Activity In Chronic Obstructive Pulmonary Disease Patients Research Articles

Motivation and confidence about physical activity in COPD patients: health benefits matter to patients.

Physical activity (PA) has shown great benefits in patients with chronic obstructive pulmonary disease (COPD), however, their PA is below average. Motivational factors associated with PA in COPD have not been widely studied and could be a target for improving adherence to PA. The objective of our study was to identify and understand the different motivational and confidence factors related to low levels of PA in a COPD cohort. Observational, prospective, multicentre study of COPD patients. Sociodemographic data, respiratory symptoms, comorbidities, spirometry and exercise capacity were collected. PA was measured using the Dynaport accelerometer and patient motivation and confidence in PA were assessed by a questionnaire previously used in a COPD population in the United States. Eighty-six COPD patients were included, 68.6% being male, with a mean (SD) age of 66.6 (8.5) years and a mean forced expiratory volume in the first second (%) of 50.9% (17.3%). The mean walking time was 82.8 (37.8) minutes/day. Questions related to health benefits and enjoying exercise were ranked highest in the motivation questionnaire and statistically significant differences were found in PA measures between patients with low and high motivation. A lack of confidence regarding hot weather and health-related issues significantly influenced PA levels. Advice from third parties, including healthcare providers, was not associated with higher PA levels. Improving the health of COPD patients is their main motivation to perform PA. Lack of confidence when it is hot or when they fear for their health is related to low levels of PA. Advice from third parties, including healthcare professionals, is not associated with higher PA. These results are relevant for developing strategies to increase the adherence of COPD patients to PA programmes.

The impact of wearing facemask on COPD patients: A protocol of a systematic review and meta-analysis.

Chronic obstructive pulmonary disease (COPD) is a common, irreversible but preventable disease characterized by persistent respiratory symptoms. The mortality rate of COPD is predicted to reach 5.4 million by the year 2060. Despite its heavy burden on healthcare expenditure worldwide, only 15% of cases are medically identified. The potential benefits of facemask-wearing for COPD patients remain a topic of debate. We will conduct a systematic review of all randomized trials and non-randomized controlled trials to evaluate the impact of facemasks on COPD patients. Our review will be based on literature obtained through a comprehensive search strategy across multiple electronic databases, including the Cochrane Library, Embase, PubMed, Web of Science, the Chinese Biomedical Database (SinoMed), and China National Knowledge Infrastructure (CNKI), with no restrictions on language or date of publication. Two independent researchers will extract and assess all relevant data using pre-designed data extraction forms. The included studies will be assessed using the Cochrane RoB2 tool and the suggested risk of bias criteria proposed by the Effective Practice and Organization of Care reviews group of the Cochrane collaboration. The quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We will use Review Manager 5.4 software for statistical analysis. In the context of COVID-19, it is important for COPD patients to wear facemasks. This study aims to conduct a comprehensive and systematic assessment of the impact of facemasks on the physiology and activity of COPD patients. PROSPERO registration number CRD42022326265.

Exercise capacity and physical activity in COPD patients treated with a LAMA/LABA combination: a systematic review and meta-analysis

BackgroundPersistent airflow limitation and dyspnoea may reduce chronic obstructive pulmonary disease (COPD) patients exercise capacity and physical activity, undermining their physical status and quality of life. Long-acting muscarinic antagonists and long-acting beta-2 agonists (LAMA/LABA) combinations are amongst moderate-to-severe COPD recommended treatments. This article analyses LAMA/LABA combinations effect on COPD patients exercise capacity and physical activity outcomes.MethodsA systematic review and meta-analysis of double-blind randomized controlled trials comparing LAMA/LABA combinations against monotherapy or placebo was conducted.ResultsSeventeen articles were identified (N = 4041 patients). In endurance shuttle walk test and constant work rate cycle ergometry, LAMA/LABA combinations obtained better results than placebo, but not monotherapy, whereas in 6-min walking test, results favoured LAMA/LABA over monotherapy (four studies), but not over placebo (one study). Moreover, LAMA/LABA combinations obtained better results than placebo in number of steps per day, reduction in percentage of inactive patients and daily activity-related energy expenditure, and better than monotherapy when measuring time spent on ≥ 1.0–1.5, ≥ 2.0 and ≥ 3.0 metabolic equivalents of task activities.ConclusionsLAMA/LABA combinations in COPD patients provided better results than monotherapy or placebo in most exercise capacity and physical activity outcomes.

