Understanding the impact of physical activity in COPD outcomes: moving forward

Abstract

@ERSpublications From observational studies, it is now clear that physical inactivity is linked with poor outcome in COPD http://ow.ly/AJ7mFArguably, three outcome categories are of greatest importance to chronic obstructive pulmonary disease (COPD) patients, their families and their caregivers: health-related quality of life (including symptom burden); hospitalisations and other forms of healthcare utilisation; and, of course, mortality. Lower levels of baseline physical activity are not only prevalent in patients with COPD [1, 2], they are associated a negative impact in each of these three outcome categories [3][4][5].Of considerable importance to healthcare professionals, increases in physical activity appear to predict enhanced health-related quality of life and reduced hospitalisations. For example, in an analysis of 391 patients with COPD who had physical activity and health-related quality of life assessments at baseline and 5 years later [6], those who increased or maintained their high levels of physical activity had clinically meaningful improvements in quality of life. In contrast, those who stayed at a low level or decreased their physical activity had a worsening in this outcome. From one perspective, this comes close to a tautology, as physical function impairment and distressing symptoms associated with physical activity are prominent components of health-related quality of life questionnaires. With respect to healthcare utilisation, a longitudinal analysis of COPD patients over 5 years demonstrated that the change in physical activity over the first 2 years significantly predicted hospitalisations 3 years later: those without regular physical activity, those who maintained a low level of physical activity or those who decreased their physical activity were at significantly greater risk of being hospitalised than those with higher levels of physical activity [7].The reanalysis of the very large Copenhagen City Heart Study database by VAES et al. [8], reported in this issue of the European Respiratory Journal, adds new and important information by relating changes in physical activity to mortality risk in COPD. We already know there are often strong associations between low levels of physical and mortality. For instance, all-cause mortality risk is higher in patients with coronary artery disease and cancer who have lower levels of physical activity [9,10]. This also holds true for COPD: using Copenhagen City Heart Study data, demonstrated that, in participants meeting spirometric criteria for COPD, those with very low levels of self-reported physical activity had a higher risk of hospitalisation and mortality over approximately the next 17 years than those who participated in regular physical activity. This negative relationship between physical activity and poor outcome remained in their model even after controlling for potential relevant confounding factors. This study provides strong evidence that physical inactivity is bad for individuals with COPD. Subsequent studies by WASCHKI et al. [4] a...

High 24-Hour Respiratory Symptoms and Low Physical Activity in the Stable COPD Romanian Cohort of SPACE Study

“…12 Previous studies have shown that physical inactivity leads to a higher risk of hospitalizations, exacerbations and mortality and a reduced healthrelated quality of life in COPD patients, although the exact relationship between various clinical and functional indicators and physical activity is not yet elucidated. [13][14][15] In consequence, increasing physical activity has the potential of being one key nonpharmacological interventions in COPD patients, irrespective of the specific ABCD group. 1 In Romania, the respiratory symptoms (RS) were explored in several national COPD awareness campaigns that showed an increasing prevalence of lung function impairment.…”

Factors associated with physical activity among COPD patients with mild or moderate airflow obstruction

“…[3] However, it is incompletely understood why patients with COPD are inactive. [4,5] Defining patient characteristics that are associated with physical inactivity is important for the development of targeted interventions, also for COPD patients with mild or moderate airflow obstruction. The decline in physical activity already starts in mild disease stages, [5][6][7][8] even before the physician diagnosis of COPD is made.…”

Effects of Tiotropium/Olodaterol on Activity-Related Breathlessness, Exercise Endurance and Physical Activity in Patients with COPD: Narrative Review with Meta-/Pooled Analyses

“…Population-based data demonstrate that as little as 2 h of activity per week, either walking or cycling, can have significant positive effects on the course of COPD [11]. Conversely, physical inactivity is a major-indeed, perhaps the strongest-risk factor for poor outcomes in patients with COPD [12]. As well as its association with breathlessness, physical inactivity is also linked to an increased risk of exacerbations, hospitalisations and mortality [11,[13][14][15].…”