Physical Activity Is the Strongest Predictor of All-Cause Mortality in Patients With COPD

Waschki, Benjamin; Kirsten, Anne; Holz, Olaf; Müller, Kai-Christian; Meyer, Thorsten; Watz, Henrik; Magnussen, H

doi:10.1378/chest.10-2521

Cited by 869 publications

(740 citation statements)

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“…There is evidence from the Copenhagen City Heart Study [30] and elsewhere [31] that physical inactivity may in fact precede the occurrence of airflow obstruction, and that it is a significant aetiological factor for the development of COPD. In addition, recent data have highlighted physical activity as a strong predictor of all-cause mortality in COPD [11], emphasising its importance in this patient group, although that study compared activity to measures of whole-body FFM and BMI, rather than quadriceps muscle bulk or strength. Consistent with previous work [14,32], we found that lung function is associated with the level of physical activity in COPD and RV/TLC ratio, rather than FEV1 % pred, is an independent predictor of physical activity level in stage II-IV disease.…”

Section: Significance Of the Findingsmentioning

confidence: 99%

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Quadriceps wasting and physical inactivity in patients with COPD

et al. 2012

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Quadriceps weakness is an important complication of advanced chronic obstructive pulmonary disease (COPD) but few data exist concerning muscle bulk in early disease. We hypothesised that quadriceps bulk, measured by ultrasound rectus femoris cross-sectional area (USRFCSA), would be reduced in mild, as well as advanced, COPD compared with controls, and would correlate with physical activity.161 patients with stable COPD and 40 healthy subjects had a measurement of USRFCSAand wore a multisensor armband to record physical activity.USRFCSAwas reduced in Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage I patients compared with healthy subjects (p=0.0002). Stage II–IV patients had reduced USRFCSA(p<0.0001) compared with controls but were not significantly different from those with stage I disease. Physical activity level was reduced in stage I (p=0.002) and stage II–IV disease compared with controls. Using regression analysis, physical activity level was independently associated with USRFCSAin stage I (p=0.01) but not stage II–IV disease, where residual volume to total lung capacity ratio was the only independent predictor of physical activity level.Quadriceps wasting exists in patients with mild, as well as advanced, COPD, and is independently associated with physical inactivity in GOLD stage I disease. The identification of these patients may guide early lifestyle and therapeutic interventions.

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Section: Significance Of the Findingsmentioning

confidence: 99%

“…Objectively measured physical activity has been identified as a strong predictor of all-cause mortality in COPD [11], highlighting its importance in a ''downward disease spiral'' where progressive dyspnoea leads to reduced exercise capacity with subsequent muscle deconditioning and further inactivity [12].…”

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confidence: 99%

Quadriceps wasting and physical inactivity in patients with COPD

et al. 2012

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“…In patients with COPD, the level of physical activity is found to be a predictor of hospital admission and mortality [44][45][46][47] . Maintaining low PA or a decrease in PA in a five year follow-up study was associated with a significant decline in health-related quality of life (HRQL) while an increase in HRQL was found in those who maintained a high level of PA 48 .…”

Section: Physical Activitymentioning

confidence: 99%

The relationship between physical function and experience of fatigue in patients with chronic obstructive pulmonary disease

Tödt¹

2014

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Background Chronic Obstructive Pulmonary Disease (COPD) is increasing throughout the world and most rapidly among women. COPD is characterized by a progressive loss of physical functions. The reason for this is multi-factorial and include not only lung related deficiencies but also several systemic consequences and symptoms of which several are potential restrictors of physical function. The relationship between physical function and symptoms are not clear, especially not among women with COPD. Aim The overall aim of this thesis was to illuminate the relationship between two dimensions of physical function (physical activity and physical capacity) and experience of fatigue. The specific aims were to explore factors associated with low physical activity and to examine experience of fatigue and its relationship to physical capacity and disease severity in men and women with COPD. Methods A cross-sectional study was conducted including 121 patients (67 women) with stable COPD and mean age of 67 (+/-7) years. Physical activity was measured with the International Physical Activity Questionnaire short form. Physical capacity included assessment of lung function (dynamic spirometry), exercise capacity (the 6-minute walk distance [perceived dyspnoea and leg fatigue in connection to the test]) and muscle strength (the Timed Stands Test and grip strength). Fatigue was assessed with structured questions covering the frequency, duration and severity of fatigue the previous month and patients were categorized as those with no fatigue, moderate fatigue or severe fatigue. Data about other symptoms (dyspnoea, anxiety and depression), symptom burden (Memorial Symptom Assessment Scale), fat and fat free mass (bio-impedance analysis) and smoking history was collected. Results Forty-two percent of the patients reported a low physical activity level. A majority of the patients reported experience of fatigue the previous month, 52% moderate fatigue and 25% severe fatigue. Low physical activity was associated with severe fatigue, worse exercise capacity and a higher amount of smoking. There were no differences in experience of fatigue between men and women. Men with fatigue had worse physical capacity and disease severity compared to men without fatigue. Women with fatigue had comparable physical capacity and disease severity to women without fatigue except for a higher perceived leg fatigue after the exercise capacity test. Multiple logistic regression analysis showed that exercise capacity and disease severity were associated with fatigue in both men and women but in women, leg fatigue was also strongly associated with the presence of fatigue. Conclusions Severe fatigue, worse exercise capacity and a higher amount of smoking were independently associated with low PA. This result suggests that patients with severe fatigue might need specific strategies to become more physically active. Presence of fatigue was associated with exercise capacity and disease severity in both men and women. In addition, in women leg fatigue was strongly a...

