Findings of the Chronic Obstructive Pulmonary Disease-Sitting and Exacerbations Trial (COPD-SEAT) in reducing sedentary time using wearable and mobile technologies with educational support: Randomized controlled feasibility trial

Background: Targeting sedentary time post exacerbation may be more relevant than targeting structured exercise for individuals with chronic obstructive pulmonary disease. Focusing interventions on sitting less and moving more after an exacerbation may act as a stepping stone to increase uptake to pulmonary rehabilitation. Objective: The aim of this paper was to conduct a randomized trial examining trial feasibility and the acceptability of an education and self-monitoring intervention using wearable technology to reduce sedentary behavior for individuals with chronic obstructive pulmonary disease admitted to hospital for an acute exacerbation. Methods: Participants were recruited and randomized in hospital into 3 groups, with the intervention lasting 2 weeks post discharge. The Education group received verbal and written information about reducing their time in sedentary behavior, sitting face-to-face with a study researcher. The Education+Feedback group received the same education component along with real-time feedback on their sitting time, stand-ups, and steps at home through a waist-worn inclinometer linked to an app. Patients were shown how to use the technology by the same study researcher. The inclinometer also provided vibration prompts to encourage movement at patient-defined intervals of time. Patients and health care professionals involved in chronic obstructive pulmonary disease exacerbation care were interviewed to investigate trial feasibility and acceptability of trial design and methods. Main quantitative outcomes of trial feasibility were eligibility, uptake, and retention, and for acceptability, were behavioral responses to the vibration prompts. Results: In total, 111 patients were approached with 33 patients recruited (11 Control, 10 Education, and 12 Education+Feedback). Retention at 2-week follow-up was 52% (17/33; n=6 for Control, n=3 for Education, and n=8 for Education+Feedback). No study-related adverse events occurred. Collectively, patients responded to 106 out of 325 vibration prompts from the waist-worn inclinometer (32.62%). Within 5 min of the prompt, 41% of responses occurred, with patients standing for a mean 1.4 (SD 0.8) min and walking for 0.4 (SD 0.3) min (21, SD 11, steps). Interviews indicated that being unwell and overwhelmed after an exacerbation was the main reason for not engaging with the intervention. Health care staff considered reducing sedentary behavior potentially attractive for patients but suggested starting the intervention as an inpatient. Conclusions: Although the data support that it was feasible to conduct the trial, modifications are needed to improve participant retention. The intervention was acceptable to most patients and health care professionals

Self-tracking of/and time: from technological to biographical and political temporalities of work and sitting

Self-tracking devices have been observed to accelerate time, be used sporadically and busyness being a barrier to use at work. Drawing on notion of multiple temporalities, this article expands the focus on temporalities of users’ engagement with technologies to analysing them within broader biographical, institutional and political times. The argument is grounded in interviews with UK public sector office workers self-tracking sitting time that featured the following three themes: (1) the participants related their sitting to deteriorated work conditions after government austerity politics and redundancies, (2) the pressurised rhythm of work made it difficult to reduce sitting time and fostered a sense of discontent and powerlessness and (3) the workers did not self-track in their free time, defined as free from monitoring. We suggest that the analytical lens of multiple temporalities expands understanding of user experiences as well as illuminates lived contemporary political and institutional times, characterised by both discontent and powerlessness

Meanings of sitting in the context of chronic disease: Critical reflection on sedentary behaviour, health, choice and enjoyment

Reducing sedentary behaviour or sitting is a new public health focus. Emerging research has, however, found that sedentary activities may be associated with health and mental health benefits for older adults. This article reports findings of the qualitative arm of a feasibility trial to reduce sedentary behaviour among patients with Chronic Obstructive Pulmonary Disease (COPD). From interviews (n=21) conducted prior to the intervention we identified three themes: (i) participants sat to enable them to perform activities, such as housework, (ii) sitting, such as watching TV or fishing, was experienced as enjoyable, and (iii) the most ill participants experienced sitting in terms of sadness, as the only thing they could do. Our observations draw attention to three issues. First, our participants did not always sit out of choice, they had to rest between activities and sat due to breathlessness and mournfulness. Second, the intrinsic value of enjoyment associated with sedentary activities comes into sharp relief in the context of progressive chronic disease, which makes it increasingly difficult to enjoy any activity or life. Third, trials, predicated on trying out a pre-defined solution, are particularly challenging for mixed methods qualitative research seeking to trouble categories, such as choice, health and enjoyment. In conclusion we concur with research that has highlighted that sedentary activities may also have benefits, however, we would make a stronger case for appreciating alternative values, such as enjoyment of life, rather than just health, when appropriate, in research and in practice.