Associations between Physical Activity and Comorbidities in People with COPD Residing in Spain: A Cross-Sectional Analysis

There is a high prevalence of comorbidities among patients with chronic obstructive pulmonary disease (COPD). Comorbidities are likely common in patients with any COPD degree and are associated with increased mortality. The aim of this study was to determine the prevalence of thirty-one different COPD comorbidities and to evaluate the association between physical activity (PA) levels in people with COPD residing in Spain. Cross-sectional data from the Spanish National Health Survey 2017 were analysed. A total of 601 adults (52.2% females) with COPD aged 15 to 69 participated in this study. PA (exposure) was measured with the International Physical Activity Questionnaire (IPAQ) short form and comorbidities (outcomes) were self-reported in response to the question “Have you ever been diagnosed with…?” Multivariable logistic regression, in three different models, was used to assess this association. Results showed a high prevalence of comorbidities (94%), these being chronic lumbar back pain (38.9%), chronic allergy (34.8%), arthrosis (34.1%), chronic cervical back pain (33.3%), asthma (32.9%) and hypertension (32.8%) the most prevalent. Low PA level was significantly associated with urinary incontinence (2.115[1.213–3.689]), chronic constipation (1.970[1.119–3.459]), cataracts (1.840[1.074–3.153]), chronic anxiety (1.508[1.002–2.269]) and chronic lumbar back pain (1.489[1.044–2.125]). Therefore, people with COPD should increase their PA levels in order to reduce their risk of comorbidities and increase their quality of life.

Physical Activity Behaviour in People with COPD Residing in Spain: A Cross-Sectional Analysis

PURPOSE

Chronic obstructive pulmonary disease (COPD) represents a major public health problem due to its high prevalence, morbidity and health cost. It has been demonstrated that physical activity (PA) is one of the most beneficial measures to prevent chronic diseases. The aim of this study was to examine PA levels of adults with COPD residing in Spain, and to analyse the differences by sex, age, education, marital status, cohabiting, tobacco consumption, alcohol consumption and body mass index.

METHODS

A total of 615 adults aged 15 to 69 years participated in this study. Data from the Spanish National Health Survey 2017 were used. This survey included the short version of IPAQ to measure PA levels. PA was expressed in total volume (MET·min/week), classified as low, moderate and high, and analysed according to sample characteristics. Statistical significance was set at p < 0.05 (CI = 95%).

RESULTS

Level of PA was higher in men than in women (1808.8 vs. 1575.6 MET·min/week; p = 0.016), in those aged under 30 years than in those older than 60 years (2129.4 vs. 1381.4 MET·min/week; p = 0.047) and in those who drank alcohol than in those who did not drink (1912.8 vs. 1248.2 MET·min/week; p = 0.004). Also, underweight and obese participants participated in lower levels of PA than normal weight participants (p= 0.001). When classifying PA level, a total of 37.9% had a low level, 47.5% had a moderate level and only 14.6% had a high level of PA (p < 0.001).

CONCLUSION

It is recommendable to implement programs to raise awareness of the importance and benefits of PA in the control of COPD, and these programs should focus on those with lower levels of PA.

Mobile health applications in self-management of patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis of their efficacy

Background

Mobile health applications are increasingly used in patients with Chronic Obstructive Pulmonary Disease (COPD) to improve their self-management, nonetheless, without firm evidence of their efficacy. This meta-analysis was aimed to assess the efficacy of mobile health applications in supporting self-management as an intervention to reduce hospital admission rates and average days of hospitalization, etc.

Methods

PubMed, Web of Science (SCI), Cochrane Library, and Embase were searched for relevant articles published before November 14th, 2017. A total of 6 reports with randomized controlled trials (RCTs) were finally included in this meta-analysis.

Results

Patients using mobile phone applications may have a lower risk for hospital admissions than those in the usual care group (risk ratio (RR) = 0.73, 95% CI [0.52, 1.04]). However, there was no significant difference in reducing the average days of hospitalization.

Conclusion

Self-management with mobile phone applications could reduce hospital admissions of patients with COPD.

Standardizing the analysis of physical activity in patients with COPD following a pulmonary rehabilitation program

BACKGROUND

There is a wide variability in measurement methodology of physical activity. This study investigated the effect of different analysis techniques on the statistical power of physical activity outcomes after pulmonary rehabilitation.

