Health and Technology

, Volume 6, Issue 4, pp 259–268 | Cite as

Adherence to an online exercise program for COPD patients in the home environment- a pilot study

  • M. G. H. Dekker-van Weering
  • M. M. R. Vollenbroek-Hutten
  • H. J. Hermens
Original Paper


The objective of this study was to determine the adherence to an online exercise program for patients with moderate to very severe COPD in their home environment. The intervention consisted of three modules: module 1 online exercising; module 2 telemonitoring and module 3 telecommunication. Patients were instructed to use the service for 12 weeks after the normal rehabilitation period ended (aftercare). The study had a single-center exploratory study design. Adherence to module 1 was assessed by adherence to exercise sessions and log in time (duration in minutes) and frequency of training (amount of time a week) was measured for each patient. In addition, adherence to the exercises was measured as the percentage of performed exercises versus prescribed exercises. The adherence to module 2 was measured by logging the day and time the diary has been filled in. The adherence to module 3 was measured by logging the types of telecommunication options used. Satisfaction with the service was measured with a questionnaire, a number from 0 to 10 and whether patients would recommend the service to others. Twenty patients used the online exercise module. The adherence to the three weekly exercise protocol was 61 %. Patients logged in on average 20.3 min (±15) for 3.6 times a week (±2.3). The mean adherence to these exercises was 58 %. The adherence to the monitoring module was 82 %. Seventeen patients (77 %) used module 3 and send on average 9 messages (± 9.8) during the 12 weeks. Patient satisfaction with the service was high. The adherence to the home-based telemedicine service for patients with moderate to very severe COPD was similar to hospital-based maintenance exercise interventions. However, strategies to improve exercise adherence should be investigated.


Adherence Exercise Telemedicine Compliance Ehealth 



This study was funded by Het Innovatie programma of Revalidatie Nederland. The authors would like to thank Merem, Behandelcentra in the Netherlands for their support and inclusion of their patients for the study.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.


