Screening for severe physical inactivity in chronic obstructive pulmonary disease

Abstract

Objectively measured severe physical inactivity (SPI) has been reported as the strongest independent predictor of mortality in patients with chronic obstructive pulmonary disease (COPD). Activity monitoring is not feasible in routine clinical practice; therefore, we set out to determine the utility of simple clinical measures for predicting SPI in patients with COPD. A total of 165 patients with COPD wore an activity monitor for 5 days to define the presence or absence of SPI. Logistic models were generated including the modified Medical Research Council (MMRC) dyspnea grade, spirometry and the age-dyspnea-airflow obstruction (ADO) index. Physical Activity Scale for the Elderly (PASE) and Stanford Brief Activity Scale (SBAS) were also tested for validity and reliability in a subgroup of 67 patients. The MMRC dyspnea grade, PASE score, ADO index and SBAS score were associated with SPI, but general self-efficacy and spirometry were not. An MMRC dyspnea grade !3 was the best independent predictor of SPI (AUC: 0.74; PPV: 0.83; NPV: 0.68) followed closely by a PASE score of <111. The combination of MMRC dyspnea grade and PASE score provided the most robust model (AUC: 0.83; Positive Predictive Value (PPV): 0.95; Negative Predictive Value (NPV): 0.63). The results were confirmed using 5000 bootstrapped models from the cohort of 165 patients. MMRC dyspnea grade !3 may be the best triage tool for SPI in patients with COPD. The combination of the MMRC and PASE score provided the most robust prediction. Our results may have significant practical applicability for clinicians caring for patients with COPD.

Coherence between self-reported and objectively measured physical activity in patients with chronic obstructive lung disease: a systematic review

“…The PASE questionnaire was able to predict SPI in COPD patients, although, together with mMRC, it had a more accurate outcome 17. The PAR questionnaire was the only questionnaire to reach significant correlation with SenseWear™ 18.…”

“…Likewise, DePew et al applied both the PASE questionnaire and SenseWear™ 17. PASE demonstrated a moderate correlation with the PAL measured by SenseWear™ in 67 COPD patients with a positive correlation coefficient ( r =0.62).…”

“…Heterogeneity was observed in patient selection (ranging from mild to very severe COPD), intensity, and duration of PA. Steele et al confirmed the correlation between FEV 1 and PA, as measured by the accelerometer and the 6MWT, highlighting the relationship between airway obstruction and maximum exercise capacity 19,23,28. A general overestimation of self-reported PA was demonstrated, and no reliable PA questionnaire was found 17,19,27,29. The most accurate tool for self-reported PA based on the papers assessed here is to keep a daily diary with a description of all activities 24…”

“…An accurate PA questionnaire in the, mostly sedentary, COPD population should include various questions on the reasons for low PA. The PASE questionnaire was designed for an elderly population, whereas the validation of the SQUASH questionnaire was done in a subgroup including mostly men (70%), with a mean age of 44 years, and 50% had a good or high fitness level, which is far from that expected for the COPD population 17,30…”

“…The following validated questionnaires were used in the papers included in the study: PASE, PAR, Baecke Physical Activity Questionnaire, ZPAQ, and MARQ 17–19. Other validated questionnaires for the COPD population include Yale Physical Activity Survey20 and Minnesota Leisure Time Physical Activity Questionnaire, among others 20,21.…”