patients and 88±10 for HP. Patients with experience using PA apps (n=5, 33%; 86±17) scored significantly higher in the SUS than those without experience (n=10, 67%; 56±19). Participants' main suggestions were related to information labels (n=8, 22%), graphical aspects (n=6, 16%) and improvement of the feature "add new goal" (n=8, 22%). The need for guidance or tutorials to get the most of the apps was referred by 10 patients (67%) and 7 HP (32%). Overall, end-users found the OnTRACK platform easy to use. Improvements in some features and inclusion of guidance/tutorials on how to use them, especially for patients, are still needed.

A decline in physical activity (PA) levels have been observed in pre-frail older adults and are associated with progression to frailty. People with COPD are at risk for frailty, however, PA levels in pre-frail patients with COPD are unknown. This study described and compared PA levels and sedentary behaviour (SB) between non-frail and pre-frail patients with COPD. Frailty was determined based on the 5 criteria of Fried’s frailty phenotype: low grip strength (Jamar dynamometer), unintentional weight loss (self-report), slow walking speed (4.57m course), exhaustion (2 questions from the Center for Epidemiological Studies Depression scale) and low PA (cut-off points of weekly energy expenditure from accelerometry) ( ≥3 criteria – frail; 1-2 criteria – pre-frail; 0 – non-frail). Daily PA was assessed using accelerometry (7 days): steps/day; time in moderate and vigorous PA (MVPA), total PA (TPA – light PA+MVPA) and SB. Mann-Whitney-U tests were used to compare PA and SB between groups. Forty-three pre-frail (67±8 years, 81% male, FEV1pp 43±18, BMI 26±6) and 39 non-frail (68±8 years, 72% male, FEV1pp 58±17, BMI 26±4) patients were included. Exhaustion was the most prevalent factor in pre-frail patients (72%). Pre-frail patients spent less time in MVPA (median [Q1; Q3] 15[6;31] min/day vs 30[14;55], p=0.012); TPA (107[85;193] min/day vs 152[134;212] min/day, p=0.029) and presented lower steps/day (3566 [2289;5683] vs 5894 [3434;7909] steps/day, p=0.006) than non-frail patients. No differences were found in SB (p=0.605). PA levels are reduced in pre-frail when compared to non-frail patients with COPD. Future studies should explore if increasing PA in PF patients reduces their risk for frailty.

INTRODUCTIONCOPD often leads to loss of independence in daily activities which may increase the dependency on the informal caregiver, resulting in caregiving burden. Several instruments have been used to assess caregiving burden in COPD; however, their measurement properties have been poorly investigated in this population. This study assessed the construct validity and reliability of the Informal Caregiver Burden Assessment Questionnaire (QASCI) in informal caregivers of patients with COPD.METHODSParticipants completed the QASCI (higher scores indicate higher burden) and the following questionnaires to assess construct validity: Zarit Burden Interview (ZBI), Hospital Anxiety and Depression Scale (HADS) and World Health Organization Quality of Life Instrument - Short Form (WHOQOL-Bref). QASCI was completed again one week later to assess test-retest reliability. Statistical analyses included: Pearson's (r) or Spearman's (ρ) correlations (construct validity); Cronbach's α (internal consistency); Intraclass Correlation Coefficient (ICC2,1, test-retest reliability) and Standard Error of Measurement (SEM), Minimal Detectable Change (MDC95) and Bland and Altman 95% Limits of Agreement (LoA).RESULTSFifty caregivers (62.7 ± 9.8 years, 88% female; patients' FEV1 = 45.2 ± 21.3%predicted) participated. QASCI mean score was 28.5 ± 19.8 (moderate burden). QASCI was positively correlated with ZBI (r = 0.908; p < 0.01), HADS anxiety (r = 0.613; p < 0.01) and depression (ρ = 0.634; <0.01) and negatively correlated with WHOQOL-Bref (-0.476 to -0.739) (all p < 0.01). Cronbach's α was 0.793 for the QASCI total score (subscales: 0.747-0.932). The ICC2,1 was 0.924, SEM 2.8 and MDC95 7.8, and the LoA were -18.3 to 11.1.CONCLUSIONSThe QASCI seems to be a promising measure to assess burden levels associated with informal caregiving in COPD.