METHODS

Physical activity was measured with an activity monitor armband in 57 patients with COPD (mean ± SD age, 66 ± 7 years; FEV1, 46 ± 17% predicted) before and after 3 months of pulmonary rehabilitation. The choice of the outcome (daily number of steps [STEPS], time spent in at least moderate physical activity [TMA], mean metabolic equivalents of task level [METS], and activity time [ACT]), impact of weekends, number of days of assessment, postprocessing techniques, and influence of duration of daylight time (DT) on the sample size to achieve a power of 0.8 were investigated.

RESULTS

The STEPS and ACT (1.6-2.3 metabolic equivalents of task) were the most sensitive outcomes. Excluding weekends decreased the sample size for STEPS (83 vs 56), TMA (160 vs 148), and METS (251 vs 207). Using 4 weekdays (STEPS and TMA) or 5 weekdays (METS) rendered the lowest sample size. Excluding days with < 8 h wearing time reduced the sample size for STEPS (56 vs 51). Differences in DT were an important confounder.

CONCLUSIONS

Changes in physical activity following pulmonary rehabilitation are best measured for 4 weekdays, including only days with at least 8 h of wearing time (during waking hours) and considering the difference in DT as a covariate in the analysis.

TRIAL REGISTRY

ClinicalTrials.gov; No.: NCT00948623; URL: www.clinicaltrials.gov.

Motivational cues as real-time feedback for changing daily activity behavior of patients with COPD

OBJECTIVE

To investigate how COPD patients respond to motivational cues that aim to improve activity behavior and how these responses are related to cue- and context characteristics. In addition, to explore whether activity can be increased and better distributed over the day by providing such cues.

METHODS

Fifteen COPD patients participated. Patients used an activity sensor with a smartphone for four weeks, at least four days/week. Patients received motivational cues every 2h with advice on how to improve their activity, on top of real-time visual feedback. The response was calculated by the amount of activity 30 min before and after a cue.

RESULTS

In total, 1488 cues were generated. The amount of activity significantly decreased in the 30 min after a discouraging cue (p<0.001) and significantly increased (p<0.05) in the 10 min after an encouraging cue. The activity level increased with 13% in the intervention period compared to corrected baseline (p=0.008). The activity was not more balanced over the day.

CONCLUSIONS

COPD patients significantly change their activity level in response to motivational cues, based on continuous ambulatory assessment of activity levels.

PRACTICE IMPLICATIONS

Motivational cues could be a valuable component of telemedicine interventions that aim to improve activity behavior.

A telerehabilitation intervention for patients with Chronic Obstructive Pulmonary Disease: a randomized controlled pilot trial

OBJECTIVE

First, to investigate the effects of a telerehabilitation intervention on health status and activity level of patients with Chronic Obstructive Pulmonary Disease (COPD), compared to usual care. Second, to investigate how patients comply with the intervention and whether compliance is related to treatment outcomes.

DESIGN

a randomized controlled pilot trial

SUBJECTS

Thirty-four patients diagnosed with COPD.

INTERVENTION

The telerehabilitation application consists of an activity coach (3D-accelerometer with smartphone) for ambulant activity registration and real-time feedback, complemented by a web portal with a symptom diary for self-treatment of exacerbations. The intervention group used the application for 4 weeks. The control group received usual care.

MAIN MEASURES

Activity level measured by a pedometer (in steps/day), health status by the Clinical COPD Questionnaire at baseline and after intervention. Compliance was expressed as the time the activity coach was worn.

RESULTS

Fourteen intervention and 16 control patients completed the study. Activity level (steps/day) was not significantly affected by the intervention over time. There was a non-significant difference in improvement in health status between the intervention (-0.34±0.55) and control group (0.02±0.57, p=0.10). Health status significantly improved within the intervention group (p=0.05). The activity coach was used more than prescribed (108%) and compliance was related to the increase in activity level for the first two feedback weeks (r=0.62, p=0.03).

CONCLUSIONS

This pilot study shows the potential of the telerehabilitation intervention: compliance with the activity coach was high, which directly related to an improvement in activity levels.

Telemonitoring of Daily Activity and Symptom Behavior in Patients with COPD

Objectives. This study investigated the activity behavior of patients with COPD in detail compared to asymptomatic controls, and the relationship between subjective and objective activities (awareness), and readiness to change activity behavior. Methods. Thirty-nine patients with COPD (66.0 years; FEV₁% predicted: 44.9%) and 21 healthy controls (57.0 years) participated. Objective daily activity was assessed by accelerometry and expressed as amount of activity in counts per minute (cpm). Patients' baseline subjective activity and stage of change were assessed prior to measurements. Results. Mean daily activity in COPD patients was significantly lower compared to the healthy controls (864 ± 277 cpm versus 1162 ± 282 cpm, P < 0.001). COPD patients showed a temporary decrease in objective activities in the early afternoon. Objective and subjective activities were significantly moderately related and most patients (55.3%) were in the maintenance phase of the stages of change. Conclusions. COPD patients show a distinctive activity decrease in the early afternoon. COPD patients are moderately aware of their daily activity but regard themselves as physically active. Therefore, future telemedicine interventions might consider creating awareness of an active lifestyle and provide feedback that aims to increase and balance activity levels.