The Peculiarities of Six-Minute Walk Test in Patients with Chronic Obstructive Pulmonary Disease, Some with Normal Weight and Some Overweight

Background: The combination of chronic obstructive pulmonary disease (COPD) and overweight/obesity is a common clinical situation in modern healthcare. The objective of this study was to conduct a comparative analysis of exercise tolerance in normal body weight (NBW) and overweight patients with COPD in the 6MWT using the original device for cardiorespiratory analysis and a method for assessing the cardiorespiratory condition. Methods and Results: The study included 194 patients with COPD. The patients were divided into two groups. Group 1 consisted of 96 COPD patients with NBW: 77(80.21%) men and 19(19.79%) women aged 41 to 73 years (mean age of 63.33 ± 8.44 years). Group 2 consisted of 98 overweight COPD patients: 74(75.51%) men and 24(24.49%) women aged 55 to 71 (mean age of 64.84 ± 5.46 years). To assess tolerance to physical activity and to objectify the functional status of patients, the 6MWT was used and carried out according to generally accepted principles. The distance covered in 6 minutes (6MWD) was measured in meters and compared with the proper 6MWD(i). The developed device for cardiorespiratory analysis was used to obtain the most accurate 6MWT result. All patients in the study groups underwent an analysis of the composition of the body by the bioelectrical impedance method using a fat mass analyzer BC-555 (Tanita Corporation, Tokyo, Japan). The percentages of fat, water, muscle mass (MM), and bone mass were evaluated. The average value of the 6MWD/6MWD(i) ratio in COPD patients with NBW was significantly lower than in COPD patients with overweight (P=0.0121). Before the test, the study groups did not differ in the level of SpO2. However, according to the results of comparative analysis, this parameter was significantly lower in patients with NBW immediately after the 6MWT (P=0.0000), which, along with a lower value of the distance traveled as a percentage of the proper value in Group 1 patients, may indicate a lower tolerance to physical activity in COPD patients with NBW than in patients with overweight. In COPD patients with NBW, the percentage of fat and MM were significantly lower than in COPD patients with overweight (P=0.0000 in both cases). There was a direct correlation between 6MWD and body mass index (r=0.56, P=0.003) and between 6MWD and MM percentage (r=0.59, P=0.016). Conclusion: Higher exercise tolerance is found in overweight COPD patients than in COPD patients with NBW. This phenomenon can be explained to some extent by the compositional components of the body, in particular, by a significantly lower percentage of lean MM in patients with NBW.

Pro-thrombotic changes associated with exposure to ambient ultrafine particles in patients with chronic obstructive pulmonary disease: roles of lipid peroxidation and systemic inflammation

