Physical Inactivity in Pulmonary Sarcoidosis

Abstract

Purpose Reduced physical activity in many chronic diseases is consistently associated with increased morbidity. Little is known about physical activity in sarcoidosis. The aim of this study was to objectively assess physical activity in patients with pulmonary sarcoidosis and investigate its relationship with lung function, exercise capacity, symptom burden, and health status. Methods Physical activity was assessed over one week in 15 patients with pulmonary sarcoidosis and 14 age-matched healthy controls with a tri-axial accelerometer (ActivPal™) and the International Physical Activity Questionnaire (IPAQ). All participants underwent pulmonary function tests, 6-min walk test (6MWT) and completed the Fatigue Assessment Scale (FAS), Medical Research Council (MRC) Dyspnoea Scale and the King’s Sarcoidosis Questionnaire (KSQ). Results Patients with sarcoidosis had significantly lower daily step counts than healthy controls; mean (SD) 5624 (1875) versus 10,429 (2942) steps ( p < 0.01) and a trend towards fewer sit-to-stand transitions each day ( p = 0.095). Only two patients (13%) self-reported undertaking vigorous physical activity (IPAQ) compared to half of healthy individuals ( p < 0.01). Daily step count was significantly associated with 6MWT distance in sarcoidosis ( r = 0.634, p = 0.01), but not with forced vital capacity ( r = 0.290), fatigue ( r = 0.041), dyspnoea ( r = −0.466) or KSQ health status ( r = 0.099–0.484). Time spent upright was associated with fatigue ( r = −0.630, p = 0.012) and health status (KSQ Lung scores r = 0.524, p = 0.045), and there was a significant correlation between the number of sit-to-stand transitions and MRC dyspnoea score ( r = −0.527, p = 0.044). Conclusion Physical activity is significantly reduced in sarcoidosis and is associated with reduced functional exercise capacity (6MWD). Fatigue, exertional symptoms and health status were more closely associated with time spent upright and the number of bouts of physical activity, as compared to step counts. Further studies are warranted to identify the factors that determine different physical activity profiles in sarcoidosis. Electronic supplementary material The online version of this article (10.1007/s00408-019-00215-6) contains supplementary material, which is available to authorized users.

Health-Related Quality of Life in Sarcoidosis

“…57,58,117 Additionally, assessing HRQoL in sarcoidosis presents a unique challenge because successful antigranuloma treatment is not always associated with improved HRQoL. 5,30,46,47,57,118 Sarcoidosis-specific PROMs have been developed to address these shortcomings and include the SHQ, 35,68,72,73,107,[118][119][120][121][122] Kings Sarcoidosis Questionnaire (KSQ), 92,[123][124][125][126][127] and the Sarcoidosis Assessment Tool (SAT) 93,118 (►Table 3).…”

“…92,123-127,132, 133 Cho et al found a significant negative correlation between selfreported physical activity and the KSQ lung domain. 127 Baughman et al evaluated 16 patients with chronic sarcoidosis who received repository corticotropin as a steroid-sparing agent and noted that at the end of 6 months, there was a decrease in the dose of prednisone and significant improvements in HRQoL. 125 The KSQ was made available online in 2018.…”

High-intensity resistance training in newly diagnosed sarcoidosis- an exploratory study of effects on lung function, muscle strength, fatigue, dyspnea, health-related quality of life and lung immune cells

“…Instead, research has found a correlation between muscle strength, fatigue, dyspnea, and quality of life [7][8][9] and that patients with sarcoidosis have lower muscle strength compared to healthy controls [5,8,[10][11][12][13][14]. A newly published paper also reported that physical activity is significantly reduced in patients with sarcoidosis compared to healthy controls [15]. In many chronic lung diseases and inflammatory disorders, physical training has been shown to improve exercise intolerance, muscle weakness, quality of life, and reduce fatigue without adverse events [16] and limited data indicates that inflammatory activity is reduced [17][18][19][20].…”

Benefit of Wearing an Activity Tracker in Sarcoidosis

“…Sarcoidosis patients often suffer not only from organ-related symptoms but also from disabling non-specific, non-organ-related symptoms, such as fatigue, reduced muscle strength, loss of physical condition, reduction of physical activity (PA) in daily life, and pain [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. Fatigue is the most frequently reported symptom in sarcoidosis patients, regardless of the clinical presentation, varying from 50 to 90% [ 3 , 5 , 9 ].…”