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Tsokani A, Stefanouli V, Adriaenssens N, Kotsakis A, Kapreli E, Strimpakos N. The effects of green exercise on the mental and physical health of people with chronic conditions: a systematic review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024:1-15. [PMID: 39166712 DOI: 10.1080/09603123.2024.2391991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 08/09/2024] [Indexed: 08/23/2024]
Abstract
Green exercise, defined as physical activity in natural settings, shows promise for enhancing exercise participation and improving health. This systematic review aimed to assess the effectiveness of green exercise in people with chronic conditions. Seven electronic databases were searched and of the 7801 screened articles, 14 trials met the inclusion criteria. Green exercise was a safe and well-tolerated intervention, with low drop-out levels. It was found to positively affect participants' quality of life in three studies and mental health in four studies. Compared to non-exercise groups, green exercise significantly improved physical and mental health in patients with breast cancer, COPD, cardiovascular disease risk, chronic low back pain, obesity, and diabetes. However, it had no impact on the physical health of stroke patients or the cognitive performance of those with ADHD. Green exercise appears to be a safe intervention that can improve various chronic health issues.
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Affiliation(s)
- Aristi Tsokani
- Health Assessment and Quality of Life Research Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Vasiliki Stefanouli
- Health Assessment and Quality of Life Research Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Nele Adriaenssens
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Athanasios Kotsakis
- Laboratory of Oncology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Eleni Kapreli
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Nikolaos Strimpakos
- Health Assessment and Quality of Life Research Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, University of Manchester, Manchester, UK
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COVID-19 Post-Acute Sequela Rehabilitation: A look to the future through the lens of COPD and Pulmonary Rehabilitation. Arch Rehabil Res Clin Transl 2022; 4:100185. [PMID: 35229076 PMCID: PMC8868001 DOI: 10.1016/j.arrct.2022.100185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Post–COVID-19 condition is characterized by a myriad of persistent symptoms experienced up to 60 days after the acute infection, not only in those hospitalized, but also in patients with mild to moderate acute symptoms. The overwhelming evidence on multisystem involvement in post–COVID-19 condition brings to attention the need for integrated delivery models to address health care needs of this population. The World Health Organization recently highlighted critical gaps in adequately providing the level of integrative care required to address the multisystem needs of this population in current health care delivery models and recommended development of new innovative models of delivery. This article presents a novel approach to addressing these gaps from a rehabilitation perspective.
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Du Y, Lin J, Wang X, Zhang Y, Ge H, Wang Y, Ma Z, Zhang H, Liu J, Wang Z, Lin M, Ni F, Li X, Tan H, Tan S. Early Pulmonary Rehabilitation in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Meta-Analysis of Randomized Controlled Trials. COPD 2022; 19:69-80. [PMID: 35099336 DOI: 10.1080/15412555.2022.2029834] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Pulmonary rehabilitation (PR) is an essential method for Acute exacerbation in chronic obstructive pulmonary disease (AECOPD) recovery. We perform a meta-analysis to compare early PR with usual care. A literature search was performed through these databases: PubMed, MEDLINE database, Google Scholar, Cochrane, Embase from inception to July 2021. Eligible trials were clinical randomized controlled trials comparing the effects of early PR and usual care in AECOPD patients. The primary endpoint of this meta-analysis was FEV1% predicted, 6-min walk test (6MWD), modified Medical Research Council (mMRC) and George Respiratory Questionnaire-total (SGRQ-total). The secondary outcomes were borg dyspnea score, short-form 36 health survey questionnaire physical (SF-36 physical) and SF-36 mental. We included 13 RCTs with a total of 866 patients. There were no significant effects of the PR group on measures of FEV1% predicted (MD = 0.50, 95%CI -1.43 to 2.44, Z = 0.51, p = 0.61), borg dyspnea score (MD = -0.88, 95%CI -1.89 to 0.13, Z = 1.71, p = 0.09) and SF-36 mental (MD = 4.34, 95%CI -1.64 to 10.32, Z = 1.42, p = 0.16) compared with usual care. PR group achieved better 6MWD (MD = 97.58, 95%CI 17.21 to 177.96, Z = 2.38, p = 0.02), mMRC (MD = -0.36, 95%CI -0.52 to -0.21, Z = 4.56, p ˂ 0.00001), SGRQ-total (MD= -9.67, 95%CI -16.23 to -3.11, Z = 2.89, p = 0.004) and SF-36 physical (MD = 4.98, 95%CI 0.60 to 9.35, Z = 2.23, p = 0.03) compared with usual care group. Early PR in AECOPD patients would lead to better 6MWD, mMRC, SGRQ-total and SF-36 physical. But there were no significant effects of the PR group on measures of FEV1% predicted, borg dyspnea score and SF-36 mental.
