View Abstract

A7066 - Depression and Anxiety Are Associated with COPD Patients' Lower Confidence for Increasing Physical Activity but Not with Their Motivation
Author Block: E. L. Estrada1, K. Silva1, E. Medina1, S. Desai1, V. S. Fan2, H. Q. Nguyen3; 1Research and Evaluation, Kaiser Permanente, Pasadena, CA, United States, 2VA Puget Sound Health Care System (S-111-PULM), Seattle VA Med Ctr, Seattle, WA, United States, 3Kaiser Permanente Southern California, Pasadena, CA, United States.
Background: Cognitive and psychological factors are associated with patients’ initiation and maintenance of physical activity. The purpose of this analysis was to examine if depression and anxiety are associated with patients’ beliefs regarding the importance of physical activity and their level of motivation for and confidence in increasing physical activity to manage their COPD. Methods: We used baseline data from an ongoing pragmatic randomized controlled trial of a 12-month physical activity coaching intervention (Walk On!) compared to standard care for 2,707 patients at high risk for recurrent COPD exacerbations from a large integrated health care system. Eligible patients with a COPD-related hospitalization, emergency department visit, or observational stay in the previous 12 months were automatically identified from the electronic medical records (EMR) system and randomized to treatment arms. Only patients randomized to Walk On! (n=1,358) were approached for consent. The intervention includes collaborative monitoring of step counts, semi-automated step goal recommendations, individualized reinforcement, and peer/family support. At the start of the program, patients participate in a baseline intake visit and asked three questions towards the end of the visit, “How (important is it for-, motivated are-, and confident are-) you to increase your physical activity to manage your lung condition?” using a 0 (not at all) -10 (completely) point scale. Depression and anxiety were measured using both EMR diagnostic codes and the Personal Health Questionnaire (PHQ-8) and Generalized Anxiety Disorder (GAD-7) Scale. Results: A total of 321 patients (24%) agreed to enroll in Walk On! and attended the baseline intake visit (mean age: 72±9, 55% female, FEV1% predicted: 59.3±22.1); survey data were missing for 5 patients. Mean ratings of importance, motivation and confidence were uniformly high: 8.7±1.7, 8.1±2.0, and 8.2±1.9, respectively. For depression, 20% of patients had a PHQ-8 score of 10+ and 26% were ever depressed based on diagnostic codes. For anxiety, 16% of patients had a GAD-7 score of 10+ and 25% were ever anxious. Current depression and anxiety had no impact on patients’ beliefs in the importance of, or motivation for, increasing their activity, but both depression and anxiety symptoms were significantly associated with patients’ lower confidence in their ability to increase activity. Conclusions: Patients with high depressive and anxiety symptoms who enroll in a physical activity program have similar positive beliefs about and are motivated to change as those with better emotional well-being. Greater attention should be given to boosting self-confidence for depressed and/or anxious patients.