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“…1,2 Several studies have shown that the FEV 1 and diminished FEV 1 , hypoxemia, exercise capacity, body mass in-dex (BMI), dyspnea index, and physical activity predict morbidity and mortality in COPD patients. [3][4][5][6][7] Celli et al reported excellent predictive value of the multidimensional BODE (BMI, air-flow obstruction, dyspnea, exercise performance) index, which incorporates these variables into a single score. 7 Identification and amelioration of predictors for COPD morbidity and mortality may improve longterm outcomes.…”

Section: Introductionmentioning

confidence: 99%

An Integrated Index Combined by Dynamic Hyperinflation and Exercise Capacity in the Prediction of Morbidity and Mortality in COPD

et al. 2012

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BACKGROUND: Dynamic hyperinflation (DH) and exercise limitation develop in patients with COPD; however, there is lack of knowledge about their long-term clinical consequences. We aimed to assess the impact of DH and exercise capacity in predicting mortality and also morbidity, as evaluated by emergency visits and hospital admissions in COPD patients during a 4-year period. METHODS: We recruited 73 stable COPD patients. The relationships of different respiratory parameters (FEV 1 %, body mass index, 6 min walk test distance [6MWD], static hyperinflation as measured by the ratio of inspiratory capacity to total lung capacity (IC/TLC) at rest, DH as measured by the change between the post-and pre-exercise values of IC/TLC [⌬IC/TLC], P aO 2 , and P aCO 2 ) with emergency visits and hospital admissions because of exacerbations and also with respiratory and all-cause mortality were assessed. RESULTS: The median follow-up period was 47 months (IQR 45-48 months, n ‫؍‬ 73). During the follow-up there were 8 (11%) deaths. The ⌬IC/TLC value was 3.9 ؎ 4.6%. The Kaplan-Meier survival curve showed that the cumulative survival rate was significantly lower in the patients with ⌬IC/TLC > 4 and with 6MWD < 439.56 m, using these values as thresholds. (The rates for sensitivity were 100% and 87.5%, and for specificity were 56.92% and 87.69%, respectively). The Cox proportional hazards model showed that DH (hazard ratio ‫؍‬ 1.4, 95% CI ‫؍‬ 1.09 -1.84, P ‫؍‬ .009) and 6MWD (hazard ratio ‫؍‬ 0.98, 95% CI ‫؍‬ 0.97-0.99, P ‫؍‬ .006) were independent predictors of all-cause and respiratory mortality. 6MWD, FEV 1 %, IC/TLC, and ⌬IC/TLC were found to be significantly related to emergency visits (r ‫؍‬ ؊0.28, r ‫؍‬ ؊0.41, r ‫؍‬ ؊0.24, and r ‫؍‬ 0.38, respectively) and hospital admissions (r ‫؍‬ ؊0.41, r ‫؍‬ ؊0.45, r ‫؍‬ ؊0.36, and r ‫؍‬ 0.28, respectively). CONCLUSIONS: DH and exercise capacity are reliable and independent predictors for mortality and morbidity in COPD patients. We propose that DH and exercise capacity be considered in the assessment of long-term clinical consequences of COPD patients.

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Physical Activity Is the Strongest Predictor of All-Cause Mortality in Patients With COPD

Cited by 869 publications

References 72 publications

Quadriceps wasting and physical inactivity in patients with COPD

Quadriceps wasting and physical inactivity in patients with COPD

The relationship between physical function and experience of fatigue in patients with chronic obstructive pulmonary disease

An Integrated Index Combined by Dynamic Hyperinflation and Exercise Capacity in the Prediction of Morbidity and Mortality in COPD

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