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Affiliation(s)
- Yanping Du
- Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China
| | - Jun Lin
- Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China
| | - Xiaoxia Wang
- Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China
| | - Yan Zhang
- Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China
| | - Hua Ge
- Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China
| | - Ye Wang
- Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China
| | - Zhiyi Ma
- Pulmonary and Critical Care Medicine, The First Hospital of Longyan Affiliated to Fujian Medical University, Longyan, Fujian, China
| | - Huaping Zhang
- Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Fujian Medical University, Respiratory Medicine Center of Fujian Province, Quanzhou, Fujian, China
| | - Jun Liu
- Pulmonary and Critical Care Medicine, The Second Hospital of Longyan, Longyan, Fujian, China
| | - Zhiyong Wang
- Pulmonary and Critical Care Medicine, The First Hospital of Putian, Putian, Fujian, China
| | - Meixia Lin
- Pulmonary and Critical Care Medicine, The First Hospital of Putian, Putian, Fujian, China
| | - Fayu Ni
- Pulmonary and Critical Care Medicine, Fuqing Hospital, Fuqing, Fujian, China
| | - Xi Li
- Pulmonary and Critical Care Medicine, The Second People's Hospital Affiliated to Fujian Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Hui Tan
- Pulmonary and Critical Care Medicine, Chenzhou No. 1 People's Hospital, Chenzhou Hunan, China
| | - Shifan Tan
- Pulmonary and Critical Care Medicine, Chenzhou No. 1 People's Hospital, Chenzhou Hunan, China.,Pulmonary and Critical Care Medicine, Maoming People's Hospital, Maoming, Guangdong, Chian
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Stefan MS, Pekow PS, Priya A, ZuWallack R, Spitzer KA, Lagu TC, Pack QR, Pinto-Plata VM, Mazor KM, Lindenauer PK. Association between Initiation of Pulmonary Rehabilitation and Rehospitalizations in Patients Hospitalized with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2021; 204:1015-1023. [PMID: 34283694 PMCID: PMC8663014 DOI: 10.1164/rccm.202012-4389oc] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
Rationale: Although clinical trials have found that pulmonary rehabilitation (PR) can reduce the risk of readmissions after hospitalization for a chronic obstructive pulmonary disease (COPD) exacerbation, less is known about PR's impact in routine clinical practice. Objectives: To evaluate the association between initiation of PR within 90 days of discharge and rehospitalization(s). Methods: We analyzed a retrospective cohort of Medicare beneficiaries (66 years of age or older) hospitalized for COPD in 2014 who survived at least 30 days after discharge. Measurements and Main Results: We used propensity score matching and estimated the risk of recurrent all-cause rehospitalizations at 1 year using a multistate model to account for the competing risk of death. Of 197,376 total patients hospitalized in 4,446 hospitals, 2,721 patients (1.5%) initiated PR within 90 days of discharge. Overall, 1,534 (56.4%) patients who initiated PR and 125,720 (64.6%) who did not were rehospitalized one or more times within 1 year of discharge. In the propensity-score-matched analysis, PR initiation was associated with a lower risk of readmission in the year after PR initiation (hazard ratio, 0.83; 95% confidence interval, 0.77-0.90). The mean cumulative number of rehospitalizations at 1 year was 0.95 for those who initiated PR within 90 days and 1.15 for those who did not (P < 0.001). Conclusions: After hospitalization for COPD, Medicare beneficiaries who initiated PR within 90 days of discharge experienced fewer rehospitalizations over 1 year. These results support findings from randomized controlled clinical trials and highlight the need to identify effective strategies to increase PR participation.