BackgroundExposure to particulate matter air pollution is associated with an increased risk of cardiovascular mortality in patients with chronic obstructive pulmonary disease (COPD), but the underlying mechanisms are not yet understood. Enhanced platelet and pro-thrombotic activity in COPD patients may explain their increased cardiovascular risk. We aim to explore whether short-term exposure to ambient particulate matter is associated with pro-thrombotic changes in adults with and without COPD, and investigate the underlying biological mechanisms in a longitudinal panel study. Serum concentration of thromboxane (Tx)B2 was measured to reflect platelet and pro-thrombotic activity. Lipoxygenase-mediated lipid peroxidation products (hydroxyeicosatetraenoic acids [HETEs]) and inflammatory biomarkers (interleukins [ILs], monocyte chemoattractant protein-1 [MCP-1], tumour necrosis factor alpha [TNF-α], and macrophage inflammatory proteins [MIPs]) were measured as potential mediating determinants of particle-associated pro-thrombotic changes.Results53 COPD and 82 non-COPD individuals were followed-up on a maximum of four visits conducted from August 2016 to September 2017 in Beijing, China. Compared to non-COPD individuals, the association between exposure to ambient ultrafine particles (UFPs) during the 3–8 days preceding clinical visits and the TxB2 serum concentration was significantly stronger in COPD patients. For example, a 103/cm3 increase in the 6-day average UFP level was associated with a 25.4% increase in the TxB2 level in the COPD group but only an 11.2% increase in the non-COPD group. The association in the COPD group remained robust after adjustment for the levels of fine particulate matter and gaseous pollutants. Compared to the non-COPD group, the COPD group also showed greater increases in the serum concentrations of 12-HETE (16.6% vs. 6.5%) and 15-HETE (9.3% vs. 4.5%) per 103/cm3 increase in the 6-day UFP average. The two lipid peroxidation products mediated 35% and 33% of the UFP-associated increase in the TxB2 level of COPD patients. UFP exposure was also associated with the increased levels of IL-8, MCP-1, MIP-1α, MIP-1β, TNF-α, and IL-1β in COPD patients, but these inflammatory biomarkers did not mediate the TxB2 increase.ConclusionsShort-term exposure to ambient UFPs was associated with a greater pro-thrombotic change among patients with COPD, at least partially driven by lipoxygenase-mediated pathways following exposure.Trial registrationChiCTR1900023692. Date of registration June 7, 2019, i.e. retrospectively registered.

Impact of non-exercise activity thermogenesis on physical activity in patients with COPD.

Physical inactivity is associated with comorbidities and mortality in chronic obstructive pulmonary disease (COPD) patients. Although non-exercise activity thermogenesis (NEAT) is important for evaluating the physical activity level (PAL) of patients with chronic diseases, it has not yet been assessed in COPD patients. This study included male patients with COPD (n = 28) and high risk for COPD (n = 8). Total energy expenditure (TEE) and basal metabolic rate (BMR) were measured using the doubly labeled water (DLW) method and indirect calorimetry, respectively. PAL was calculated as TEE/BMR, while the NEAT was obtained from a questionnaire. Physical activity was also assessed using an accelerometer. The total NEAT score was correlated with PAL (r = 0.534, P < 0.001), while PAL was correlated more strongly with the non-locomotive NEAT score (r = 0.548, P < 0.001) than the locomotive NEAT score (r = 0.278, P = 0.10). Regarding accelerometer-obtained data, this questionnaire mainly reflected steps/day and the duration of light locomotive and non-locomotive daily activities. The NEAT score is a possible option for evaluating PAL in daily clinical practice. The present results indicated that non-locomotive activity may have a greater impact on PAL than locomotive activity in COPD patients.

Factors associated with physical activity among COPD patients with mild or moderate airflow obstruction.

Physical inactivity is already present among patients with chronic obstructive pulmonary disease (COPD) of mild or moderate airflow obstruction. Most previous studies that reported on determinants of physical activity in COPD included patients with severe COPD. Therefore, the aim of this study was to explore which patient characteristics were related with physical activity in COPD patients with mild or moderate airflow obstruction. Cross-sectional analyses were performed on patients selected from the population-based Netherlands Epidemiology of Obesity study. Patients were included if they had a physician-diagnosed COPD GOLD 0-2 or had newly diagnosed COPD GOLD 1-2. Physical activity was evaluated using the Short Questionnaire to Assess Health-Enhancing Physical Activity (SQUASH) questionnaire and reported in hours per week of metabolic equivalents (MET-h/week). Associations between sociodemographic, lifestyle, clinical and functional characteristics were examined using regression analysis. 323 patients were included in research (77 with physician-diagnosed and 246 with newly diagnosed COPD). We found that physical activity was positively associated with pulmonary function: FEV1 (regression coefficient 0.40 (95% CI 0.09,0.71)) and FVC (regression coefficient 0.34 (95% CI 0.06,0.61)). Physical activity was associated with anxiety (regression coefficient =0.9 (95% CI 0.3,1.6)) only for physician-diagnosed patients.Lung function and anxiety level determine level of physical activity among COPD patients with mild or moderate airflow obstruction. Thus, integrating it into the physical activity plans could help to increase physical activity level of the patients.

