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      Progression of physical inactivity in COPD patients: the effect of time and climate conditions – a multicenter prospective cohort study

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          Longitudinal data on the effect of time and environmental conditions on physical activity (PA) among COPD patients are currently scarce, but this is an important factor in the design of trials to test interventions that might impact on it. Thus, we aimed to assess the effect of time and climate conditions (temperature, day length and rainfall) on progression of PA in a cohort of COPD patients.

          Patients and methods

          This is a prospective, multicenter, cohort study undertaken as part of the EU/IMI PROactive project, in which we assessed 236 COPD patients simultaneously wearing two activity monitors (Dynaport MiniMod and Actigraph GT3X). A multivariable generalized linear model analysis was conducted to describe the effect of the explanatory variables on PA measures, over three time points (baseline, 6 and 12 months).


          At 12 months (n=157; FEV 1% predicted=57.7±21.9) there was a significant reduction in all PA measures (Actigraph step count (4284±3533 vs 3533±293)), Actigraph moderate- to vigorous-intensity PA ratio (8.8 (18.8) vs 6.1 (15.7)), Actigraph vector magnitude units (374,902.4 (265,269) vs 336,240 (214,432)), MiniMod walking time (59.1 (34.9) vs 56.9 (38.7) mins) and MiniMod PA intensity (0.183 (0) vs 0.181 (0)). Time had a significant, negative effect on most PA measures in multivariable analysis, after correcting for climate factors, study center, age, FEV 1% predicted, 6MWD and other disease severity measures. Rainfall was the only climate factor with a negative effect on most PA parameters.


          COPD patients demonstrate a significant decrease in PA over 1 year follow-up, which is further affected by hours of rainfall, but not by other climate considerations.

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          Most cited references 21

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          The effect of season and weather on physical activity: a systematic review.

          This study reviewed previous studies to explore the effect of season, and consequently weather, on levels of physical activity. Thirty-seven primary studies (published 1980-2006) representing a total of 291883 participants (140482 male and 152085 female) from eight different countries are described, and the effect of season on moderate levels of physical activity is considered. Upon review of the evidence, it appears that levels of physical activity vary with seasonality, and the ensuing effect of poor or extreme weather has been identified as a barrier to participation in physical activity among various populations. Therefore, previous studies that did not recognize the effect of weather and season on physical activity may, in fact, be poor representations of this behaviour. Future physical activity interventions should consider how weather promotes or hinders such behaviour. Providing indoor opportunities during the cold and wet months may foster regular physical activity behaviours year round.
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            Validity of Six Activity Monitors in Chronic Obstructive Pulmonary Disease: A Comparison with Indirect Calorimetry

            Reduced physical activity is an important feature of Chronic Obstructive Pulmonary Disease (COPD). Various activity monitors are available but their validity is poorly established. The aim was to evaluate the validity of six monitors in patients with COPD. We hypothesized triaxial monitors to be more valid compared to uniaxial monitors. Thirty-nine patients (age 68±7years, FEV1 54±18%predicted) performed a one-hour standardized activity protocol. Patients wore 6 monitors (Kenz Lifecorder (Kenz), Actiwatch, RT3, Actigraph GT3X (Actigraph), Dynaport MiniMod (MiniMod), and SenseWear Armband (SenseWear)) as well as a portable metabolic system (Oxycon Mobile). Validity was evaluated by correlation analysis between indirect calorimetry (VO2) and the monitor outputs: Metabolic Equivalent of Task [METs] (SenseWear, MiniMod), activity counts (Actiwatch), vector magnitude units (Actigraph, RT3) and arbitrary units (Kenz) over the whole protocol and slow versus fast walking. Minute-by-minute correlations were highest for the MiniMod (r = 0.82), Actigraph (r = 0.79), SenseWear (r = 0.73) and RT3 (r = 0.73). Over the whole protocol, the mean correlations were best for the SenseWear (r = 0.76), Kenz (r = 0.52), Actigraph (r = 0.49) and MiniMod (r = 0.45). The MiniMod (r = 0.94) and Actigraph (r = 0.88) performed better in detecting different walking speeds. The Dynaport MiniMod, Actigraph GT3X and SenseWear Armband (all triaxial monitors) are the most valid monitors during standardized physical activities. The Dynaport MiniMod and Actigraph GT3X discriminate best between different walking speeds.
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              Validity of physical activity monitors during daily life in patients with COPD.

              Symptoms during physical activity and physical inactivity are hallmarks of chronic obstructive pulmonary disease (COPD). Our aim was to evaluate the validity and usability of six activity monitors in patients with COPD against the doubly labelled water (DLW) indirect calorimetry method. 80 COPD patients (mean ± sd age 68 ± 6 years and forced expiratory volume in 1 s 57 ± 19% predicted) recruited in four centres each wore simultaneously three or four out of six commercially available monitors validated in chronic conditions for 14 consecutive days. A priori validity criteria were defined. These included the ability to explain total energy expenditure (TEE) variance through multiple regression analysis, using TEE as the dependent variable with total body water (TBW) plus several physical activity monitor outputs as independent variables; and correlation with activity energy expenditure (AEE) measured by DLW. The Actigraph GT3X (Actigraph LLC, Pensacola, FL, USA), and DynaPort MoveMonitor (McRoberts BV, The Hague, the Netherlands) best explained the majority of the TEE variance not explained by TBW (53% and 70%, respectively) and showed the most significant correlations with AEE (r=0.71, p<0.001 and r=0.70, p<0.0001, respectively). The results of this study should guide users in choosing valid activity monitors for research or for clinical use in patients with chronic diseases such as COPD.

                Author and article information

                On behalf of : On behalf of the PROactive consortium
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of Chronic Obstructive Pulmonary Disease
                03 September 2019
                : 14
                : 1979-1992
                [1 ]National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College , London, UK
                [2 ]Department of Respiratory Medicine, “G. Papanikolaou” Hospital , Thessaloniki, Greece
                [3 ]Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences and Respiratory Division, University Hospital Leuven , Leuven, Belgium
                [4 ]First Department of Respiratory Medicine, National & Kapodistrian University of Athens , Athens, Greece
                [5 ]Department of Sport, Exercise and Rehabilitation, Northumbria University , Newcastle, UK
                [6 ]ELEGI Colt Laboratory, Centre for Inflammation Research, The Queen’s Medical Research Institute, University of Edinburgh , Edinburgh, UK
                [7 ]Department of General Practice, University Medical Center Groningen, University of Groningen , Groningen, The Netherlands
                [8 ]ISGlobal , Barcelona, Spain
                [9 ]Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP) , Barcelona, Spain
                [10 ]Universitat Pompeu Fabra (UPF) , Barcelona, Spain
                Author notes
                Correspondence: Afroditi K BoutouDepartment of Respiratory Medicine, “G. Papanikolaou” Hospital , Exohi, Thessaloniki 57010, GreeceTel +30 231 330 7277Email

                These authors contributed equally to this work

                © 2019 Boutou et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (

                Page count
                Figures: 1, Tables: 4, References: 38, Pages: 14
                Original Research


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