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Affiliation(s)
- Mihaela S. Stefan
- Institute for Healthcare Delivery and Population Science
- Department of Medicine
| | - Penelope S. Pekow
- Institute for Healthcare Delivery and Population Science
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
| | - Aruna Priya
- Institute for Healthcare Delivery and Population Science
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
| | - Richard ZuWallack
- Pulmonary and Critical Care Division, Saint Francis Hospital and Medical Center, Hartford, Connecticut
| | | | - Tara C. Lagu
- Center for Health Services and Outcomes Research, Institute of Public Health and Medicine and
- Division of Hospital Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois; and
| | - Quinn R. Pack
- Institute for Healthcare Delivery and Population Science
- Department of Medicine
- Division of Cardiovascular Medicine, and
| | - Victor M. Pinto-Plata
- Department of Medicine
- Division of Pulmonary and Critical Care Medicine, University of Massachusetts Medical School–Baystate, Springfield, Massachusetts
| | | | - Peter K. Lindenauer
- Institute for Healthcare Delivery and Population Science
- Department of Medicine
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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5
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Ryrsø CK, Faurholt-Jepsen D, Ritz C, Pedersen BK, Hegelund MH, Dungu AM, Sejdic A, Lindegaard B, Krogh-Madsen R. The impact of physical training on length of hospital stay and physical function in patients hospitalized with community-acquired pneumonia: protocol for a randomized controlled trial. Trials 2021; 22:571. [PMID: 34454594 PMCID: PMC8397876 DOI: 10.1186/s13063-021-05503-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 08/02/2021] [Indexed: 01/10/2023] Open
Abstract
Background Community-acquired pneumonia (CAP) is a leading cause of hospitalization worldwide. Bed rest with low levels of physical activity is common during periods of hospitalization and leads to functional decline as well as increased risk of complications. The aim of this study is to assess the effect of supervised physical training during hospitalization with CAP compared with standard usual care for CAP on length of hospital stay, risk of readmission, mortality risk, physical capacity, muscle and fat mass, muscle strength, metabolic function, systemic inflammation, health-related quality of life, and physical activity level. Methods This study is a randomized controlled trial with three parallel experimental arms. Based on a sample size calculation, a total of 210 patients admitted with CAP at Nordsjællands Hospital, Hillerød, Denmark, will be recruited. Patients will be randomly allocated (1:1:1) to either (1) standard usual care, (2) standard usual care combined with in-bed cycling, or (3) standard usual care combined with exercises from a booklet. The primary outcome is differences in length of hospital stay between groups, with secondary outcomes being differences between groups in time to (1) 90-day readmission and (2) 180-day mortality. Further secondary outcomes are differences in changes from baseline between groups in (3) lean mass, (4) fat mass, (5) fat-free mass, (6) physical capacity, (7) health-related quality of life, (8) systemic inflammation, and (9) physical activity level after discharge. Data on length of hospital stay, readmission, and mortality will be collected from patient files, while total lean, fat, and fat-free mass will be quantitated by dual-energy x-ray absorptiometry and bioelectrical impedance analysis. Physical function will be assessed using grip strength, 30-s chair stand tests, and Barthel Index-100. Health-related quality of life will be assessed with the EQ-5D-5L questionnaire. Systemic inflammation will be assessed in blood samples, while accelerometers are used for measuring physical activity. Discussion If a simple physical training program appears to diminish the impact of critical illness and hospitalization on clinical outcome, mobility, and health-related quality of life, it may lead to novel therapeutic approaches in the treatment of patients hospitalized with CAP. Trial registration ClinicalTrials.gov NCT04094636. Registered on 1 April 2019 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05503-2.
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Affiliation(s)
- Camilla Koch Ryrsø
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark.,Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Daniel Faurholt-Jepsen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Bente Klarlund Pedersen
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Maria Hein Hegelund
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark
| | - Arnold Matovu Dungu
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark
| | - Adin Sejdic
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark
| | - Birgitte Lindegaard
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark. .,Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Rikke Krogh-Madsen
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
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6
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Chaulin AM, Duplyakov DV. Comorbidity in chronic obstructive pulmonary disease and cardiovascular disease. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2021. [DOI: 10.15829/1728-8800-2021-2539] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Comorbidity is one of the most significant problems of modern healthcare. Numerous studies have analyzed the possible pathogenetic mechanisms and relationships between a wide variety of diseases. Cardiovascular (CVD) and pulmonary diseases, in particular chronic obstructive pulmonary disease (COPD), have a number of the same risk factors and pathogenetic links, which aggravate each other's course. Moreover, CVD and COPD are among the most common diseases in the world. This review provides up-to-date information on the prevalence, risk factors and pathophysiological mechanisms underlying this unfavorable combination of diseases. Some problems of diagnosis and treatment of patients with COPD and CVD are also discussed.
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Affiliation(s)
- A. M. Chaulin
- Samara Regional Clinical Cardiology Dispensary; Samara State Medical University
| | - D. V. Duplyakov
- Samara Regional Clinical Cardiology Dispensary; Samara State Medical University
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7
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COMBORIDITY OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND CARDIOVASCULAR DISEASES: GENERAL FACTORS, PATHOPHYSIOLOGICAL MECHANISMS AND CLINICAL SIGNIFICANCE. КЛИНИЧЕСКАЯ ПРАКТИКА 2020. [DOI: 10.17816/clinpract21218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Currently, the comorbidity (combination) of chronic obstructive pulmonary disease (COPD) and cardiovascular diseases (CVD) is an relevant problem for health care. This is due to the high prevalence and continued growth of these pathologies. CVD and COPD have common risk factors and mechanisms underlying their development and progression: smoking, inflammation, sedentary lifestyle, aging, oxidative stress, air pollution, and hypoxia.
In this review, we summarize current knowledge relating to the prevalence and frequency of cardiovascular diseases in people with COPD and the mechanisms that underlie their coexistence. The implications for clinical practice, in particular the main problems of diagnosis and treatment of COPD/CVD comorbidity, are also discussed.
