The impact of pulmonary rehabilitation on severe physical inactivity in patients with chronic obstructive pulmonary disease: a pilot study

Abstract

IntroductionIn patients with COPD, severe physical inactivity (SPI, which is defined as total daily energy expenditure/resting energy expenditure; physical activity level [PAL] ratio, <1.4) is associated with increased morbidity and mortality. Pulmonary rehabilitation (PR) increases physical capacity in COPD, but the impact on SPI is unknown. In this study, we aimed at elucidating the prevalence of SPI in COPD patients attending standard PR, the impact of PR on SPI prevalence, and the relationship between SPI and time spent in moderate physical activity thus whether American College of Sports Medicine (ACSM) recommendations are clinically useful in excluding SPI in COPD.MethodsThis is a prospective non-interventional pilot study on patients with COPD completing PR, consenting to wear an accelerometer (Sensewear© Armband) for a week before and after completing PR to assess changes in energy expenditure, time spent in physical activity, and number of daily steps. Low level of daily physical activity was not an inclusion criterion.ResultsIn total, 57 patients completed the study and 31 (54%) had SPI at baseline. In patients with SPI, baseline median FEV1 was 48 (range, 28–86) % of predicted and GOLD B, n=11 (35%)/GOLD D, n=20 (65%). Surprisingly, 31 of SPI patients (97%) spent ≥150 minutes/week in moderate physical activity. After rehabilitation, 24 (78%) did not change activity level and were persistently SPI. We observed no differences at baseline between patient responding (n=7) vs not responding (n=24) to PR. Responders increased number of daily steps and time spent in lighter but not moderate physical activity during rehabilitation.ConclusionIn this pilot study, SPI was prevalent, and PR had limited impact. Contraintui-tively, most patients with SPI complied with general recommendations of weekly hours spent in moderate physical activity. Our study highlights that increasing time spent in light activity rather than improving time spent in moderate activity is important in COPD patients with chronic dyspnea.

Physical Activity as a New Tool to Evaluate the Response to Omalizumab and Mepolizumab in Severe Asthmatic Patients: A Pilot Study

“…Pitta et al (2008) analyzed PA levels in patients with COPD, reporting that walking time in daily life did not improve significantly after 3 months of a multidisciplinary rehabilitation program, but only after 6 months. Thyregod et al (2018), in their pilot study, reported that the median daily steps were significantly improved in patients with COPD responding to their rehabilitation program.…”

Severe physical inactivity in chronic obstructive pulmonary disease: changes in systemic inflammation after pulmonary rehabilitation – a pilot study

“…We have recently published the clinical data and study design 5 . Brie y, this was a prospective, observational cohort study conducted in 2013-2014 at four pulmonary rehabilitation units in Region Zealand, Denmark.…”

“…forced expiratory volume in rst second (FEV 1 ), 6-minute walk test, and patient-reported outcomes. For further details on the results of these measurements please refer to reference 5 .…”

“…The sample size calculation was based on the clinical study 5 . However, assuming a signi cant level (α) of 0.05, power (1-β) of 0.80, minimal clinically important difference (MCID) of 20%, and a standard deviation of 2 times MCID, a total number of 34 patient was needed to detect a 20% difference in change in IL-8 levels between patients with SPI at baseline who at follow-up still have SPI vs. those improving to non-SPI.…”

“…A minority of patients with COPD are severely physical inactive (SPI), de ned as a total daily energy expenditure/resting energy expenditure ratio <1.4 1 . SPI is inversely correlated to disease severity, including lung function decline, disease burden, frequency of hospitalization and mortality in patients with COPD [2][3][4] , and recent evidence suggests that patients with SPI does not improve as much from pulmonary rehabilitation as the general COPD population 5 . Current evidence increasingly supports the association between reduced lung function and systemic in ammation and a possible link with comorbidities such as cardiovascular disorders, skeletal muscle dysfunction, diabetes, and osteoporosis 6,7 .…”