This study explored the relationship of dietary pattern with body composition and symptoms in patients with COPD. Data collection included: dietary pattern – n. meals/day; period of day of highest food intake (morning [6AM–12PM], afternoon [12–18PM] and evening [18PM–6AM]); time interval between meals (3-4h, 5-6h, 9-10h), and daily energy and nutrient intake using a semiquantitative food frequency questionnaire (last 12 months); body composition – body mass index (BMI), % fat mass (%FM), % fat-free mass (%FFM), % total muscle mass (%MM), fat-free mass index (FFMI) and visceral fat index (VAT) (SECA mBCA 525); symptoms – dyspnoea (modified Medical Research Council Dyspnea Scale, mMRC), fatigue (Checklist of Individual Strength, CIS20-P total score), impact of COPD (COPD Assessment Test, CAT). Pearson’s (r) or Spearman’s (ρ) correlations were conducted. 18 patients participated (16 males, 68±7 years old, FEV1 43±20% predicted, BMI 25±5kg/m2, FFMI 18±3kg/m2). Most participants reported having 3-4 meals/day (n=14, 78%) with a 3-4-hour interval (n=15, 83%). Moderate correlations were found between %FM and carbohydrates (ρ=-.501), and between FFMI and monosaturated fat (r=.476) (p<.05). Moderate correlations were also found between: mMRC, CAT and CIS20-P with proteins, saturated fat, zinc and phosphorus (.469≤ρ≤.634, p<.05); CAT and CIS20-P with calories and carbohydrates (.497≤ρ≤.551, p<.05); and CIS20-P and mMRC with sodium and calcium (.517≤ρ≤.551, p<.05). mMRC was also correlated with vitamin B12 (ρ=.506, p<.05). No other significant correlations were observed (p>.05). Energy and nutrient intake are related to COPD symptoms and body composition. The nature of these relationships should be explored.

Introduction: eHealth platforms can be used as a tool to promote physical activity (PA) in patients with COPD. When developing such platforms, a bottom-up approach is needed to ensure that patients’ and healthcare professionals’ (HCP) needs and expectations are addressed. Aim: To assess patients’ and HCP’ perspectives on the ideal eHealth platform (web application - app - for HCP + mobile app for patients) for PA promotion in patients with COPD. Methods: One focus group with 5 patients (68±8 yrs, FEV1 44±21pp) and 6 individual interviews with HCP (physicians and physiotherapist, 39±10 yrs) were conducted using a semi-structured interview guide. Interviews were recorded and transcripts were analysed using the Grounded Theory approach. Results: Participants considered an eHealth platform to promote patients9 PA valuable. Both groups suggested that PA should be individualised according to patients’ characteristics. The main features for a mobile app included: shared goal setting, PA progress graphs, motivational messages and goal badges, notifications, a bi-directional communication system to support patients and information on breathing exercises. Both groups highlighted the importance of measuring steps, PA duration, SpO2, and dyspnoea on exertion. For the web app, the HCP highlighted the importance of a notification system to signal PA changes or non-compliance (e.g., colour scheme), as well as tabs for PA goal setting and monitoring. HCP recommended this platform for patients with stable or mild disease and/or those attending pulmonary rehabilitation. Conclusion: Findings provide guidance to the design of future eHealth platforms for PA promotion in COPD.

Abstract Introduction Chronic obstructive pulmonary disease (COPD) often leads to an increased dependence on the informal carer, which can result in higher levels of distress, anxiety or depression associated with the burden of caregiving and, consequently, reduced quality of life [1]. Several instruments have been used to assess carer burden in COPD; however, their measurement properties have been poorly assessed in this population [2]. The Questionário de Avaliação de Sobrecarga do Cuidador Informal (QASCI) is a Portuguese questionnaire, originally created for carers of patients with stroke [3] and later validated in a sample with various chronic diseases, including respiratory diseases [4]. However, its reliability and validity in informal carers of patients with COPD have yet to be established. Therefore, this study aimed to assess the reliability and validity of the QASCI questionnaire for informal carers of patients with COPD. Materials and methods The Portuguese questionnaire QASCI evaluates the distress associated with burden of caregiving (scores range from 0 to 100, with higher scores indicating higher levels of burden). It has 32 items divided in 7 subscales (emotional burden; personal life implications; financial burden; reactions to demands; mechanism of efficacy and control; familiar support; and satisfaction with the role). Each item is scored with a 5-point Likert scale. Reliability included internal consistency assessment using the Cronbach’s alpha. Construct validity was assessed using the following questionnaires: Zarit Burden Interview (ZBI) for concurrent validity; the Hospital Anxiety and Depression Scale (HADS) (anxiety and depression) and WHOQOL-Bref (quality of life) for convergent validity. Pearson’s (r) or Spearman’s (ρ) correlation coefficients were used according to the distribution of each variable. QASCI was expected to present a stronger (positive) correlation with ZBI than with HADS (r ≥ 0.5) and a negative correlation with WHOQOL-Bref (r≤–0.4) [3,4]. Results Forty-one carers (62.4 ± 10.1 years, 90.2% female; patients’ FEV1=43.7 ± 19.7%pred) completed the questionnaires. Cronbach’s alpha of the full QASCI scale was 0.767 and the subscales presented values between .633 and .929. QASCI and ZBI had a very strong positive correlation (r = 0.914; p=.01). QASCI had a strong positive correlation with HADS anxiety (r = 0.608; p=.01) and depression (ρ = 0.617; p=.01) subscales and moderate to strong negative correlations with all the WHOQOL-Bref subscales (–0.418 to 0.723, p=.01). Discussion and conclusions QASCI presented good internal consistency and construct validity results. QASCI seems to be a promising measure to evaluate distress levels associated with burden of caregiving in informal carers of patients with COPD.