Impact of cathepsin D activity and C224T polymorphism (rs17571) on chronic obstructive pulmonary disease: correlations with oxidative and inflammatory markers.

Cathepsin D (CTSD) is an aspartyl proteinase that plays an important role in protein degradation, antigen processing and apoptosis. It has been associated with several pathologies such as cancer, Alzheimer's disease and inflammatory disorders. Its function in lung diseases remains, however, controversial. In the current study, we determined CTSD activity in serum of patients with chronic obstructive pulmonary disease (COPD) and evaluated the correlations between this proteinase and inflammatory and oxidative parameters. We also investigated the impact of a CTSD C224T polymorphism on enzyme activity and clinicopathological parameters. Our population included 211 healthy controls and 138 patients with COPD. CTSD activity, MMPs (-1/-7/-12), cytokines (IL-6, TNF-α), malondialdehyde (MDA), nitric oxide and peroxynitrite levels were measured in patients and controls using standard methods. Genotyping of CTSD C224T polymorphism was determined using PCR-RFLP. Our results showed an increased CTSD activity in COPD patients compared to healthy controls (4.87 [3.99-6.07] vs. 3.94 [2.91-5.84], respectively, p < 0.001). COPD smokers presented also a higher CTSD activity when compared to nonsmokers (4.91[3.98-6.18] vs. 4.65[4.16-5.82], respectively, p = 0.01), while no differences were found when subjects were compared according to their GOLD stages. The activity of this proteinase was not dependent on the C224T polymorphism because we did not found any influence of this SNP on proteinase activity among patients and controls. Furthermore, our data provide the first evidence of the interrelationships between CTSD activity and both MMPs and TNF-α levels (MMP-1[r = -0.4; p = 0.02], MMP-7[r = 0.37; p = 0.04], MMP-12[r = 0.43; p = 0.02], TNF-α [r = 0.89, p = 0.001]) in COPD smokers. There were no correlations, however, between CTSD activity and oxidative stress parameters in controls and patients. Our findings suggest that CTSD could be a relevant marker for COPD disease. Alteration of CTSD activity may be related to increased MMPs and TNF-α levels, particularly in COPD smokers.

Data Reproducibility and Effectiveness of Bronchodilators for Improving Physical Activity in COPD Patients.

Increasing physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD) is an important issue, however, the effect of bronchodilators on PA is still controversial. The indicators of PA, as measured by an accelerometer, can easily fluctuate based on several factors, which might cause inconsistent results. In this review, we listed the indicators of PA and the factors influencing the reproducibility of indicators of PA, and reviewed reports in which the effects of bronchodilators on PA were evaluated by an accelerometer. Then, we investigated the association between the processing of influencing factors and the effectiveness of bronchodilators for improving the PA of COPD patients. Fifteen reports were extracted using the PubMed database. In all seven reports in which adjustment was performed for at least two of four influencing factors (non-wear time, data from days with special behavior, environmental factors, and number of valid days required to obtain reproducible data), bronchodilators showed beneficial effects on PA. No adjustment was made for any of these factors in any of the four bronchodilator-ineffective reports. This suggests that the processing of influencing factors to secure reproducibility might affect the results regarding the effectiveness of bronchodilators for improving PA in COPD patients.

The study on effect of home based pulmonary rehabilitation in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease(COPD) is a leadingcauseof mortality and morbidity globally (3 million deaths in 2012). COPD is common in older population and kills on average one person every 10 seconds. In 2002, COPD was the fifth leading cause of death. Total deaths from COPD are proposed to grow through more than 30% in the next 10 years. Estimations indicate that COPD in 2030 turns into the 0.33 main reason for the loss of life worldwide. The WHO estimate quotes a figure of almost 5,56,000 deaths attributable to COPD in the SoutheastAsian region, which majorly comprises India. The challenge in both treatment and prevention of COPD remains the same. Despite major improvement in health care particularly in the treatment of COPD, the mortality due to COPD tends to be high and is expected to increase in the future according to . Use intolerance is an individual and a disturbing appearance of the disease. Lack of physical activity in COPD patients contributes a major complication to the disease. Oral or inhaled medicine have incomplete role in cultivating the physical capacity of these patients. So the main aim of treatment is control of symptoms, decreasing exacerbation frequency and hospitalization rates, maximizing lung function, refining the quality of life and implementation capacity by means of pulmonary reintegration. Extensive search of literature has not revealed larger data on effect of pulmonary rehabilitation in management of COPD pertaining to South Indian population. Hence, the present study was undertaken to assess the effect of home based rehabilitation program in South Indian population.