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Larson JL, Webster KE. Feasibility and acceptability of active for life with COPD, an intervention to increase light physical activity in people with COPD. Heart Lung 2020; 49:132-138. [PMID: 32008809 PMCID: PMC7278526 DOI: 10.1016/j.hrtlng.2020.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND People with chronic obstructive pulmonary disease (COPD) are very sedentary; increasing light physical activity (LPA) may help to promote long-term maintenance of physical activity. OBJECTIVES We evaluated feasibility and acceptability of Active for Life with COPD, a self-efficacy-enhancing intervention designed to increase LPA. METHODS The 10-week intervention included walking, functional circuit training, and behavioral and educational strategies. Measures included attrition, adherence, objectively measured physical activity, and qualitative interviews. RESULTS Thirty-six subjects enrolled in the study; 26 completed the intervention and 19 completed the two-month follow-up. Subjects reported the intervention was enjoyable and beneficial, but disliked the activity log and buddy system. Subjects increased mean time spent standing/stepping by 36 (SD = 82) min/24 h (P > 0.05); they retained a gain of 21 (SD = 88) min/24 h at the two-month follow-up (P > 0.05). CONCLUSIONS The Active for Life with COPD intervention is feasible, acceptable, and may support long term maintenance of physical activity.
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Affiliation(s)
- Janet L Larson
- University of Michigan School of Nursing, 400 North Ingalls Building, Ann Arbor, MI 48109-5482, United States.
| | - Katelyn E Webster
- University of Michigan School of Nursing, 400 North Ingalls Building, Ann Arbor, MI 48109-5482, United States
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9
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Sievi NA, Kohler M, Thurnheer R, Leuppi JD, Irani S, Frey M, Brutsche M, Brack T, Clarenbach CF. No impact of exacerbation frequency and severity on the physical activity decline in COPD: a long-term observation. Int J Chron Obstruct Pulmon Dis 2019; 14:431-437. [PMID: 30863043 PMCID: PMC6388775 DOI: 10.2147/copd.s188710] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction COPD exacerbations are associated with a concomitant profound reduction in daily physical activity (PA). Thereby, exacerbation frequency and severity may have an amplifying effect. Whether the reduced level of PA returns to the level prior to exacerbation or has a sustained negative impact on activity behavior over time is unclear. Methods The number of steps per day over 1 week, as a measure of daily PA, was assessed annually in a cohort of patients with COPD. Exacerbation frequency and severity were documented. Uni- and multivariate mixed effect models were used to investigate associations between change in number of steps per day (dependent variable) and exacerbations. Stratification by possible confounders was performed. Results One hundred and eighty one COPD patients (median [quartile] age 64 [59/69] years, 65% male, median [quartiles] FEV1 % pred. 46 [33/65]) suffered a total of 273 exacerbations during the observation period (median [quartiles] follow-up time of 2.1 [1.6/3.1] years). Neither the frequency nor the severity of exacerbations was significantly related to the overall decline in PA over time. Stratification by different possible confounders such as age, sex and disease severity did not yield a subgroup in which exacerbations enhance the decrease in PA over time. Conclusion The drop in PA during the phase of an acute exacerbation seems not to be a lasting phenomenon leading to a fundamental change in activity behavior. Trial registration www.ClinicalTrials.gov, NCT01527773
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Affiliation(s)
- Noriane A Sievi
- Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland,
| | - Malcolm Kohler
- Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland,
| | - Robert Thurnheer
- Pulmonary Division, Cantonal Hospital of Münsterlingen, Münsterlingen, Switzerland
| | - Joerg D Leuppi
- University Clinic of Medicine, Cantonal Hospital Baselland and University of Basel, Basel, Switzerland
| | - Sarosh Irani
- Pulmonary Division, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Martin Frey
- Pulmonary Division, Clinic Barmelweid, Barmelweid, Switzerland
| | - Martin Brutsche
- Pulmonary Division, Cantonal Hospital of St Gallen, St Gallen, Switzerland
| | - Thomas Brack
- Pulmonary Division, Cantonal Hospital of Glarus, Glarus, Switzerland
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10
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Ryrsø CK, Godtfredsen NS, Kofod LM, Lavesen M, Mogensen L, Tobberup R, Farver-Vestergaard I, Callesen HE, Tendal B, Lange P, Iepsen UW. Lower mortality after early supervised pulmonary rehabilitation following COPD-exacerbations: a systematic review and meta-analysis. BMC Pulm Med 2018; 18:154. [PMID: 30219047 PMCID: PMC6139159 DOI: 10.1186/s12890-018-0718-1] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/04/2018] [Indexed: 11/28/2022] Open
Abstract