Motivation can be broadly defined as what moves people to act. Low motivation is a frequently reported factor for the reduced physical activity (PA) levels observed in patients with chronic obstructive pulmonary disease (COPD). This study assessed patients' motives to be physically active, according to three pulmonary rehabilitation (PR) participation groups (Never PR, Previous PR and Current PR) and explored whether these motives were related to the PA levels and clinical characteristics. The motives to be physically active were assessed with the Exercise Motivation Inventory-2 (EMI-2, 14 motivational factors, five dimensions) and PA with accelerometry (PA groups: <5000 steps/day vs. ≥5000 steps/day). The clinical variables included symptoms, impact of the disease, exercise capacity and comorbidities. Ninety-two patients (67.4 ± 8.1 years, 82.6% male, forced expiratory volume in 1s (FEV1) 48.3 ± 18.9% predicted; 30.4% Never PR, 51% Previous PR and 18.5% Current PR) participated. The motivational dimensions related to health/fitness presented the highest scores (3.8 ± 1.1; 3.4 ± 1.3). The motives to be active were not significantly different between PA groups (p > 0.05) but having less symptoms and ≥two comorbidities were associated with higher scores in psychological/health and body-related motives, respectively (p < 0.05). The findings may encourage health professionals to actively explore with patients their motives to be physically active to individualise PA promotion.

Effectiveness of technology-based interventions to improve physical activity (PA) in people with COPD is controversial. Mixed results may be due to participants' characteristics influencing their use of and engagement with mobile health apps. This study compared demographic, clinical, physical and PA characteristics of patients with COPD using and not using mobile apps in daily life. Patients with COPD who used smartphones were asked about their sociodemographic and clinic characteristics, PA habits and use of mobile apps (general and PA-related). Participants performed a six-minute walk test (6MWT), gait speed test and wore an accelerometer for 7 days. Data were compared between participants using (App Users) and not using (Non-App Users) mobile apps. A sub-analysis was conducted comparing characteristics of PA–App Users and Non-Users. 59 participants were enrolled (73% Male; 66.3 ± 8.3 yrs; FEV1 48.7 ± 18.4% predicted): 59% were App Users and 25% were PA-App Users. Significant differences between App Users and Non-App Users were found for age (64.2 ± 8.9 vs. 69.2 ± 6.3yrs), 6MWT (462.9 ± 91.7 vs. 414.9 ± 82.3 m), Gait Speed (Median 1.5 [Q1–Q3: 1.4–1.8] vs. 2.0 [1.0–1.5]m/s), Time in Vigorous PA (0.6 [0.2–2.8] vs. 0.14 [0.1–0.7]min) and Self-Reported PA (4.0 [1.0–4.0] vs. 1.0 [0.0–4.0] Points). Differences between PA–App Users and Non-Users were found in time in sedentary behavior (764.1 [641.8–819.8] vs. 672.2 [581.2–749.4] min) and self-reported PA (4.0 [2.0–6.0] vs. 2.0 [0.0–4.0] points). People with COPD using mobile apps were younger and had higher physical capacity than their peers not using mobile apps. PA-App Users spent more time in sedentary behaviors than Non-Users although self-reporting more time in PA.

