Physical 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.

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.

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.

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.

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.

Improvement of physical activity in chronic obstructive pulmonary disease by pulmonary rehabilitation and pharmacological treatment.

Physical activity (PA) is defined as bodily movement produced by skeletal muscles with energy expenditure beyond resting levels. PA is closely related to reduced morbidity and mortality in chronic obstructive pulmonary disease (COPD). Self-report questionnaires are often subject to recall bias, correlating poorly with objectively qualified PA, and do not provide an accurate estimate of free-living energy expenditure. PA may be objectively evaluated by newly developed tri-axial accelerometers by quantifying steps or body movements over a period of time. Low-intensity, home-based pulmonary rehabilitation (PR) using pedometer feedback improves PA. Improvement in physiological factors correlates with increased walking time in stable elderly COPD patients. This review focuses on the effects of PR and pharmacological treatment on PA in COPD patients. We selected 32 studies from our literature search evaluating the effects of PR and 11 studies examining the effects of pharmacological treatment on PA. Findings in both categories were inconsistent. Nineteen studies showed a positive effect with PR whereas 13 showed no effect. Eight studies showed a positive effect, while three revealed no effect from pharmacological intervention. As both interventions increase exercise capacity without a consistent effect on PA, counseling with behavioral changes may be necessary to achieve a significant and lasting increase in PA. Changing PA behavior in COPD patients requires an interdisciplinary approach involving specialists in respiratory medicine, rehabilitation, social, and behavioral sciences. Future research in this area is warranted to advance our knowledge in this area, specifically with regard to the interaction of pharmacological and non-pharmacological interventions.

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.

Association between morning symptoms and physical activity in COPD: a systematic review.

Morning symptoms are common in chronic obstructive pulmonary disease (COPD). Many COPD patients consider the morning as the most troublesome part of the day, in which they experience more symptoms and physical activity limitations.To systematically report evidence of the association between morning symptoms and physical activity in COPD patients, a literature search was conducted using relevant MESH terms and text words in PubMed, Embase, Web of Science, COCHRANE, CINAHL and PsycINFO. Quality of the articles was assessed with validated checklists.Eight studies were included. Morning symptoms were present in 39.8-94.4%. In 37.0-90.6% of all COPD patients, there was an association between physical activity and morning symptoms. However, causality could not be proved. Morning symptoms were associated with a sedentary lifestyle (p<0.05). Treatment in line with the guidelines improved the degree of activity limitations due to morning symptoms (p<0.0001).Across all disease stages, COPD patients experience morning symptoms which are negatively associated with physical activity. Physicians should consider morning symptoms as a treatment goal. Pharmacotherapy may improve the degree of activity limitations due to morning symptoms. More objective research should focus on symptoms, activity limitations and physical inactivity of COPD patients, especially in the morning.

Efficacy of an mHealth intervention to stimulate physical activity in COPD patients after pulmonary rehabilitation.

Physical inactivity in patients with chronic obstructive pulmonary disease (COPD) is associated with poor health status and increased disease burden. The present study aims to test the efficacy of a previously developed mobile (m)Health intervention to improve or maintain physical activity in patients with COPD after pulmonary rehabilitation.A randomised controlled trial was performed in 32 physiotherapy practices in the Netherlands. COPD patients were randomised into intervention or usual care groups. The intervention consisted of a smartphone application for the patients and a monitoring website for the physiotherapists. Measurements were performed at 0, 3, 6 and 12 months. Physical activity, functional exercise capacity, lung function, health-related quality of life and body mass index were assessed.157 patients started the study and 121 completed it. There were no significant positive effects of the intervention on physical activity (at 0 months: intervention 5824±3418 steps per weekday, usual care 5717±2870 steps per weekday; at 12 months: intervention 4819±2526 steps per weekday, usual care 4950±2634 steps per weekday; p=0.811) or on the secondary end-points. There was a significant decrease over time in physical activity (p<0.001), lung function (p<0.001) and mastery (p=0.017), but not in functional exercise capacity (p=0.585).Although functional exercise capacity did not deteriorate, our mHealth intervention did not improve or maintain physical activity in patients with COPD after a period of pulmonary rehabilitation.

Determinants of Physical Activity in Patients with Chronic Obstructive Pulmonary Disease: A 5-Year Prospective Follow-Up Study