Background Pulmonary rehabilitation (PR), delivered as a supervised multidisciplinary program including exercise training, is one of the cornerstones in the chronic obstructive pulmonary disease (COPD) management. We performed a systematic review and meta-analysis to assess the effect on mortality of a supervised early PR program, initiated during or within 4 weeks after hospitalization with an acute exacerbation of COPD compared with usual post-exacerbation care or no PR program. Secondary outcomes were days in hospital, COPD related readmissions, health-related quality of life (HRQoL), exercise capacity (walking distance), activities of daily living (ADL), fall risk and drop-out rate. Methods We identified randomized trials through a systematic search using MEDLINE, EMBASE and Cocharne Library and other sources through October 2017. Risk of bias was assessed regarding randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases using the Cochrane Risk of Bias tool. Results We included 13 randomized trials (801 participants). Our meta-analyses showed a clinically relevant reduction in mortality after early PR (4 trials, 319 patients; RR = 0.58 (95% CI: [0.35 to 0.98])) and at the longest follow-up (3 trials, 127 patients; RR = 0.55 (95% CI: [0.12 to 2.57])). Early PR reduced number of days in hospital by 4.27 days (1 trial, 180 patients; 95% CI: [− 6.85 to − 1.69]) and hospital readmissions (6 trials, 319 patients; RR = 0.47 (95% CI: [0.29 to 0.75])). Moreover, early PR improved HRQoL and walking distance, and did not affect drop-out rate. Several of the trials had unclear risk of bias in regard to the randomization and blinding, for some outcome there was also a lack of power. Conclusion Moderate quality of evidence showed reductions in mortality, number of days in hospital and number of readmissions after early PR in patients hospitalized with a COPD exacerbation. Long-term effects on mortality were not statistically significant, but improvements in HRQoL and exercise capacity appeared to be maintained for at least 12 months. Therefore, we recommend early supervised PR to patients with COPD-related exacerbations. PR should be initiated during hospital admission or within 4 weeks after hospital discharge. Electronic supplementary material The online version of this article (10.1186/s12890-018-0718-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Camilla Koch Ryrsø
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark. .,Danish Health Authority, Copenhagen, Denmark.
| | - Nina Skavlan Godtfredsen
- Department of Respiratory Medicine, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Linette Marie Kofod
- Department of Physiotherapy, Copenhagen University Hospital, Hvidovre, Denmark
| | - Marie Lavesen
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, Nordsjælland, Hillerød, Denmark
| | - Line Mogensen
- The Department of the Elderly and Disabled, Odense Municipality, Odense, Denmark
| | - Randi Tobberup
- Department of Gastroenterology, Center for Nutrition and Bowel Disease, Aalborg University Hospital, Aalborg, Denmark
| | - Ingeborg Farver-Vestergaard
- Unit for Psychooncology and Health Psychology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | | | | | - Peter Lange
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.,Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark.,Medical Department O, Respiratory Section, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Ulrik Winning Iepsen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
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11
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Dogra S, Good J, Buman MP, Gardiner PA, Copeland JL, Stickland MK. Physical activity and sedentary time are related to clinically relevant health outcomes among adults with obstructive lung disease. BMC Pulm Med 2018; 18:98. [PMID: 29879930 PMCID: PMC5992845 DOI: 10.1186/s12890-018-0659-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 05/23/2018] [Indexed: 12/22/2022] Open
Abstract
Background The purpose of the current study was to determine the association between sedentary time and physical activity with clinically relevant health outcomes among adults with impaired spirometry and those with or without self-reported obstructive lung disease (asthma or COPD). Methods Data from participants of the Canadian Longitudinal Study on Aging were used for analysis (n = 4156). Lung function was assessed using spirometry. Adults were said to have impaired spirometry if their Forced Expiratory Volume in 1 s was <5th percentile lower limit of normal (LLN). A modified version of the Physical Activity Scale for the Elderly was used to assess sitting time and physical activity levels. Healthcare use and quality of life outcomes were assessed using self report. Results Among those with asthma, participating in strengthening activities was associated with lower odds of reporting poor perceived health (OR = 0.65, CI: 0.53, 0.79), poor perceived mental-health (OR = 0.73, CI: 0.60, 0.88), unhealthy aging (OR = 0.68, CI: 0.56, 0.83), and reporting an emergency department visit in the past 12 months (OR = 0.76, CI: 0.60, 0.95). Among those with COPD, those who reported highest weekly sedentary time had higher odds of reporting poor perceived health (OR = 2.70, CI: 1.72, 4.24), poor perceived mental-health (OR = 1.99, CI: 1.29, 3.06), and unhealthy aging (OR = 3.04, CI: 1.96, 4.72). Among those below the LLN, sitting time (OR = 2.57, CI: 1.40, 4.72) and moderate intensity physical activity (OR = 0.23, CI: 0.09, 0.63) were associated with overnight hospital stays. Conclusions Higher physical activity levels and lower sedentary time may be associated with lower healthcare use and better quality of life. This research may have implications related to the use of physical activity for improving health outcomes and quality of life among adults with obstructive lung disease or impaired spirometry. Electronic supplementary material The online version of this article (10.1186/s12890-018-0659-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shilpa Dogra
- Faculty of Health Sciences (Kinesiology), University of Ontario Institute of Technology, 2000 Simcoe St N, Oshawa, ON, L1H-7K4, Canada.