Effects of pulmonary rehabilitation on activity levels in patients with chronic obstructive pulmonary disease

PURPOSE

The purpose of this study was to determine whether patients with chronic obstructive pulmonary disease (COPD) increase physical activity immediately after a short course (8 weeks) of pulmonary rehabilitation (PR). Activity levels in patients with COPD were also compared with those in healthy controls.

METHODS

Consecutive patients with COPD (n = 24, aged 71.9 ± 7.7 years, forced expiratory ventilation in 1 second 44.1 ± 17.9% predicted, who completed PR) and 8 aged-matched controls (aged 66.6 ± 7.2 years) were studied. Activity was monitored with a triaxial accelerometer for 5 days before and after PR. Activity was expressed as vector magnitude units (VMU) per minute and time spent at VMU above 250 and 500, respectively.

RESULTS

Overall activity was significantly less in patients with COPD compared with that in controls (117 ± 63 compared with 242 ± 103 VMU/min, P = .0003). Time spent at VMU above 250 and 500 was also less in patients with COPD (166 ± 71 vs 227 ± 37 min, P = .028 and 39 ± 43 vs 124 ± 26 min, P < .0001, respectively). After PR, overall VMU activity was not significantly increased (117 ± 63 vs 120 ± 63 VMU/min). Time spent at VMU above 250 and 500 was also not significantly increased after PR. Increases in activity levels after PR did not correlate with improvements in exercise performance, quality of life, or quadriceps strength.

CONCLUSIONS

Despite significant improvements in exercise capacity and quality of life after PR, this did not translate into a significant increase in activity level. Improving function in patients with copd may not translate into behavioral change.

Level of daily physical activity in individuals with COPD compared with healthy controls

BACKGROUND

Persons with chronic obstructive pulmonary disease (COPD), performing some level of regular physical activity, have a lower risk of both COPD-related hospital admissions and mortality. COPD patients of all stages seem to benefit from exercise training programs, thereby improving with respect to both exercise tolerance and symptoms of dyspnea and fatigue. Physical inactivity, which becomes more severe with increasing age, is a point of concern in healthy older adults. COPD might worsen this scenario, but it is unclear to what degree. This literature review aims to present the extent of the impact of COPD on objectively-measured daily physical activity (DPA). The focus is on the extent of the impact that COPD has on duration, intensity, and counts of DPA, as well as whether the severity of the disease has an additional influence on DPA.

RESULTS

A literature review was performed in the databases PubMed [MEDLINE], Picarta, PEDRO, ISI Web of Knowledge and Google scholar. After screening, 11 studies were identified as being relevant for comparison between COPD patients and healthy controls with respect to duration, intensity, and counts of DPA. Four more studies were found to be relevant to address the subject of the influence the severity of the disease may have on DPA. The average percentage of DPA of COPD patients vs. healthy control subjects for duration was 57%, for intensity 75%, and for activity counts 56%. Correlations of DPA and severity of the disease were low and/or not significant.

CONCLUSIONS

From the results of this review, it appears that patients with COPD have a significantly reduced duration, intensity, and counts of DPA when compared to healthy control subjects. The intensity of DPA seems to be less affected by COPD than duration and counts. Judging from the results, it seems that severity of COPD is not strongly correlated with level of DPA. Future research should focus in more detail on the relation between COPD and duration, intensity, and counts of DPA, as well as the effect of disease severity on DPA, so that these relations become more understandable.

Activity monitoring in chronic obstructive pulmonary disease

The measurement of daily physical activity (PA) has become a significant outcome in patients with chronic obstructive pulmonary disease (COPD). Recent data have shown the independent association between PA markers, hospitalizations, and mortality. Daily PA can be quantified by direct observation, assessment of energy expenditure, questionnaires, and activity monitors (motion sensors). This review aims to describe the methods used to quantify daily PA in COPD on the basis of the published literature and to suggest potential applications of activity monitoring methods in clinical research and daily care of COPD patients.