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      Improving physical activity in COPD: towards a new paradigm

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          Abstract

          Chronic obstructive pulmonary disease (COPD) is a debilitating disease affecting patients in daily life, both physically and emotionally. Symptoms such as dyspnea and muscle fatigue, lead to exercise intolerance, which, together with behavioral issues, trigger physical inactivity, a key feature of COPD. Physical inactivity is associated with adverse clinical outcomes, including hospitalization and all-cause mortality. Increasing activity levels is crucial for effective management strategies and could lead to improved long-term outcomes. In this review we summarize objective and subjective instruments for evaluating physical activity and focus on interventions such as pulmonary rehabilitation or bronchodilators aimed at increasing activity levels. To date, only limited evidence exists to support the effectiveness of these interventions. We suggest that a multimodal approach comprising pulmonary rehabilitation, pharmacotherapy, and counselling programs aimed at addressing emotional and behavioural aspects of COPD may be an effective way to increase physical activity and improve health status in the long term.

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          Most cited references70

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          American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation.

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            Characteristics of physical activities in daily life in chronic obstructive pulmonary disease.

            Quantification of physical activities in daily life in patients with chronic obstructive pulmonary disease has increasing clinical interest. However, detailed comparison with healthy subjects is not available. Furthermore, it is unknown whether time spent actively during daily life is related to lung function, muscle force, or maximal and functional exercise capacity. We assessed physical activities and movement intensity with the DynaPort activity monitor in 50 patients (age 64 +/- 7 years; FEV1 43 +/- 18% predicted) and 25 healthy elderly individuals (age 66 +/- 5 years). Patients showed lower walking time (44 +/- 26 vs. 81 +/- 26 minutes/day), standing time (191 +/- 99 vs. 295 +/- 109 minutes/day), and movement intensity during walking (1.8 +/- 0.3 vs. 2.4 +/- 0.5 m/second2; p < 0.0001 for all), as well as higher sitting time (374 +/- 139 vs. 306 +/- 108 minutes/day; p = 0.04) and lying time (87 +/- 97 vs. 29 +/- 33 minutes/day; p = 0.004). Walking time was highly correlated with the 6-minute walking test (r = 0.76, p < 0.0001) and more modestly to maximal exercise capacity, lung function, and muscle force (0.28 < r < 0.64, p < 0.05). Patients with chronic obstructive pulmonary disease are markedly inactive in daily life. Functional exercise capacity is the strongest correlate of physical activities in daily life.
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              Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study.

              Information about the influence of regular physical activity on the course of chronic obstructive pulmonary disease (COPD) is scarce. A study was undertaken to examine the association between regular physical activity and both hospital admissions for COPD and all-cause and specific mortality in COPD subjects. From a population-based sample recruited in Copenhagen in 1981-3 and 1991-4, 2386 individuals with COPD (according to lung function tests) were identified and followed until 2000. Self-reported regular physical activity at baseline was classified into four categories (very low, low, moderate, and high). Dates and causes of hospital admissions and mortality were obtained from Danish registers. Adjusted associations between physical activity and hospital admissions for COPD and mortality were obtained using negative binomial and Cox regression models, respectively. After adjustment for relevant confounders, subjects reporting low, moderate or high physical activity had a lower risk of hospital admission for COPD during the follow up period than those who reported very low physical activity (incidence rate ratio 0.72, 95% confidence interval (CI) 0.53 to 0.97). Low, moderate and high levels of regular physical activity were associated with an adjusted lower risk of all-cause mortality (hazard ratio (HR) 0.76, 95% CI 0.65 to 0.90) and respiratory mortality (HR 0.70, 95% CI 0.48 to 1.02). No effect modification was found for sex, age group, COPD severity, or a background of ischaemic heart disease. Subjects with COPD who perform some level of regular physical activity have a lower risk of both COPD admissions and mortality. The recommendation that COPD patients be encouraged to maintain or increase their levels of regular physical activity should be considered in future COPD guidelines, since it is likely to result in a relevant public health benefit.
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                Author and article information

                Contributors
                Journal
                Respir Res
                Respir. Res
                Respiratory Research
                BioMed Central
                1465-9921
                1465-993X
                2013
                30 October 2013
                : 14
                : 1
                : 115
                Affiliations
                [1 ]Pulmonary Rehabilitation and Respiratory Division, UZ Gasthuisberg, Herestraat 49, B3000 Leuven, Belgium
                [2 ]Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
                [3 ]University of Groningen University Medical Center, Groningen, Netherlands
                [4 ]NIHR Respiratory Biomedical Research Unit, Royal Brompton Hospital, National Heart and Lung Institute (Imperial College), London, UK
                [5 ]ELEGI Colt Laboratory, Centre for Inflammation Research. The Queen’s Medical Research Institute, University of Edinburgh, Scotland, UK
                [6 ]Department of Physical Education & Sport Sciences and 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, Athens, Greece
                [7 ]Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
                [8 ]Novartis Pharma AG, Basel, Switzerland
                Article
                1465-9921-14-115
                10.1186/1465-9921-14-115
                4176094
                24229341
                dd90460a-3215-4fc0-a9ec-d30d09e7b3be
                Copyright © 2013 Troosters et al.; licensee BioMed Central Ltd.

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 29 May 2013
                : 22 August 2013
                Categories
                Review

                Respiratory medicine
                physical activity,bronchodilators,pulmonary rehabilitation,copd,activity monitors

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