| | - Joshua Good
- Faculty of Health Sciences (Kinesiology), University of Ontario Institute of Technology, 2000 Simcoe St N, Oshawa, ON, L1H-7K4, Canada
| | - Matthew P Buman
- College of Health Solutions, Arizona State University, 550 N 3rd Street, Phoenix, AZ, 85004, USA
| | - Paul A Gardiner
- Faculty of Medicine, The University of Queensland, Level 2, Building 33, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - Jennifer L Copeland
- Department of Kinesiology and Physical Education, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada
| | - Michael K Stickland
- Faculty of Medicine and Dentistry, University of Alberta, and G.F. Macdonald Centre for Lung Health, 3-135 Clinical Sciences Building, 11304 - 83 Avenue, Edmonton, Alberta, T6G 2J3, Canada
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12
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Commonly Used Patient-Reported Outcomes Do Not Improve Prediction of COPD Exacerbations. Chest 2017; 152:1179-1187. [DOI: 10.1016/j.chest.2017.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 08/14/2017] [Accepted: 09/06/2017] [Indexed: 12/25/2022] Open
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13
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Tsai LLY, Alison JA, McKenzie DK, McKeough ZJ. Physical activity levels improve following discharge in people admitted to hospital with an acute exacerbation of chronic obstructive pulmonary disease. Chron Respir Dis 2016; 13:23-32. [PMID: 26374299 PMCID: PMC5720195 DOI: 10.1177/1479972315603715] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study aimed to determine the physical activity level of people admitted to hospital with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and whether physical activity changed immediately after discharge and 6 weeks post hospital admission. In this prospective observational study, people admitted to hospital with an AECOPD had physical activity levels monitored using the SenseWear(®) Armband (model MF-SW) for 3 days in hospital (T1), during the first week at home following discharge (T2), and at home during the sixth week after admission (T3). Fifty participants (mean age (SD) 71 (10) years) completed the study. There was a linear increase in average steps per day over the three time periods (T1, mean (SD) 1385 (1972) steps/day; T2, 2040 (2680); T3, 2328 (2745); analysis of variance (ANOVA) p = 0.001) and time spent in moderate activity (3.0-6.0 metabolic equivalents; minutes/day) (T1, mean (SD) 16 (27) minutes/day; T2, 32 (46) minutes/day; T3, 35 (58) minutes/day; ANOVA p = 0.008). For both outcomes, post hoc t-tests showed significant improvements from T1 to T2 and from T1 to T3, but not between T2 and T3. Physical activity was low in hospital and significantly improved in the week after discharge but showed no further significant improvement at 6 weeks following a hospitalized AECOPD.
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Affiliation(s)
- Ling Ling Y Tsai
- Clinical and Rehabilitation Sciences, University of Sydney, Lidcombe, New South Wales, Australia Department of Physiotherapy, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Jennifer A Alison
- Clinical and Rehabilitation Sciences, University of Sydney, Lidcombe, New South Wales, Australia Department of Physiotherapy, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - David K McKenzie
- Department of Respiratory and Sleep Medicine, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Zoe J McKeough
- Clinical and Rehabilitation Sciences, University of Sydney, Lidcombe, New South Wales, Australia
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14
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Di Marco F, Santus P, Sotgiu G, Blasi F, Centanni S. Does Improving Exercise Capacity and Daily Activity Represent the Holistic Perspective of a New COPD Approach? COPD 2015; 12:575-81. [PMID: 26457460 DOI: 10.3109/15412555.2015.1008694] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In COPD patients a reduced daily activity has been well documented, resulting from both respiratory and non-respiratory manifestations of the disease. An evaluation by multisensory armband has confirmed that daily physical activity is mainly associated with dynamic hyperinflation, regardless of COPD severity. This aspect is crucial, since exercise capacity is closely correlated to life expectancy. Notwithstanding the causal key role of lung impairment in the patient's symptoms, some authors have suggested that other factors, such as systemic inflammation and co-morbidities, have an important role, particularly as mortality risk factors. Many studies suggest the efficacy of bronchodilators and rehabilitation in improving exercise capacity, and, speaking in terms of daily life, in increasing the number of days in which patients are able to perform their usual activities. On this evidence, the first aim in the management of COPD should be to improve exercise capacity and daily activity since these outcomes have direct effects on patients' quality of life, co-morbidities (heart and metabolic diseases), and prognosis. Thus, improving physical activity represents a modern approach aimed at dealing with both pulmonary and systemic manifestations of the disease. It is however worth of notice to remember that in patients affected by COPD the relationship between the improvement of "potential" exercise capacity and daily physical activity has been found to be only moderate to weak. Obtaining a significant behavior modification with regard to daily physical activity, together with the optimization of therapy thus represents currently the true challenge.