Comparison of Physiotherapeutic Intervention Programs on Handgrip Force and Myoelectric Activity in Individuals with COPD

Background: Chronic obstructive pulmonary disease (COPD) modifies the electrical activity of accessory respiratory muscles, also leading to a marked peripheral muscular dysfunction, measured by the handgrip strength taken as an indicator of total body strength. Objective: To compare the effects of two different physiotherapeutic programs on handgrip strength and myoelectric activity in COPD patients. Methods: Participated in the study 17 individuals, randomly allocated into 2 groups: 1) Maneuvers: 62.7±15.4 years, 1.65±0.12 m, 81.4±18.2 kg, BMI: 29.9±5.0 kg/m2 ; 2) Threshold: 64.4±11.2 years, 1.58±0.08 m, 70.7±9.4 kg, BMI: 28.6±3.7 kg/m2 , diagnosed with COPD, submitted to surface electromyographic (sEMG) evaluation of sternocleidomatoid (SCM) and anterior scalene (AS), and handgrip strength, before and after the interventions. The data were analyzed with SPSS (20.0). Pared t-student and Wilcoxon tests were used to compare mean values of the handgrip strength and the Root Mean Square (RMS) of the sEMG signal (SCM and AS muscles), pre- and post-interventions. In addition, independent t-Student and Mann-Whitney tests were used to compare the RMS average of the sEMG signal between the right and left sides. Significant level was set at 5%. Results: When comparing pre and post-intervention values, there was a significant increase for the Threshold group handgrip strength (P=0.037). It was observed a sEMG activity of SCM and AS during dynamometry, vital capacity, forced vital capacity on inspiratory and expiratory pressure (P&lt;0.05) for both analyzed groups. In the comparison of the myoelectric activity between the right and left sides for the SCM and AS, there was a significant difference in handgrip strength (P=0.009) and forced vital capacity (P=0.001) of the SCM muscle, post intervention for the Threshold group. Conclusion: The proposed physiotherapeutic programs improved the overall muscle strength for the Threshold group and the electromyographic activity of SCM and AS in the 2 groups.This study was registered in ReBEC: RBR-4VGP58

Sleep disturbance and next-day physical activity in COPD patients

Physical inactivity and sleep disturbance are more problematic in patients with chronic obstructive pulmonary disease (COPD) than in healthy individuals. The purpose of the study was to identify impacts of nighttime sleep on next-day physical activity in COPD patients. The study included 52 COPD patients reporting disturbed sleep. Sleep and physical activity were measured using an accelerometer for 5 days. Increased sleep latency was associated with less next-day physical activity during the afternoon (4–6 p.m.). Greater waking duration/times were associated with less next-morning (6–8 a.m.) physical activity. Greater total sleep time was associated with less next-morning (12–9 a.m.) physical activity, and greater sleep efficiency was associated with less next-morning (1–3 a.m.) and more next-evening (6–7 p.m.) physical activity. Results suggest that sleep disturbance had varying influences on next-day hourly physical activity. These results support the potential value of sleep management in promoting physical activity in COPD patients.

Prevención no farmacológica de las exacerbaciones en la EPOC: efecto antiinflamatorio de la actividad física

The chronic obstructive pulmonary disease (COPD) is the chronic respiratory condition most prevalent in adults, caused mainly by smoking. Its burden is progressively increasing and, according to the World Health Organization, is one of the main causes of mortality and disability around the world. Patients with COPD present acute worsening of the disease, defined as acute exacerbations, which are the main cause of hospitalizations and deaths. Therefore, it is crucial to identify effective interventions focused in their prevention. Patients with COPD present dyspnoea and intolerance to exercise responsible for a progressive reduction in the level of physical activity, which is an independent risk factor for future exacerbations and mortality. On the other hand, it has been demonstrated that COPD patients with low level of physical activity present higher marker levels of systemic inflammation. Interventions able to increase the level of physical activity in COPD patients have demonstrated positive effects in quality of life and a few clinical trials suggest that improving physical activity is able to prevent exacerbations. We hypothesize that these effects could be explained by changes in systemic inflammation secondary to an increase of physical activity.

