Pain in Veterans with COPD: relationship with physical activity and exercise capacity

Rebecca A Raphaely,Stephanie A Robinson,Rebekah L Goldstein,Maria A Mongiardo,Marilyn L Moy,Emily S Wan

doi:10.1186/s12890-021-01601-8

Abstract

BackgroundPain is a common but underappreciated symptom experienced by people with Chronic Obstructive Pulmonary Disease (COPD). The relationships between pain and physical activity (PA) and exercise capacity are poorly understood.MethodsThis retrospective secondary analysis includes three cohorts of Veterans with COPD who participated in longitudinal studies evaluating PA and exercise capacity with objective measures of daily step counts and 6-min walk test (6MWT) distance, respectively. Pain was assessed using the bodily pain domain of the Veterans RAND-36. In two cohorts, participants were randomly assigned to a web-based, pedometer-mediated PA intervention which has previously been demonstrated to improve PA.ResultsThree-hundred and seventy-three (373) unique study participants were included in this analysis. Eighty-three percent (n = 311) of the population reported at least mild pain and/or at least a little bit of interference due to pain at baseline. Cross-sectionally, greater bodily pain was associated with lower 6MWT distance (β = 0.51; 95% CI 0.20, 0.82; p = 0.0013). Longitudinally, worsening bodily pain was associated with a decline in 6MWT distance (β = 0.30; 95% CI 0.03, 0.58; p = 0.0312). There was no association between baseline bodily pain and baseline daily step counts, baseline bodily pain and change in PA, or change in bodily pain and change in PA. Compared to usual care, our PA intervention improved bodily pain scores (β = 6.17; 95% CI 1.84, 10.45; p = 0.0054). Bodily pain scores did not affect the impact of the intervention on daily step counts.ConclusionPain is highly prevalent and significantly associated with lower exercise capacity among Veterans with COPD. Worsening pain co-occurred with decline in exercise capacity but not PA. Our intervention reduced pain, although pain did not affect the impact of the intervention on PA.

Highlights

Despite optimal medical management, people with Chronic Obstructive Pulmonary Disease (COPD) experience a substantial physical and psychological symptom burden [1,2,3]
Prevalence of pain For the combined cohort of Veterans interested in engaging in physical activity (PA), 98% of participants were male with an average age of 70 ± 8 years, percent predicted FEV1 of 59 ± 21, and body mass index (BMI) of 29 ± 6 kg/m2
Cross‐sectional relationships between pain, 6-min walk test (6MWT) distance, and daily step counts At baseline, higher bodily pain scores were positively associated with higher 6MWT distance

Summary

Introduction

People with Chronic Obstructive Pulmonary Disease (COPD) experience a substantial physical and psychological symptom burden [1,2,3]. Epidemiological studies suggest that people with COPD have higher rates of chronic opiate and non-opiate pain medication prescription compared to age and gender match controls, supporting the assertion that pain is more prevalent in this population [12, 13]. Promotion of exercise and physical activity (PA) is the standard of care in persons with COPD [14,15,16]. Understanding the prevalence of pain in this population and studying how technology-based PA interventions impact pain are critical to effectively implement the GOLD recommendation to promote PA in all persons with stable COPD [14]. Pain is a common but underappreciated symptom experienced by people with Chronic Obstructive Pulmonary Disease (COPD). The relationships between pain and physical activity (PA) and exercise capacity are poorly understood

Methods

Results

Discussion

Conclusion