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Affiliation(s)
- Fabiano Di Marco
- a Respiratory Unit, Ospedale San Paolo, Dept of Scienze della Salute , Università degli Studi di Milano , Milan , Italy
| | - Pierachille Santus
- b Respiratory Unit Fondazione Salvatore Maugeri-Istituto Scientifico di Milano - IRCCS , Università degli Studi di Milano , Milan , Italy
| | - Giovanni Sotgiu
- c Clinical Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences , University of Sassari - Research, Medical Education and Professional Development Unit , AOU Sassari , Italy
| | - Francesco Blasi
- d Respiratory Unit, IRCCS Fondazione Cà Granda Milano, Department of Pathophysiology and Transplantation , University of Milan , Milan , Italy
| | - Stefano Centanni
- a Respiratory Unit, Ospedale San Paolo, Dept of Scienze della Salute , Università degli Studi di Milano , Milan , Italy
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15
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Schönmann M, Sievi NA, Clarenbach CF, Brack T, Brutsche M, Frey M, Irani S, Leuppi JD, Ruediger J, Senn O, Thurnheer R, Kohler M. Physical Activity and the Frequency of Acute Exacerbations in Patients with Chronic Obstructive Pulmonary Disease. Lung 2014; 193:63-70. [DOI: 10.1007/s00408-014-9673-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/06/2014] [Indexed: 11/30/2022]
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16
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Feasibility and Acceptability of Utilizing a Smartphone Based Application to Monitor Outpatient Discharge Instruction Compliance in Cardiac Disease Patients around Discharge from Hospitalization. Int J Telemed Appl 2014; 2014:415868. [PMID: 25574165 PMCID: PMC4276693 DOI: 10.1155/2014/415868] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 11/10/2014] [Accepted: 11/24/2014] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study was to determine the feasibility and acceptability of utilizing a smartphone based application to monitor compliance in patients with cardiac disease around discharge. For 60 days after discharge, patients' medication compliance, physical activity, follow-up care, symptoms, and reading of education material were monitored daily with the application. 16 patients were enrolled in the study (12 males, 4 females, age 55 ± 18 years) during their hospital stay. Five participants were rehospitalized during the study and did not use the application once discharged. Seven participants completed 1-30 days and four patients completed >31 days. For those 11 patients, medication reminders were utilized 37% (1-30-day group) and 53% (>31-day group) of the time, education material was read 44% (1-30) and 53% (>31) of the time, and physical activity was reported 25% (1-30) and 42% (>31) of the time. Findings demonstrated that patients with stable health utilized the application, even if only minimally. Patients with decreased breath sounds by physical exam and who reported their health as fair to poor on the day of discharge were less likely to utilize the application. Acceptability of the application to report health status varied among the stable patients.
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17
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Glycopyrronium for chronic obstructive pulmonary disease: evidence and rationale for use from the GLOW trials. ACTA ACUST UNITED AC 2014. [DOI: 10.4155/cli.14.89] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Garcia-Aymerich J, Pitta F. Promoting Regular Physical Activity in Pulmonary Rehabilitation. Clin Chest Med 2014; 35:363-8. [DOI: 10.1016/j.ccm.2014.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Association between physical activity measurements and key parameters of cardiopulmonary exercise testing in patients with heart failure. J Card Fail 2014; 19:635-40. [PMID: 24054340 DOI: 10.1016/j.cardfail.2013.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 07/20/2013] [Accepted: 08/07/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND A hallmark characteristic of heart failure (HF) is reduced physical activity (PA) patterns. The relationship between key cardiopulmonary exercise testing (CPX) variables and PA patterns has not been investigated. Therefore, we evaluated PA patterns in patients with ischemic HF and its relationship to peak oxygen consumption (VO2), the minute ventilation/carbon dioxide production (VE/VCO2) slope, and the oxygen uptake efficiency slope (OUES). METHODS AND RESULTS Sixteen patients with HF wore an accelerometer for six days to measure total steps/day as well as percentage of time at light, moderate, and vigorous PA. Symptom-limited CPX was performed on a treadmill using a ramping protocol. Total steps correlated with VO2 (r = 0.64 P < .05), the VE/VCO2 slope (r = -0.72; P < .05), and the OUES (0.63; P < .05). The percentage of time at light-intensity PA correlated with the VE/VCO2 slope (r = 0.58; P < .05) and the OUES (r = -0.51; P < .05). The percentage of time at vigorous-intensity PA correlated with peak VO2 (r = 0.55; P < .05) and the VE/VCO2 slope (r = -0.52; P < .05). CONCLUSIONS PA assessed by accelerometer is significantly associated with key CPX variables in patients with HF.