Coping Versus Mastery Modeling Intervention to Enhance Self-efficacy for Exercise in Patients with COPD

The literature suggests self-efficacy is a determinant of physical activity and management of Chronic Obstructive Pulmonary Disease (COPD). The purpose of this study was to (1) test the effects of two vicarious experience interventions, coping versus mastery modeling, on self-efficacy in COPD patients performing a cardiopulmonary exercise test (CPET), and (2) determine the type of self-efficacy most strongly related to physical activity in COPD patients. After a baseline assessment of self-efficacy (task, coping for exercise, coping for breathing, scheduling, and walking) and potential moderators, 120 COPD patients watched a mastery model or coping model CPET video, or received usual care verbal instructions. Then, self-efficacy was assessed, followed by a CPET, and another assessment of self-efficacy. Fitbits tracked participants’ step count the week following contact. Repeated measures MANOVAs assessed the intervention effects and multiple regressions assessed the contribution of self-efficacy subtypes to step count. All self-efficacy subtypes improved in the mastery and coping conditions, although greater improvement of self-efficacy for coping with exercise barriers was observed in the coping condition. Self-efficacy did not improve in the control condition and no moderators were identified. Self-efficacy for coping with exercise barriers was the self-efficacy subtype most strongly related to step count. This research suggests modeling is a useful intervention technique to enhance self-efficacy in COPD patients, although coping models may be more beneficial than mastery models for enhancing capability beliefs during complex tasks. Future interventions in COPD patients should target self-efficacy for coping with exercise barriers.

Physical Activity Decline

Background: Chronic obstructive pulmonary disease (COPD) is a progressive disease which significantly affects patients’ physical activity. The purpose of the present study was to gain insight into the COPD patients’ perception of the disease and their experience during physical activity decline. Methods: This qualitative study was performed in National Research Institute of Tuberculosis and Lung Diseases, a university hospital located in Tehran, Iran, which represents a referral center for COPD. Data were collected through in-depth semistructured interviews with 18 patients with COPD. Patients were recruited by purposeful sampling with the maximum variation sampling to achieve representative variation in patient’s gender, age, educational level, and severity and duration of COPD. Data were analyzed via conventional content analysis approach. Results: The COPD patients’ perception of the disease and their experience during physical activity decline was summarized in 6 categories: variable strength, experienced dyspnea, changed communication patterns, changed self-care patterns, lack of education, and environmental factors. Findings indicated that the patterns of physical activities, communication, and self-care in COPD patients change toward living normal and independent. Conclusion: It is imperative for the relevant health-care professionals to have a correct understanding of the characteristics of physical activity in COPD patients, because by knowing the characteristics of a phenomenon, it can be better measured and managed. Education and behavioral interventions are the most important ways to improve physical activity in COPD patients. This education should be cultural based and be adapted to the patients’ situation, and also emotional and environmental factors should be considered.

Effectiveness of a community-based exercise training programme to increase physical activity level in patients with chronic obstructive pulmonary disease: A randomized controlled trial.