Introduction: This study assessed the test-retest reliability/agreement and construct validity of the International Physical Activity Questionnaire short-form (IPAQ-sf) in patients with chronic obstructive pulmonary disease (COPD). It also explored differences in its validity according to age, sex and GOLD airflow obstruction levels. Methods: 62 participants (68 +/- 8 years, 53 males, FEV1 51 +/- 23%pred) completed the Portuguese IPAQ-sf, wore an accelerometer for 7 days and completed a second IPAQ-sf. Test-retest reliability/agreement was assessed with Intraclass Correlation Coefficient (ICC2,1), 95% Limits of Agreement (LoA), standard error of measurement (SEM) and minimal detectable change (MDC95) for continuous variables, and percentage of agreement (%agreement) for categories ("active"/"inactive"). Validity was assessed with 95% LoA and Spearman's correlations (rho) between IPAQ-sf 2 (METs-min/week, time in vigorous [VPA], moderate PA [MPA] and walking) and accelerometry (time in MVPA, VPA, MPA and step counts) for continuous variables; %agreement, Cohen's kappa, and sensitivity specificity and +/- predictive values for categories. Correlations were also performed for age, sex and GOLD airflow obstruction grades. Results: Reliability was good (ICC2,1 = 0.707) with wide LoA (-6446-6409 METs-min/week). SEM and MDC95 were 1840 and 4971 METs-min/week, respectively. %agreement between the two IPAQ-sf was 84% (kappa = 0.660). Positive, moderate and significant correlations were found between IPAQ-sf and accelerometry (0.396 <= rho < 0.527, p < 0.001), except for VPA (p > 0.05). The strongest correlations were found in age (<65 years) and male (0.466 < rho < 0.653, p < 0.05). %agreement between tools was 65% (kappa = 0.313), with high sensitivity (0.830) but low specificity (0.500). Conclusions: The IPAQ-sf seems valid to be used in COPD but caution on its widespread use is recommended as its accuracy may be limited.

This work, was funded by Fundo Europeu de Desenvolvimento Regional (FEDER) - Comissao Diretiva do Programa Operacional Regional do Centro and by Fundacao para a Ciencia e Tecnologia - FCT (SAICT-POL/23926/2016), and partially funded by Programa Operacional Competitividade e Internacionalizacao (COMPETE), through COMPETE 2020 (POCI-01-0145- FEDER-016701 and POCI-01-0145-FEDER-007628) and FCT (UID/BIM/04501/ 2013 and UID/BIM/04501/2019).

Chronic obstructive pulmonary disease (COPD) can lead to increased dependence on the informal caregiver and, consequently, to distress associated with caregiving burden. In the general population, higher levels of physical activity (PA) are related to lower distress levels; however, this relationship has been scarcely studied in COPD. This study aimed to explore the relationship between distress and PA in informal caregivers of patients with COPD, and the influence of caregivers' (age, sex) and patients' (age, sex, lung function) characteristics and caregiving duration on this relationship.A cross-sectional study was conducted with 50 caregivers (62.7 ± 9.8 years, 88% female; 78% caring for a spouse/partner; 38% caring >40 h/week; patients' FEV1=45.2 ± 21.3% predicted). Data collection comprised questions related to the caregiving context, distress related to caregiving burden assessed with the Informal Caregiver Burden Assessment Questionnaire (QASCI; total score, 7 subscales), and self-reported PA with the Habitual Physical Activity Questionnaire (HPAQ). Spearman's correlation coefficient and linear regressions were used.Significant, negative and moderate correlations were found between the QASCI (28.5 ± 19.8) and the HPAQ (5.2 ± 1.3) (ρ=-0.46; p = 0.01); and between the HPAQ and some QASCI subscales (emotional burden ρ=-0.47; implications for personal life ρ=-0.52; financial burden ρ=-0.44; perception of efficacy and control mechanisms ρ=-0.42; p < 0.01). Two linear regression models were tested to predict QASCI total score including as predictors: 1) HPAQ alone (p = 0.001; r2=0.23); 2) HPAQ and caregiving h/week (p < 0.001; r2=0.34).Higher self-reported PA levels are related to decreased levels of distress associated with caregiver burden in COPD caregivers. Duration of caregiving may negatively influence this relationship.

