Exercise and COPD: Therapeutic Responses, Disease-Related Outcomes, and Activity-Promotion Strategies

Abstract

Chronic obstructive pulmonary disease (COPD) reduces patients' exercise capacities and their abilities to perform daily physical activities, thereby increasing morbidity and mortality rates. The cycle of dyspnea, deconditioning, and declining physical activity not only accelerates the progression of COPD but also increases the risk for developing or aggravating metabolic and cardiovascular diseases. Cardiovascular and metabolic comorbidities also limit physical function, and their disabling effects in combination with COPD may be greater than the effects of each disease alone. The impact of COPD and its treatment on the ability to exercise, and the degree of physical activity in daily life, can be measured by field-based tests (eg, the 6-minute walk test or incremental and endurance shuttle-walk test), laboratory-based tests (eg, incremental or constant work-rate treadmill and cycle-ergometer tests), and physical activity assessments (eg, questionnaires and accelerometers). Walking tests increase oxygen consumption and desaturation in patients with COPD more than cycling tests with similar work-rate profiles and may more closely resemble patients' normal activities. Despite the questionable relevance of exercise testing to patients' daily functionality, exercise parameters remain important predictors of survival in patients with COPD. Treatment of COPD (pharmacotherapy, pulmonary rehabilitation, or both) can increase exercise capacity and physical activity in daily life, which potentially slows the decline of lung function, reduces the frequencies of exacerbations and hospitalizations, decreases mortality, slows the progression of comorbidities, improves health-related quality of life, and increases the activity reserve for routine function. This article examines the interactions of reduced physical activity and decreased exercise capacity with the progression of COPD, comorbidities, and mortality. The article also describes the available exercise tests for patients with COPD and reviews the evidence indicating that treating COPD improves exercise capacity. Notably, it appears that even mild COPD reduces exercise capacity and daily physical activity, indicating the need for early intervention.

The dyspnoea–inactivity vicious circle in COPD: development and external validation of a conceptual model

“…Identification of vicious circle models in the systematic literature review We identified nine articles that reported the conceptual model of the dyspnoea-inactivity vicious circle as a diagram (supplementary figure S1) [5,7,8,[32][33][34][35][36][37]. There were differences in variables and paths across different models (table 1 and figure 1).…”

Shuttle walking test in obese women: test‐retest reliability and concurrent validity with peak oxygen uptake

“…Another field test of potential clinical interest is the incremental shuttle walking test (ISWT), which induces to progressive increase in walking speed through the time, demonstrates a good correlation with peak oxygen uptake (VO 2 ) in certain chronic disease cohorts (Singh et al, 1992;Billings et al, 2013). (Faulkner et al, 2013;Maltais, 2013). Therefore, its use for functional evaluation in patients with cardiopulmonary disease has increased.…”

“…Therefore, its use for functional evaluation in patients with cardiopulmonary disease has increased. (Faulkner et al, 2013;Maltais, 2013).…”

Physical Activity and Risk of Lymphoma: A Meta-Analysis

“…Physical inactivity has recently received much attention as modifiable risk factor. It is well known that physical activity is effective in preventing and modifying chronic diseases, such as osteoporosis (8), obesity (9), type II diabetes (9,10), dementia (11), hypertension (12), metabolic syndrome (13), cardiovascular (14), and respiratory diseases (15). Since the last decades, evidence is growing that physical activity also reduces the risk of some types of cancer.…”