  1. 1.
    Lopez AD, Shibuya K, Rao C, Mathers CD, Hansell AL, Held LS, et al. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J. 2006;27:397–412.CrossRefGoogle Scholar
  2. 2.
    Berry MJ, Walschlager SA. Exercise training and chronic obstructive pulmonary disease: past and future research directions. J Cardpulm Rehabil. 1998;18:181–91 .ReviewCrossRefGoogle Scholar
  3. 3.
    Casaburi R. Exercise for pulmonary rehabilitation. Contemp Intern Med. 1994;6:36–8 .44–6. No abstract availableGoogle Scholar
  4. 4.
    Lacasse Y, Goldstein R, Lasserson TJ, Martin S. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2006;(4):CD003793. doi: 10.1002/14651858.CD003793.pub2.
  5. 5.
    Beauchamp MK, Francella S, Romano JM, Goldstein RS, Brooks D. A novel approach to long-term respiratory care: results of a community-based post-rehabilitation maintenance program in COPD. Respir Med. 2013;107(8):1210–6.CrossRefGoogle Scholar
  6. 6.
    Holland A, Mahal A, Hill C, Lee A, Burge A, Moore R, Nicolson C, O’Halloran P, Cox N, Lahham A, Ndongo R, Bell E, McDonald C. Benefits and costs of home-based pulmonary rehabilitation in chronic obstructive pulmonary disease - a multi-centre randomised controlled equivalence trial. BMC Pulm Med. 2013;13:57.CrossRefGoogle Scholar
  7. 7.
    Donesky-Cuenco D, Janson S, Neuhaus J, Neilands TB, Carrieri-Kohlman V. Adherence to a home-walking prescription in patients with chronic obstructive pulmonary disease. Heart Lung. 2007;36:348–63.CrossRefGoogle Scholar
  8. 8.
    Heppner PS, Morgan C, Kaplan RM, Ries AL. Regular walking and long-term maintenance of outcomes after pulmonary rehabilitation. J Cardpulm Rehabil. 2006;26:44–53.CrossRefGoogle Scholar
  9. 9.
    Emery CF, Shermer RL, Hauck ER, Hsiao ET, MacIntyre NR. Cognitive and psychological outcomes of exercise in a 1-year follow-up study of patients with chronic obstructive pulmonary disease. Health Psychol. 2003;22:598–604.CrossRefGoogle Scholar
  10. 10.
    Liu W, Wang C, Lin H, Lin S, Lee K, Lo Y, Hung S, Chang Y, Chung K, Kuo H. Efficacy of a cell phone-based exercise programme for COPD. Eur Respir J. 2008;32:651–9.CrossRefGoogle Scholar
  11. 11.
    Tabak M, Op den Akker H, Hermens H. Motivational cues as real-time feedback for changing daily activity behavior of patients with COPD. Patient Educ Couns. 2013;94:372–8.CrossRefGoogle Scholar
  12. 12.
    Lange B, Flynn SM, Rizzo AA. Game-based telerehabilitation. Eur J Phys Rehabil Med. 2009;45:143–51.Google Scholar
  13. 13.
    Baranowski T, Buday R, Thompson DI, Baranowski J. Playing for real: video games and stories for health-related behavior change. Am J Prev Med. 2008;34:74–82.CrossRefGoogle Scholar
  14. 14.
    van Het Reve E, Silveira P, Daniel F, Casati F, de Bruin ED. Tablet-based strength-balance training to motivate and improve adherence to exercise in independently living older people: part 2 of a phase II preclinical exploratory trial. J Med Internet Res. 2014;16(6):e159.Google Scholar
  15. 15.
    Wanko NS, Brazier CW, Young-Rogers D, Dunbar VG, Boyd B, George CD, Rhee MK, IM e-K, CB C. Exercise preferences and barriers in urban African Americans with type 2 diabetes. Diabetes Educ. 2004;30:502–13.CrossRefGoogle Scholar
  16. 16.
    Guo S-E, Bruce A. Improving understanding of and adherence to pulmonary rehabilitation in patients with COPD: a qualitative inquiry of patient and health professional perspectives. PLoS One. 2014;9:e110835.Google Scholar
  17. 17.
    Kessler R, Partridge MR, Miravitlles M, Cazzola M, Vogelmeierf C, Leynaud D, Ostinelli J. Symptom variability in patients with severe COPD: a pan-European cross-sectional study. Eur Respir J. 2011;37:264–72.CrossRefGoogle Scholar
  18. 18.
    Partridge MR, Karlsson N, Small IR. Patient insight into the impact of chronic obstructive pulmonary disease in the morning: an internet survey. Curr Med Res Opin. 2009;25:2043–8.CrossRefGoogle Scholar
  19. 19.
    Cockram J, Cecins N, Jenkins S. Maintaining exercise capacity and quality of life following pulmonary rehabilitation. Respirology. 2006;11:98–104.CrossRefGoogle Scholar
  20. 20.
    Cote CG, Celli BR. Pulmonary rehabilitation and the BODE index in COPD. Eur Respir J. 2005;26:630–6.CrossRefGoogle Scholar
  21. 21.
    Garrod R, Marshall J, Barley E, Jones PW. Predictors of success and failure in pulmonary rehabilitation. Eur Respir J. 2006;27:788–94.CrossRefGoogle Scholar
  22. 22.
    Hellem E, Bruusgaard K, Bergland A. Exercise maintenance: COPD patients’ perception and perspectives on elements of success in sustaining long-term exercise. Physiother Theory Pract. 2012;28:206–20.CrossRefGoogle Scholar
  23. 23.
    Keating A, Lee A, Holland AE. What prevents people with chronic obstructive pulmonary disease from attending pulmonary rehabilitation? A systematic review. Chron Respir Dis. 2011;8:89–99.Google Scholar
  24. 24.
    Almadana V, Romero C, Valido A, Gómez-Bastero A, Sánchez J, Montemayor T. Profile of patients who drop out of a pulmonary rehabilitation program. Chest. 2014;145:370A.CrossRefGoogle Scholar
  25. 25.
    Bourbeau J, Bartlett SJ. Patient adherence in COPD. Thorax. 2008;63:831–8.CrossRefGoogle Scholar

Copyright information

© IUPESM and Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • M. G. H. Dekker-van Weering
    • 1
  • M. M. R. Vollenbroek-Hutten
    • 2
  • H. J. Hermens
    • 1
    • 2
  1. 1.Roessingh Research and Development, Telemedicine GroupEnschedethe Netherlands
  2. 2.Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine GroupUniversity of TwenteEnschedethe Netherlands

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