The exercise training included in pulmonary rehabilitation (PR) programmes improves exercise capacity and quality of life in patients with chronic obstructive pulmonary disease (COPD). Nevertheless, the duration of these effects is limited, and the implementation of PR is still insufficient. Moreover, the physical activity level of COPD patients is low, and it is not modified with the classic PR programmes. The purpose of this study was to assess the effects of a community-based PR programme designed to increase physical activity in COPD patients. Stable COPD patients were assigned to either an experimental group (EG, n=17) who followed a community-based 8-week programme consisting of exercise training through walking and a plan to increase activity, using a pedometer for feedback; or a control group (n=16), who followed general recommendations to walk more every day. The following were evaluated postintervention, after 3months, and after 12months: exercise capacity (endurance shuttle test [EST]), physical activity (steps/day and modified Baecke questionnaire), quality of life (St. George's Respiratory Questionnaire [SGRQ]), dyspnoea (modified Medical Research Council scale), and exacerbations. Postintervention, the EG showed significant improvements in EST times (7.6min [4.4, 10.7]), distance (549m [282, 815]; p<0.01, both), number of steps (3,361 [1,553, 5,118]), and Baecke scores (1.6 [0.2, 3.1], p<0.01). SGRQ scores decreased (-5.4 [-8.6, -2.4], p<0.01). These results remained evident after 3 and 12months (p<0.01). There were no differences between the groups nor in the exacerbations or dyspnoea. A significant association was found between increase in physical activity level, improvement in exercise capacity, and quality of life during the period monitored. A community-based programme of exercise training through walking and increased physical activity, using pedometers as feedback, produces short- and long-term improvements in exercise capacity, physical activity level, and quality of life in COPD patients.

The carotid chemoreceptor contributes to the elevated arterial stiffness and vasoconstrictor outflow in chronic obstructive pulmonary disease.

The reason(s) for the increased central arterial stiffness in chronic obstructive pulmonary disease (COPD) are not well understood. In this study, we inhibited the carotid chemoreceptor with both low-dose dopamine and hyperoxia, and observed a decrease in central arterial stiffness and muscle sympathetic nervous activity in COPD patients, while no change was observed in age- and risk-matched controls. Carotid chemoreceptor inhibition increased vascular conductance, secondary to reduced arterial blood pressure in COPD patients. Findings from the current study suggest that elevated carotid chemoreceptor activity may contribute to the increased arterial stiffness typically observed in COPD patients. Chronic obstructive pulmonary disease (COPD) patients have increased central arterial stiffness and muscle sympathetic nervous activity (MSNA), both of which contribute to cardiovascular (CV) dysfunction and increased CV risk. Previous work suggests that COPD patients have elevated carotid chemoreceptor (CC) activity/sensitivity, which may contribute to the elevated MSNA and arterial stiffness. Accordingly, the effect of CC inhibition on central arterial stiffness, MSNA and CV function at rest in COPD patients was examined in a randomized placebo-controlled study. Thirteen mild-moderate COPD patients (forced expired volume in 1 s (FEV1 ) predicted±SD: 83±18%) and 13age- and risk-matched controls completed resting CV function measurements with either i.v. saline or i.v. dopamine (2μgkg-1 min-1 ) while breathing normoxic or hyperoxic air (100% O2 ). On a separate day, a subset of COPD patients and controls completed MSNA measurements while breathing normoxic or hyperoxic air. Arterial stiffness was determined by pulse-wave velocity (PWV) and MSNA was measured by microneurography. Brachial blood flow was determined using Doppler ultrasound, cardiac output was estimated by impedance cardiography, and vascular conductance was calculated as flow/mean arterial pressure (MAP). CC inhibition with dopamine decreased central and peripheral PWV, and MAP (P<0.05) while increasing vascular conductance in COPD. No change in CV function was observed with dopamine in controls. CC inhibition with hyperoxia decreased peripheral PWV and MSNA (P<0.05) in COPD, while no change was observed in controls. CC inhibition decreased PWV and MSNA, and improved vascular conductance in COPD, suggesting that tonic CC activity is elevated at rest and contributes to the elevated arterial stiffness in COPD.

Verification of a Motion Sensor for Evaluating Physical Activity in COPD Patients.