Background: Although many studies examined determinants of physical activity in patients with chronic obstructive pulmonary disease (COPD), most were cross-sectional and focused on single determinants only. Objectives: The aim of this study was to determine how COPD patients' physical activity changes over time and to identify the determinants of physical activity using multivariable and longitudinal methods. Methods: In a prospective cohort study, 409 primary care patients with COPD in the Netherlands and Switzerland were followed for up to 5 years. Physical activity was assessed at baseline and every 6 months using the Longitudinal Aging Study Amsterdam Physical Activity Questionnaire (LAPAQ) adapted to a 0- to 23-point scale. We studied the associations between determinants at baseline and patients' long-term physical activity levels using linear mixed models. Results: Unadjusted analysis showed an overall gradual decline in physical activity (0.22 points of the LAPAQ scale every 6 months, 95% CI: 0.17-0.28; p < 0.001). In multivariable analyses, baseline determinants that were independently associated (p ≤ 0.05) with lower long-term physical activity levels included (starting from coefficients with the smallest p value) lower exercise capacity, older age, working, more smoking pack-years, more fatigued, male sex, lower educational levels, previously not in fitness programs, more depressed, lower lung function, lower overall health status, and more prescription drug use. Conclusions: We found that physical activity of COPD patients may decline more than reported in the healthy elderly. Longitudinal analysis identified independent determinants of physical activity, which allows the identification of patients having low physical activity levels and who may benefit from physical activity interventions.

Interventions to modify physical activity in patients with COPD: a systematic review.

The broad range of interventions to increase physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD) has not been systematically assessed. We aimed to perform a systematic review of the interventional studies that have assessed PA as an outcome in patients with COPD.A systematic search in five different databases (Medline, Embase, PsycINFO, CINAHL and Web of Science) was performed in March 2015. Two independent reviewers analysed the studies against the inclusion criteria (COPD defined by spirometry; prospective, randomised/nonrandomised studies, cohort and experimental studies with interventions using PA as an outcome), extracted the data and assessed the quality of evidence.60 studies were included. Seven intervention groups were identified. PA counselling increased PA levels in COPD, especially when combined with coaching. 13 studies showed positive effects of pulmonary rehabilitation (PR) on PA, while seven studies showed no changes. All three PR programmes >12 weeks in duration increased PA. Overall, the quality of evidence was graded as very low.Interventions focusing specifically on increasing PA, and longer PR programmes, may have greater impacts on PA in COPD. Well-designed clinical trials with objective assessment of PA in COPD patients are needed.

Can health status questionnaires be used as a measure of physical activity in COPD patients?

Acting to address the amount of physical activity of patients with chronic obstructive pulmonary disease (COPD) is recommended as part of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations [1]. A level lower than approximately 5000 steps for day (sedentary lifestyle index) is associated with significantly increased health risks [2, 3]. Actively screening to identify patients below this threshold could be an important step towards targeting interventions to increase physical activity. Potential screening tools include activity monitors (objective assessment) or self-reported questionnaires (subjective assessment) to measure the amount of physical activity [4]. The latter method, which is feasible in clinical practice, may not result in an accurate representation in an individual patient, as questionnaire responses tend to misclassify physical activity [5]. Although more accurate and widely used in research, activity monitoring is not yet commonly included in patients' routine assessment. Several health status questionnaires in routine clinical use contain a domain or dimension related to physical activity [6]. In the analytical framework of Leidy [7], functional performance has been defined as the physical, psychological, social, occupational and spiritual activities that people actually do in the normal course of their lives to meet basic needs, fulfil usual roles, and maintain their health and wellbeing. A review by Kocks et al . [8] proposed that these questionnaires could be used in the measurement of functional performance (defined as “what a patient is actually doing”) and that this would be a more practical alternative to physical activity monitoring. Whether this approach is sufficiently valid as a representation of physical activity levels in clinical practice remains to be established. Health status questionnaires provide only limited insight into the physical activity of patients with COPD The PROactive Consortium members are as follows. Nathalie Ivanoff: Almirall, Barcelona, Spain; Niklas Karlsson and Solange Corriol-Rohou: AstraZeneca AB, Molndal, Sweden; Ian Jarrod: British Lung Foundation, London, UK; Damijen Erzen: Boehringer Ingelheim, Nieder-Ingelheim, Germany; Mario Scuri and Roberta Montacchini: Chiesi Farmaceutici S.A. Parma, Italy; Paul McBride: Choice Healthcare Solutions, Hitchin, UK; Nadia Kamel: European Respiratory Society, Lausanne, Switzerland; Margaret Tabberer: GlaxoSmithKline, Uxbridge, UK; Thierry Troosters, Wim Janssens and Fabienne Dobbels,: Katholieke Universiteit Leuven, Leuven, Belgium; Judith Garcia-Aymerich, Municipal Institute of Medical Research, Barcelona, Spain; Pim de Boer: Netherlands Lung Foundation, Amersfoort, The Netherlands; Karoly Kulich and Alastair Glendenning: Novartis, Basel, Switzerland; Michael I. Polkey and Nick S. Hopkinson: Royal Brompton and Harefield NHS Foundation Trust, London, UK; Ioannis Vogiatzis: Thorax Research Foundation, Athens, Greece; Enkeleida Nikai: UCB, Brussels, Belgium; Thys van der Molen and Corina De Jong: University Medical Center, Groningen, The Netherlands; Roberto A. Rabinovich and Bill MacNee: University of Edinburgh, Edinburgh, UK; Milo A. Puhan and Anja Frei: University of Zurich, Zurich, Switzerland.