Daily activity during stability and exacerbation of chronic obstructive pulmonary disease

Abstract

BackgroundDuring most COPD exacerbations, patients continue to live in the community but there is little information on changes in activity during exacerbations due to the difficulties of obtaining recent, prospective baseline data.MethodsPatients recorded on daily diary cards any worsening in respiratory symptoms, peak expiratory flow (PEF) and the number of steps taken per day measured with a Yamax Digi-walker pedometer. Exacerbations were defined by increased respiratory symptoms and the number of exacerbations experienced in the 12 months preceding the recording of daily step count used to divide patients into frequent (> = 2/year) or infrequent exacerbators.ResultsThe 73 COPD patients (88% male) had a mean (±SD) age 71(±8) years and FEV1 53(±16)% predicted. They recorded pedometer data on a median 198 days (IQR 134–353). At exacerbation onset, symptom count rose by 1.9(±1.3) and PEF fell by 7(±13) l/min. Mean daily step count fell from 4154(±2586) steps/day during a preceding baseline week to 3673(±2258) step/day during the initial 7 days of exacerbation (p = 0.045). Patients with larger falls in activity at exacerbation took longer to recover to stable level (rho = −0.56; p < 0.001). Recovery in daily step count was faster (median 3.5 days) than for exacerbation symptoms (median 11 days; p < 0.001). Recovery in step count was also faster in untreated compared to treated exacerbation (p = 0.030).Daily step count fell faster over time in the 40 frequent exacerbators, by 708 steps/year, compared to 338 steps/year in 33 infrequent exacerbators (p = 0.002).ConclusionsCOPD exacerbations reduced physical activity and frequent exacerbations accelerate decline in activity over time.

Self-reported daily walking time in COPD: relationship with relevant clinical and functional characteristics

“…The findings of this study indicate a very consistent association between self-reported walking time and known parameters of COPD severity. Moreover, the results are in line with previous research conducted in this field using objective measures of physical activity, such as pedometers and accelerometers 21–24. Therefore, although it is unlikely for the simple question of “on average how many minutes do you walk per day?” to be an accurate measure of physical activity, it may be a useful tool to stratify COPD patients according to their level of physical activity in the clinical setting.…”

“…Several studies have shown that exacerbations have a negative impact on health outcomes of patients with COPD, impairing lung function,33 quality of life,34 exercise capacity,35 and survival 36. Along this line, a fall in daily walking activity following an exacerbation has been reported using pedometry in COPD 21. Since bed rest and physical inactivity following exacerbation periods impair skeletal muscle mass and function,37 it is not surprising that patients presenting the most severe exacerbations are those who are less active.…”

Pulmonary Rehabilitation and Physical Activity in Patients with Chronic Obstructive Pulmonary Disease

“…[68][69][70][71][72][73][74][75] Physical activity levels may also be influenced by the day of the week -with activity lower on weekends as compared to other days. [28,45,76] Exacerbations clearly reduce physical activity levels in patients with COPD, [77,78] in particular in very severe exacerbations which necessitate hospitalization. [79,80] Medical comorbidities may also independently or synergistically impact physical activity levels.…”

Physical Inactivity as a Missing Link in Understanding the Progression of Chronic Obstructive Pulmonary Disease

“…This cannot be inferred directly from the study by Waschki and colleagues, as they only have two measures of PA and do not explicitly report on the relation between exacerbations in their patients and decline in PA. The data from the London cohort, however, seem to corroborate with this hypothesis (14). A last hypothesis is that the annual decline in PA is truly slightly faster in patients suffering from COPD compared with in controls, but this difference is too small to be picked up over a relatively short study duration (2.8 yr) compared with the trajectory of development of COPD (typically over decades).…”