We declare no conflicts of interest! University Healthcare Research Centre Experiences of using a mobile phone application to motivate physical activity in persons with COPD: a mixed method study Ann-Britt Zakrisson, district nurse, PhD. University Healthcare Research Centre, Faculty of Health and Medicine, Örebro University, Sweden. ann-britt.zakrisson@regionorebrolan.se Co-writers Terese Anerös, district nurse, MSc, PhD-student, University Healthcare Research Centre, Faculty of Health and Medicine, Örebro University, Sweden. Gabriella Eliason BMA, University lecturer, PhD. School of Medical Sciences, Örebro University, Sweden Anette Forsberg, RPT, ass. professor1. University Healthcare Research Centre, Faculty of Health and Medicine, Örebro University, Sweden. We declare no conflicts of interest!

Background Breathlessness and fatigue decrease physical activity University Healthcare Research Centre Background Breathlessness and fatigue decrease physical activity Social isolation and fear of deterioration (Wortz et al., 2012) Dyspnoea is experienced fearful A feeling of no oxygen when breathing (Bailey 2004) The level of physical activity is reduced already at GOLD stage II (Troosters et al., 2010, Watz et al., 2009) Care includes preventing and handling dyspnea (Marciniuk 2011, Katajisto 2012) Encourage to physical activities (van Gestel 2012) Technical devices to promote health (Joe 2013)

University Healthcare Research Centre Aim To describe the experiences of using a saturation meter with a mobile application with alarm to motivate physical activity, explore if this application increases the level of physical activity and describe persons with COPD experiences of reasons to be physical active.

Methods Mixed methods design (Sandelowski 2000) University Healthcare Research Centre Methods Mixed methods design (Sandelowski 2000) COPD at GOLD stadium II and III (n=10) Intervention: 1 group information – 6 weeks mobile app Data of physical activity – accelerometer Qualitative interview study Analysed with qualitative content analysis

Demographics of the participants at baseline (n=10) University Healthcare Research Centre Results Demographics of the participants at baseline (n=10) n (%) Mean (SD) Min - Max Genus (female) 5 (50)   Smokers Age 67.1 (3.2) 62 - 73 BMI 26,9 (5.1) 16,8 - 34,1 FEV1 51,3 (15.2) 29 - 84 6MWT 461,8 (127.4) 240 - 720 mMRC 1,57 (0.8) 0 - 3 CCQ * Total 1.8 (0.9) Symptom 2.3 (0.8) Function 1.3 (1.1) Mental 1.5 (1.4) *0 points indicate “asymptomatic/ no limitation” to 6 points indicate “extremely symptomatic/totally limited”.

University Healthcare Research Centre Accelerometer data combined with GOLD stadium I-IV and 6-minutes walking-test at base-line and after six weeks (n=7) Patient Id   GOLD ** Stadium I -IV MVPA *a (minutes) Mean MVPA *b Mean phys act *a (counts per minute) Mean phys act *b 6MWT *a *b A5 II 40 *84 244 *401 520 560 A10 III 86 *89 633 599 600 640 A13 8 7 139 141 380 320 A14 21 20 144 157 400 410 A16 26 *56 169 *282 A18 45 25 277 251 420 A20 14 15 148 143 500 * a=one week before intervention, *b=six week after intervention ** Overview of the four GOLD stages: I (mild COPD) > 80%, II (moderate) 50%-80%, III (severe) 30%-50%, IV (very severe) <30%

Technical news - interesting but difficult, University Healthcare Research Centre My use of saturation meter connected to a mobile application with alarm meant, after all, most difficulties with the technical devices Increased security with new knowledge ”Yes, I found that I dared to do a little more. Before that I had been wondering a little what I had in saturation when it felt as heavy. Now I saw that it was not so dangerous. Then I dared to go a little more.” Technical news - interesting but difficult, The mobile application - both user-friendly and dodgy Brought nothing useful. ” I do not understand it. I thought it was pure lucky hit when I found the symbol.”

A feeling of hopelessness got limits of physical activities University Healthcare Research Centre My relation to physical activity is a sense of resignation when I want to do more than I can Reasons for physical activities was a sense of feeling good ”Yes I think I'm feeling good and I will keep me moving and be active in all possible ways. I do not want to be sitting here at home. Then I have to help with that” A feeling of hopelessness got limits of physical activities Support facilitates physical activity The disease led to adjustments in daily life ” I just be out of breath and it was really hard (to be in a nordic walking group). It was no fun when I could not cope as I wanted. I walked anyway, but I was always the last one, it was not fun.”

Conclusion Much technical problems experienced University Healthcare Research Centre Conclusion Much technical problems experienced Walked slower, stayed and rest and avoided activities with others Were very active for only one or two hours per day They experienced that they were very active