Background: Chronic obstructive pulmonary disease (COPD) can lead to an increase in patient’s dependence on the informal carer and consequently to higher levels of distress. In the general population, higher levels of physical activity (PA) have been found to contribute to lower levels of distress. However, this relationship has been scarcely studied in carers of patients with COPD. Aim: This study aimed to explore the relationship between distress and PA in informal carers of patients with COPD and the influence of caregiving duration. Methods: Forty-one carers (62.4±10.1 years, 90.2% female; 41.5% caring for patients >40h/week; patients’ FEV1=43.7±19.7%pred) completed the Portuguese tool to assess distress related to caregiving (Informal Caregiver Burden Assessment Questionnaire [QASCI]; higher score meaning higher distress; 7 subscales); the Habitual Physical Activity Questionnaire (HPAQ) to assess PA; and questions related to the caregiving duration (h/week, years). Pearson’s correlations and linear regressions were used. Results: There was a negative moderate correlation between the QASCI (30.3±20.7) and the HPAQ (5.1±1.2) (r=-.517; p=.01). Correlations were also found between PA and some of the QASCI subscales (emotional burden r=-.500; implications for personal life r=-.652; financial burden r=-.471; perception of efficacy and control mechanisms r=.428; p<.01). Two linear regression models were tested to predict the QASCI score involving as predictors: 1) HPAQ (B1=-9.094) (p=.001; r2=.27); 2) HPAQ (B1=-7.401) and caregiving h/week (B2=6.156) (p<.001; r2=.39). Conclusions: Higher PA levels may be related to decreased levels of distress in this population. Further research is needed.

Background: Smartphone apps may be valuable to promote physical activity (PA) behaviours in patients with COPD. However, studies assessing their effectiveness and actual usage have yielded mixed results. Assessing patients’ perspectives may result in more engaging and effective mHealth solutions. Aim: This study aimed to assess the needs and expectations of patients with COPD on the use of smartphone apps for PA promotion. Methods: Two focus groups were conducted with 9 patients (64.3±7.6yrs, 8 male, FEV 59.4±18.1% ). Data were analysed thematically. Results: All patients reported having a smartphone and using it for calls and text messages only (n=3), plus for accessing social networks (n=6), monitoring PA (n=3) and watching videos (n=1). When asked about a smartphone app for PA promotion, all patients were interested in using the app if it proves to able to encourage and guide them towards being more physically active. Needs and expectations regarding the app consisted of: 1) the use of a simple/clear language without foreign expressions, appropriate to their culture/education levels (n=8); 2) receiving detailed progress on PA with personalised goals adjusted to their health condition (n=8); 3) sharing experiences with other patients (n=4) and 4) monitoring physiological data (e.g., heart rate, oxygen saturation; n=2). Patients reported fear of being “abandoned” by health professionals if they used the app (n=4) and of exercising above their limits (n=2). Most patients highlighted the need for support on how to use the app and information about benefits and risks of PA (n=6). Conclusion: Findings from this study provide guidance to future mHealth PA interventions. 1 pred WE USE COOKIES ON THIS SITE TO ENHANCE YOUR USER EXPERIENCE By clicking any link on this page you are giving your consent for us to set cookies. OK, I agree N , giv e more info 1/6/2020 Needs and expectations of smartphone apps features for enhancing physical activity in patients with COPD | European Respiratory S... https://erj.ersjournals.com/content/54/suppl_63/PA1244 2/6  Previous COPD management Physical activity Behavioral science

Low physical activity (PA) is associated with reduced survival in patients with chronic obstructive pulmonary disease (COPD). Pulmonary rehabilitation (PR) is essential in COPD management but its influence on patients’ perspectives about PA has been overlooked. This study assessed PA enablers, barriers, needs and preferences of patients attending or not PR. Two focus groups were conducted. One with 6 patients (70.2±8.8yrs; FEV1 55.5±14.4pp) attending a PR programme and another with 6 patients (65±7.6yrs; FEV1 58.2±21.4pp) naïve to PR. Interviews were analysed thematically. Enablers, barriers and needs were similar in both groups. Enablers/barriers fitted in health-related, psychosocial and environmental sub-themes. Identified enablers included: recognising that PA delays the onset of frailty and promotes wellbeing and functionality, being motivated by their family and health professionals, and the availability of green spaces. Main barriers were dyspnoea/fatigue and cough, exacerbations, comorbidities, fear of feeling breathless, frailty, cold/humid weather, smoke, crowded places and not having a current job. Main needs were health professional guidance and self-management education, including training on how to dose PA. Both groups identified (dog) walking as a preferred activity. Other PA preferences differed between groups: patients naïve to PR preferred activities such as playing with grandchildren, gardening and walking in daily tasks (e.g., shopping), whereas the PR group preferred exercise-related activities such as cycling or treadmill. This study provides guidance for future PA-enhancing interventions in those with/without PR previous experience.