Web-Based Intervention May Help Urban Individuals With COPD


A web-based physical activity self-management intervention for chronic obstructive pulmonary disease (COPD) might be helpful for urban participants across 4 months, but not so much for rural participants.

A web-based physical activity self-management intervention for chronic obstructive pulmonary disease (COPD) was found to be effective for urban, but not rural, participants at 4 months, found a study in The Journal of Rural Health.

Such interventions could lessen or increase rural-urban disparities in patients with COPD unless resources are available to support engagement with technology. COPD is a leading cause of global morbidity and mortality and is the fourth leading cause of death.

This study was conducted because alternative delivery models and programs are needed to address geographical disparities in center-based pulmonary rehabilitation programs and the management of COPD.

“In the last decade, research has supported the efficacy of technology-based physical activity interventions in increasing daily step counts, exercise capacity, and other secondary outcomes (ie, HRQL [health-related quality of life], reduced acute exacerbations) in individuals with COPD,” said the researchers.

They used a secondary exploratory analysis to analyze the rural-urban differences in response to a web-based physical activity self-management intervention for COPD.

The authors continued, “Moreover, rurality is associated with worse COPD outcomes, such as more severe dyspnea, poorer self-rated health, lower HRQL, and increased risk of acute exacerbations.”

First, 239 US Veterans with COPD were randomized to either a multicomponent web-based intervention (goal setting, iterative feedback of daily step counts, motivational and educational information, and an online community forum) or waitlist-control for 4 months with a 12-month follow-up.

Next, general linear modeling estimated the impact of rural/urban status of the veterans using Rural-Urban Commuting Area (RUCA codes) on 4- and 12-month daily step-count change compared with waitlist-control and intervention engagement (weekly log ons and participant feedback).

The mean (SD) age of the rural (n = 108) and urban ( = 131) participants was 66 (5.8) years. Rural/urban status significantly moderated 4-month change in daily step counts between randomization groups (P = .041). Particularly, among urban participants, intervention participants improved by 1500 daily steps more than waitlist-control participants (P = .001), and there was no difference among rural participants.

In the intervention group, rural participants engaged less with the step-count graphs on the website than the urban participants at 4 months (P = .019); this difference deteriorated at 12 months. More recurrent log ons were associated with greater change in daily step counts (P = .004); this association was not moderated by rural/urban status.

“Interestingly, we found no significant differences in objectively documented physical activity between rural and urban participants at baseline,” said the researchers.

Despite this, rural patients who engaged less frequently with the step-count graphs received less exposure to the technology and therefore decreased the likelihood that their behavior will change, which could explain the difference in effectiveness of the intervention.

Significantly more urban participants reported viewing the graph of step counts on the website compared with rural participants at 4 months, even though effectiveness did not persist at 12 months. Urban participants may have been more engaged at the beginning of the intervention.

The researchers cited differences in the walkability of rural and urban environments that might help explain the differences in physical activity between both groups. Differences in the measurement of physical activity might explain some of this variation, and subjective, self-reported measures might under or overestimate physical activity compared with objective, pedometer-based assessments.

There was a significant association between weekly website log ons and effectiveness. Furthermore, technology-based interventions might benefit from concerted efforts to support health literacy like patient education and the simplification of patient information. Additionally, it is important to identify the type of program that would help boost participants’ engagement and adherence, given their unique barriers and circumstances, said the researchers.

Several limitations were present in this study. The researchers were limited in how they could assess intervention engagement or factors like health literacy and the US veteran population in this study was mostly White men with internet access.

“Future work should focus on supporting rural patients’ engagement with technology-based interventions to address rural-urban disparities and optimize physical activity and relevant health outcomes,” the researchers concluded.


Robinson SA, Bamonti P, Richardson CR, Kadri R, Moy ML. Rural disparities impact response to a web-based physical activity self-management intervention in COPD: a secondary analysis. J Rural Health. Published online May 11, 2023. doi:10.1111/jrh.12765

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