Background Objective evaluation of the physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD) is important. We validated a triaxial accelerometer, Active Style Pro HJA-750C® (HJA), and evaluated the necessary conditions for obtaining reproducible data. Methods The PA measured by HJA was compared with that measured by two already validated accelerometers in 11 patients with COPD (age: 76.6 ± 6.9, FEV1% predicted: 57.6 ± 18.6). Then, the influence of weather and holidays on the PA and the required number of days to obtain repeatability were examined in 21 patients with COPD (age: 73.0 ± 8.0, FEV1% predicted: 58.7 ± 19.0). Results The PA values measured by HJA and those by DynaPort Move Monitor® (DMM) or Actimarker® (AM) were significantly correlated at all intensities (p=0.024 at ≥4.0 METs by DMM and p < 0.0001 at the rest) except at ≥4.0 METs by AM, though the values measured by HJA were higher than those by AM which was reported to underestimate PA. The durations of PA on rainy days were significantly shorter than those on nonrainy days, but those on holidays were not different from those on weekdays. The values of ICC for 3, 4, or 5 days were higher than 0.8 at all intensities. The PA measured by HJA was correlated with the dyspnea scale FVC and age and tended to correlate with FEV1. Conclusions The HJA was validated for evaluating the PA in patients with COPD. This trial is registered with UMIN000016363.

SIRT1 and FOXO1 mRNA expression in PBMC correlates to physical activity in COPD patients.

BackgroundPhysical activity (PA) is considered as one of the most important prognostic predictors in chronic obstructive pulmonary disease (COPD) patients. Longevity gene, SIRT1, is reported to be involved in the pathogenesis of COPD by regulating the signaling pathways of oxidative stress, inflammation, and aging. We hypothesize that SIRT1 and related genes are also associated with the benefits of PA in COPD patients.MethodsEighteen COPD outpatients were enrolled in this study, and their PA level was assessed with an accelerometer. We assessed the SIRT1 and related genes mRNA expression levels in the peripheral blood mononuclear cells (PBMCs) of the subjects. We carried out respiratory function testing, blood gas analysis, the 6-minute walk test, and measurement of the cross-sectional area of the erector spinae muscles (ESMCSA) by chest computed tomography. We analyzed the association of PA with the results of each of the examinations.ResultsThe mean age was 72±9 years, and the mean forced expiratory volume in 1 second was 1.4±0.56 L (52%±19% predicted). Our findings revealed a correlation between the daily PA and ESMCSA. The SIRT1 and Forkhead box O (FOXO)1 mRNA expression levels in PBMCs were positively correlated with moderate-PA time (r=0.60, p=0.008 for SIRT1 and r=0.59, p=0.01 for FOXO1).

Interdependence of physical inactivity, loss of muscle mass and low dietary intake: Extrapulmonary manifestations in older chronic obstructive pulmonary disease patients.

Extrapulmonary manifestations, such as reductions in skeletal muscle and physical inactivity, are important clinical features of patients with chronic obstructive pulmonary disease (COPD), and might depend on the severity of COPD. As it is still unclear whether the relationship between muscle loss and physical inactivity is dominated by a disease-specific relationship or caused by patient factors, including physiological aging, we aimed to investigate the pulmonary or extrapulmonary factors associated with physical inactivity among older COPD patients. A total of 38 older male COPD patients (aged ≥65 years) were enrolled, and were evaluated cross-sectionally. Skeletal muscle mass was measured using bioelectrical impedance, and physical activity and energy intake were recorded for 2 weeks using a pedometer and diary. Daily step counts were successfully evaluated in 28 participants (mean forced expiratory volume in 1 s [%predicted; %FEV1 ]; 49.5%), and ranged widely. The mean step counts was 5166 steps/day, and found to have a significant relationship with dyspnea (r = -0.46), diffusing capacity (r = 0.47), %FEV1 (r = 0.44), skeletal muscle index (r = 0.59) and total dietary intake (r = 0.47), but not with age (P = 0.14). A stepwise multivariate analysis showed that the skeletal muscle index (β = 0.50) and total dietary intake (β = 0.35) were significant determinants of the daily step count (R2 = 0.46, p < 0.01). Although various pulmonary factors are associated with daily physical activity, skeletal muscle mass and dietary intake are more closely correlated with physical activity in COPD patients. Because physical inactivity might be the strongest predictor of prognosis, the present results suggest that a comprehensive treatment strategy must be considered for older COPD patients to improve their extrapulmonary manifestations and pulmonary dysfunction. Geriatr Gerontol Int 2018; 18: 88-94.