Chest
Volume 136, Issue 1, July 2009, Pages 62-70
Journal home page for Chest

Original Research
COPD
Physical Activity and Clinical and Functional Status in COPD

https://doi.org/10.1378/chest.08-2532Get rights and content

Background

The mechanisms underlying the benefits of regular physical activity in the evolution of COPD have not been established. Our objective was to assess the relationship between regular physical activity and the clinical and functional characteristics of COPD.

Methods

Three hundred forty-one patients were hospitalized for the first time because of a COPD exacerbation in nine teaching hospitals in Spain. COPD diagnosis was confirmed by spirometry under stable conditions. Physical activity before the first COPD hospitalization was measured using the Yale questionnaire. The following outcome variables were studied under stable conditions: dyspnea, nutritional status, complete lung function tests, respiratory and peripheral muscle strength, bronchial colonization, and systemic inflammation.

Results

The mean age was 68 years (SD, 9 years), 93% were men, 43% were current smokers, and the mean postbronchodilator FEV1 was 52% predicted (SD, 16% predicted). Multivariate linear regression models were built separately for each outcome variable and adjusted for potential confounders (including remaining outcomes if appropriate). When patients with the lowest quartile of physical activity were compared to patients in the other quartiles, physical activity was associated with significantly higher diffusing capacity of the lung for carbon monoxide (Dlco) [change in the second, third, and fourth quartiles of physical activity, compared with first quartile (+ 6%, + 6%, and + 9% predicted, respectively; p = 0.012 [for trend])], expiratory muscle strength (maximal expiratory pressure [Pemax]) [+ 7%, + 5%, and + 9% predicted, respectively; p = 0.081], 6-min walking distance (6MWD) [+ 40, + 41, and + 45 m, respectively; p = 0.006 (for trend)], and maximal oxygen uptake (

o2peak) [+ 55, + 185, and + 81 mL/min, respectively; p = 0.110 (for trend)]. Similarly, physical activity reduced the risk of having high levels of circulating tumor necrosis factor α (odds ratio, 0.78, 0.61, and 0.36, respectively; p = 0.011) and C-reactive protein (0.70, 0.51, and 0.52, respectively; p = 0.036) in multivariate logistic regression.

Conclusions

More physically active COPD patients show better functional status in terms of Dlco, Pemax, 6MWD,

o2peak, and systemic inflammation.

Section snippets

Design

The study was a cross-sectional analysis nested in a longitudinal cohort study of COPD patients.

Participants

A total of 341 subjects hospitalized for the first time because of a COPD exacerbation between January 2004 and March 2006 in nine teaching hospitals in Spain were included in the study. The recruitment process and definitions of exacerbation, first hospital admission, and COPD are detailed in an online supplement. The protocol was approved by the ethics committees of all the participating hospitals,

Results

During the 4 weeks prior to exacerbation, patients were physically active for a median duration of 29 h/wk, with the main activity being a leisurely walk. The median energy expenditure was 5,662 kcal/wk, which was lower than that observed with the same questionnaire in healthy subjects of similar age13, 14 (Table 1). Being younger, unmarried, occupationally active, and a current smoker were associated with higher levels of physical activity (Table 2).

After hospital discharge and under

Principal Findings

Our study investigated potential relationships between regular physical activity and several phenotypic expressions of COPD in a large sample of patients recruited during their first hospital admission because of a COPD exacerbation. The main results show that regular physical activity is related to higher Dlco, expiratory muscle strength (Pemax), and exercise capacity, as well as to lower levels of systemic inflammation, after adjusting for confounders.

Strengths and Weaknesses of the Study

Present results may identify the

Conclusions

Our study shows that higher levels of regular physical activity in patients with COPD are associated with better functional status in terms of Dlco, expiratory muscle strength (Pemax, exercise capacity ([6MWD], and

o2peak), and systemic inflammation, after adjusting for confounders. These findings suggest potential underlying mechanisms for the previously reported relation between physical activity and hospitalizations and mortality in COPD patients, and they may facilitate the design of

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  • Cited by (0)

    All authors have contributed to (1) conception and design of the study; (2) analysis and interpretation of data; (3) writing the article or revising it critically for important intellectual content; and (4) final approval of the version to be published. Drs. Garcia-Aymerich, Serra, and Antó performed the statistical analysis and interpreted the results. Dr. Garcia-Aymerich prepared the first draft of the article. Dr. Garcia-Aymerich had full access to all of the data in the study, and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    This research was supported by Fondo de Investigación Sanitaria (FIS PI052292) and Spanish Society of Pneumology and Thoracic Surgery (SEPAR 2004/136). Judith Garcia-Aymerich has a researcher contract from the Instituto de Salud Carlos III (CP05/00118), Ministry of Health, Spain. Jordi de Batlle had a predoctoral fellowship from the Instituto de Salud Carlos III (FI05/01022), Ministry of Health, Spain. Diego A. Rodríguez has a long term research fellowship from the European Respiratory Society (2006/191). The PAC-COPD Study is funded by grants from Fondo de Investigación Sanitaria (FIS PI020541), Ministry of Health, Spain; Agència d'Avaluació de Tecnologia i Recerca Mèdiques (AATRM 035/20/02), Catalonia Government; Spanish Society of Pneumology and Thoracic Surgery (SEPAR 2002/137); Catalan Foundation of Pneumology (FUCAP 2003 Beca Marià Ravà); Red RESPIRA (RTIC C03/11); Red RCESP (RTIC C03/09), Fondo de Investigación Sanitaria (PI052486); Fondo de Investigación Sanitaria (PI052302); Fundació La Marató de TV3 (No. 041110); DURSI (2005SGR00392); and an unrestricted educational grant from Novartis Farmacèutica, Spain. Centro de Investigacíon Biomedica en Red Epidemiologia y Salud Pública (CIBERESP) and CIBERES are funded by the Instituto de Salud Carlos III, Ministry of Health, Spain. No involvement of funding sources in study design; in the collection, analysis, and interpretation of data; in the writing of the report; nor in the decision to submit the article for publication. Researchers are independent from funders.

    The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).

    *

    A list of Centers and Members of the PAC-COPD Study Group is located in the Appendix.

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