An official European Respiratory Society statement on physical activity in COPD

Watz, Henrik; Pitta, Fábio; Rochester, Carolyn L.; Garcia‐Aymerich, Judith; ZuWallack, Richard; Troosters, Thierry; Vaes, Anouk W.; Puhan, Milo A.; Jehn, Melissa; Polkey, Michael I.; Vogiatzis, Ioannis; Clini, Enrico; Toth, Michael J.; Gimeno‐Santos, Elena; Waschki, Benjamin; Esteban, Cristóbal; Hayot, Maurice; Casaburi, Richard; Pórszász, János; McAuley, Edward; Singh, Sally; Langer, Daniël; Wouters, Emiel F.M.; Magnussen, H; Spruit, Martijn A.

doi:10.1183/09031936.00046814

Cited by 418 publications

(477 citation statements)

References 168 publications

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“…While pulmonary rehabilitation that includes supervised exercise training is efficacious (5), several factors limit the reach of this intervention (6). Moreover, pulmonary rehabilitation and exercise training have not been consistently associated with an increase in daily levels of physical activity (2)(3)(4)7), and there are very few trials of interventions to increase physical activity among patients with COPD compared with interventions of supervised exercise training (8)(9)(10)(11)(12).…”

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confidence: 99%

A Lifestyle Physical Activity Intervention for Patients with Chronic Obstructive Pulmonary Disease. A Randomized Controlled Trial

et al. 2016

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Rationale: Physical inactivity is associated with poor outcomes among patients with chronic obstructive pulmonary disease (COPD).Objectives: To determine effectiveness of a behavioral intervention intended to increase daily physical activity with the goal of improving health-related quality of life and functional performance. Methods:We conducted a randomized trial among patients with COPD cared for in primary care and pulmonary clinics. The patients were at least 45 years of age and eligible for pulmonary rehabilitation. All patients received self-management education during a 6-week run-in period. Subsequently, patients were randomized to usual care or the intervention delivered over 20 weeks.Measurements and Main Results: Co-primary outcomes were change from baseline in Chronic Respiratory Questionnaire dyspnea domain score and 6-minute-walk distance measured at 6, 12, and 18 months after randomization. A total of 325 patients were enrolled, with 156 randomized to receive usual care and 149 to receive the intervention. At 18 months, there was no overall statistical or clinically significant change in the dyspnea domain in either group. However, for 6-minute-walk distance, there were statistically significant declines in both groups. In contrast, 6-minute-walk distance remained stable (5.3 m; P = 0.54) among patients in the intervention group with moderate spirometric impairment, but it was associated with clinically and statistically significant declines (228.7 m; P = 0.0001) among usual care patients with moderate spirometric impairment. Overall, there was no increase in adverse events associated with the intervention, which was associated with a lower prevalence of hospitalization for COPD exacerbations (28.3%) compared with usual care (49.5%).

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confidence: 99%

A Lifestyle Physical Activity Intervention for Patients with Chronic Obstructive Pulmonary Disease. A Randomized Controlled Trial

et al. 2016

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“…Despite concomitant increase in exercise capacity, the number of steps/day decreased in the placebo group, indicating a compensatory response to recover from the intensive exercise training sessions in daily physical activity. The observed dissociation between physical performance and daily physical activity has previously been reported in studies evaluating the effect of PR on daily physical activity22 and suggests that changing physical activity behaviour requires a more comprehensive approach than only targeting exercise capacity 23. In contrast to the placebo group, no adaptive decrease in daily steps was shown by patients receiving nutritional supplementation.…”

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confidence: 54%

A randomized clinical trial investigating the efficacy of targeted nutrition as adjunct to exercise training in COPD

