Beenken, M

Abstract Background Anxiety and depression have been reported in patients with fibrotic interstitial lung disease (f-ILD) and may be detected or evaluated with use of patient reported outcome measures (PROMs). The Generalized Anxiety Disorder-7 (GAD-7) is a screening tool for general anxiety, and the Patient Health Questionnaire (PHQ-9) is a screening tool for depression. We hypothesize that anxiety and depression in f-ILD may be independently associated with increased self-reported dyspnea and decreased physical activity. Methods This was a prospective observational cohort study conducted at a tertiary care institution. Patients with f-ILD were electronically sent PROMs to be completed at study enrollment, three months and six months. Patients also wore an activity monitor (ActiGraph) for 7 days at each time point. Included PROMs were the Modified Medical Research Council dyspnea scale (mMRC), GAD-7, and PHQ-9. The primary outcome was physical activity defined by average steps per day at each timepoint. Two sided, two sample t- tests were used to compare mean mMRC scores between participants with and without anxiety and depression. Mixed effects linear regression models with each patient as a random effect were used to evaluate the association between PROMS and physical activity. Models were adjusted for age, sex, FVC, and timepoint. Results Forty-eight patients were enrolled (mean age 69, female 46%, mean forced vital capacity (FVC%) 80%) and 45 completed baseline PROM and activity measures. In our cohort, 22 (46%) had background clinical anxiety and 17 (31%) had depression. In those with anxiety, 59% were classified as moderate and 2% as severe, while 47% were classified as moderate and 1% as severe in those with depression. Higher mMRC dyspnea scores were associated with both anxiety (1.955, p = 0.058) and depression (2.118, p = 0.022). Results from regression models indicated a one-point increase in GAD7, PHQ-9, and mMRC was associated with decrease in physical activity as defined by steps per day) ([GAD: -272 steps, p = 0.022], [PHQ-9: -188 steps, p = 0.014], [mMRC: -741 steps, p = 0.007]). Conclusions Patients with f-ILD and clinical anxiety and depression reported greater dyspnea and decreased measured physical activity. This abstract is funded by: None

Abstract Importance Conventional Pulmonary Rehabilitation (PR) after a hospital admission for a COPD exacerbation reduces remission and improves quality of life and survival, but only 2% of hospitalized patients complete PR. New feasible and effective strategies for increasing adherence to rehabilitation in the post hospitalization period are needed. Objective Determine the effect of patient’s choice on adherence to rehabilitation and outcomes. Design, Setting, and Participants: Individuals discharged after a COPD-related hospitalization were randomized to home rehabilitation with health coaching (HRwHC) or the choicethe choice of conventional PR or HRwHC. Intervention The HRwHC program was asynchronous and included weekly health coaching calls for 12 weeks and remote monitoring of lifestyle activities including daily exercises, and steps measured by an activity tracker, the compliance with 24-minute daily exercise routine and a daily wellbeing assessment. Participants in the choice arm that elected for conventional PR were facilitated by the study team to attend the nearest PR center. Main Outcomes and Measures The primary outcomes were adherence and effect on health-related quality of life measured by the Chronic Respiratory Questionnaire. Secondarily Physical activity was measured with Actigraph®GX3T a validated triaxial accelerometry. Results Among 1905 potential participants identified, 296 were randomized (uptake 14%). Reasons for declining include No interest in research 556 (29%), Already in PR or in other monitoring or research program 125 (6.5%), too much going/still recovering 650 (34%), Felt not needed (content with care) 208 (11%), Hospice 12 (0.6%), Technology barrier 64 (3%). Arm baseline measures were not different between arms. Among participants in the choice group, 1 of 148 (0.6%) elected HRwHC instead of PR. Because all patients received the same intervention (except one), outcomes at 3 months showed no difference, result are presented as one group before -after analysis. Among 295 patients that chose or were randomized to HRwHC, adherence (completion) was 59%. CRQ physical and Emotional Summary as well as all individuals’ domains improved significantly and beyond the MCID at 3 months Table 1A. CRQ improvement was maintained at 6- and 12-months Table 1B-C. Linear mixed models for repeated measures confirmed the significant sustained improvement over one year after adjusting to age, FEV1%, Charlson comorbidity index (p < 0.001 for all three time point 3-6-12 months). Conclusions and Relevance Home rehabilitation may represent the preferred choice after a COPD-related hospital admission. HRwHC sustainably improved quality of life over one year making a feasible and effective rehabilitation option and opportunity for primary palliative care. This abstract is funded by: NIH

Abstract Background Daily physical activity (PA) is the strongest predictor of survival and is associated with the risk of hospitalization, poor quality of life 1-3 in people living with Chronic Obstructive Pulmonary Disease COPD.2 However, symptoms of breathlessness, functional limitations, and poor exercise tolerance may make it difficult to meet the conventional physical activity guidelines of 150 minutes of moderate intensity. There is a knowledge gap in the granular amount and intensity of daily PA that may provide a survival benefit for people living with COPD: specifically in light PA (1.5-3METs) and moderate (3-6 METs) PA, which are the intensities most achievable in moderate-severe disease. We aimed to determine whether different intensities of daily physical activity, accurately measured by a gold-standard activity monitor, were associated with a survival benefit in a large cohort of people living with moderate to severe COPD followed for six years. Methods Participants wore the Actigraph® GT3X-BT, a tri-axial wrist accelerometer, for 7 days. Survival at 72 months was assessed through the National Death Index Inquiry by Accurint® and confirmed by records. Analysis Participants in this cohort were randomly assigned to a training data set (70%) and 30% to a validation set. Classification and regression tree (CART) models were generated using the training data set. Bootstrapping with 3,000 iterations was conducted. 872 patients were part of this study: mean age 69+ 8, 54% female, mMRC score, (scale 0-4) was 2.6 + 0.8 and FEV1% was 46% +19. The mean follow-up was 42+ 21 months with a range of 1-72 months. At the end of the follow up 67.3% were alive, 32.7% were deceased. The bootstrapped CART analysis modeled cut points associated with survival as follows: 296 minutes for light PA, 17 minutes for moderate PA; and 3243 steps after adjusting for age, sex, FEV1% and mMRC score. Consistent with the 17 minutes of moderate PA providing 58% survival benefits, we also found that two 10-minute Freedson bouts of activity per day (2x10 min of PA in moderate intensity) the same provided the same survival benefit1. Cox models are presented in Table 1 Conclusion This report is the first to document the survival benefit of light physical activity in patients with COPD. In the context of most patients with moderate-severe COPD not able to achieve PA guidelines, our results represent a breath of fresh air, suggesting that simple and meaningful (to the patient) light activities may provide a survival benefit. This abstract is funded by: NIH