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20
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Musculoskeletal disorders in chronic obstructive pulmonary disease. BIOMED RESEARCH INTERNATIONAL 2014; 2014:965764. [PMID: 24783225 PMCID: PMC3982416 DOI: 10.1155/2014/965764] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 02/13/2014] [Indexed: 12/17/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a lung disease characterized by airway obstruction and inflammation but also accompanied by several extrapulmonary consequences, such as skeletal muscle weakness and osteoporosis. Skeletal muscle weakness is of major concern, since it leads to poor functional capacity, impaired health status, increased healthcare utilization, and even mortality, independently of lung function. Osteoporosis leads to fractures and is associated with increased mortality, functional decline, loss of quality of life, and need for institutionalization. Therefore, the presence of the combination of these comorbidities will have a negative impact on daily life in patients with COPD. In this review, we will focus on these two comorbidities, their prevalence in COPD, combined risk factors, and pathogenesis. We will try to prove the clustering of these comorbidities and discuss possible preventive or therapeutic strategies.
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21
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Park SK, Richardson CR, Holleman RG, Larson JL. Physical activity in people with COPD, using the National Health and Nutrition Evaluation Survey dataset (2003-2006). Heart Lung 2013; 42:235-40. [PMID: 23726356 PMCID: PMC4031646 DOI: 10.1016/j.hrtlng.2013.04.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 04/25/2013] [Accepted: 04/26/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND People with chronic obstructive pulmonary disease (COPD) are sedentary but the extent of the problem is not fully understood. PURPOSES This study examines sedentary time and physical activity (PA) and the relative effects of demographic and clinical characteristics on sedentary time and PA in a population-based sample of people with COPD and a comparison group from the general population. METHODS Subjects were drawn from the National Health and Nutrition Examination Survey dataset (2003-2006). Physical activity was measured by accelerometry. RESULTS People with COPD were sedentary and spent less time in most levels of PA. Age, gender, race, level of education, working status, shortness of breath, self-reported health, and body mass index were significantly associated with sedentary time or level of PA. CONCLUSION Findings emphasize the need to decrease sedentary time and increase PA in people with COPD.
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Affiliation(s)
- Soo Kyung Park
- College of Nursing, Korea University, 145 Anam-Ro, Seongbuk-gu, Seoul, Republic of Korea.
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22
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Moy ML, Teylan M, Weston NA, Gagnon DR, Garshick E. Daily step count predicts acute exacerbations in a US cohort with COPD. PLoS One 2013; 8:e60400. [PMID: 23593211 PMCID: PMC3617234 DOI: 10.1371/journal.pone.0060400] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 02/27/2013] [Indexed: 11/24/2022] Open
Abstract
Background COPD is characterized by variability in exercise capacity and physical activity (PA), and acute exacerbations (AEs). Little is known about the relationship between daily step count, a direct measure of PA, and the risk of AEs, including hospitalizations. Methods In an observational cohort study of 169 persons with COPD, we directly assessed PA with the StepWatch Activity Monitor, an ankle-worn accelerometer that measures daily step count. We also assessed exercise capacity with the 6-minute walk test (6MWT) and patient-reported PA with the St. George's Respiratory Questionnaire Activity Score (SGRQ-AS). AEs and COPD-related hospitalizations were assessed and validated prospectively over a median of 16 months. Results Mean daily step count was 5804±3141 steps. Over 209 person-years of observation, there were 263 AEs (incidence rate 1.3±1.6 per person-year) and 116 COPD-related hospitalizations (incidence rate 0.56±1.09 per person-year). Adjusting for FEV1 % predicted and prednisone use for AE in previous year, for each 1000 fewer steps per day walked at baseline, there was an increased rate of AEs (rate ratio 1.07; 95%CI = 1.003–1.15) and COPD-related hospitalizations (rate ratio 1.24; 95%CI = 1.08–1.42). There was a significant linear trend of decreasing daily step count by quartiles and increasing rate ratios for AEs (P = 0.008) and COPD-related hospitalizations (P = 0.003). Each 30-meter decrease in 6MWT distance was associated with an increased rate ratio of 1.07 (95%CI = 1.01–1.14) for AEs and 1.18 (95%CI = 1.07–1.30) for COPD-related hospitalizations. Worsening of SGRQ-AS by 4 points was associated with an increased rate ratio of 1.05 (95%CI = 1.01–1.09) for AEs and 1.10 (95%CI = 1.02–1.17) for COPD-related hospitalizations. Conclusions Lower daily step count, lower 6MWT distance, and worse SGRQ-AS predict future AEs and COPD–related hospitalizations, independent of pulmonary function and previous AE history. These results support the importance of assessing PA in patients with COPD, and provide the rationale to promote PA as part of exacerbation-prevention strategies.
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Affiliation(s)
- Marilyn L Moy
- Department of Veteran Affairs, Veterans Health Administration, Rehabilitation Research and Development Service, Washington, DC, United States of America.
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