Bool

Rutten

Helvoort

et al. 2017

J cachexia sarcopenia muscle

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111

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BackgroundEvidence regarding the efficacy of nutritional supplementation to enhance exercise training responses in COPD patients with low muscle mass is limited.The objective was to study if nutritional supplementation targeting muscle derangements enhances outcome of exercise training in COPD patients with low muscle mass.MethodsEighty‐one COPD patients with low muscle mass, admitted to out‐patient pulmonary rehabilitation, randomly received oral nutritional supplementation, enriched with leucine, vitamin D, and omega‐3 fatty acids (NUTRITION) or PLACEBO as adjunct to 4 months supervised high intensity exercise training.ResultsThe study population (51% males, aged 43–80) showed moderate airflow limitation, low diffusion capacity, normal protein intake, low plasma vitamin D, and docosahexaenoic acid. Intention‐to‐treat analysis revealed significant differences after 4 months favouring NUTRITION for body mass (mean difference ± SEM) (+15 ± 06 kg, P = 001), plasma vitamin D (+24%, P = 0004), eicosapentaenoic acid (+91%,P < 0001), docosahexaenoic acid (+31%, P < 0001), and steps/day (+24%, P = 0048). After 4 months, both groups improved skeletal muscle mass (+04 ± 01 kg, P < 0001), quadriceps muscle strength (+123 ± 23 Nm,P < 0001), and cycle endurance time (+1914 ± 343 s, P < 0001). Inspiratory muscle strength only improved in NUTRITION (+05 ± 01 kPa, P = 0001) and steps/day declined in PLACEBO (−18%,P = 0005).ConclusionsHigh intensity exercise training is effective in improving lower limb muscle strength and exercise performance in COPD patients with low muscle mass and moderate airflow obstruction. Specific nutritional supplementation had additional effects on nutritional status, inspiratory muscle strength, and physical activity compared with placebo.

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“…[48][49][50] Physical activity in patients with COPD is dependent on many factors, including physiological, behavioral, social, environmental, and cultural factors. 51,52 Watz and colleagues 53 have shown that daily physical activity is only weakly associated with post-bronchodilator FEV1. There is, however, a strong inverse association between daily physical activity and dynamic hyperinflation, which correlates strongly with exertional dyspnea in COPD.…”

Section: Pulmonary Research and Respiratory Medicine Issn 2377-1658mentioning

confidence: 99%

“…Pedometers are devices which estimate the number of steps taken through mechanical or digital measurements in only the vertical plane. [45][46][47] This is a limited measure of physical activity. Accelerometers detect acceleration in one, two or three directions (uni-, bi-or triaxial accelerometers).…”

Section: Pulmonary Research and Respiratory Medicine Issn 2377-1658mentioning

confidence: 99%

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Recent Advances in Pulmonary Rehabilitation for Patients with COPD

Shioya¹,

Iwakura²,

Kawagoshi³

et al. 2017

Pulm Res Respir Med Open J

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Pulmonary rehabilitation (PR) is a non-pharmacologic therapy that has emerged as a standard of care for patients with chronic obstructive pulmonary disease (COPD). It is a comprehensive, multidisciplinary, patient-centered intervention that includes patient assessment, exercise training, self-management education, and psychosocial support. PR is usually given in inpatient, outpatient, community-based or home-based setting lasting 8-12 weeks. Positive outcomes from PR include increased exercise tolerance, reduced dyspnea and anxiety, increased selfefficacy, and improvement in health-related quality of life (QoL). Hospital admissions after exacerbations of COPD are also reduced with this intervention. The positive outcomes associated with PR are realized without demonstrable improvements in lung function. This paradox is explained by the fact that PR identifies and treats the systemic effects of the disease. This intervention should be considered in patients who remain symptomatic or have decreased functional status despite optimal medical management. Physical activity in patients with COPD is dependent on many factors, including physiologic, behavioral, social, environmental, and cultural factors. A strong inverse association between daily physical activity and dynamic hyperinflation, which correlates strongly with exertional dyspnea in COPD. Changing physical activity behavior inpatients with COPD needs an interdisciplinary approach, bringing together respiratory medicine, rehabilitation sciences, social sciences, and behavioral sciences. There is a need for more education and learning opportunities for primary care physicians, nurse practitioners, and all allied health care professionals about the process and benefits of PR. There is also a need for the sustainability and the safety of PR in the future study.

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An official European Respiratory Society statement on physical activity in COPD

Cited by 418 publications

References 168 publications

A Lifestyle Physical Activity Intervention for Patients with Chronic Obstructive Pulmonary Disease. A Randomized Controlled Trial

A Lifestyle Physical Activity Intervention for Patients with Chronic Obstructive Pulmonary Disease. A Randomized Controlled Trial

A randomized clinical trial investigating the efficacy of targeted nutrition as adjunct to exercise training in COPD

Recent Advances in Pulmonary Rehabilitation for Patients with COPD

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