Associations of total and type-specific physical activity with mortality in chronic obstructive pulmonary disease: a population-based cohort study

Abstract

BackgroundRegular physical activity is recommended for all people with chronic obstructive pulmonary disease (COPD), but the dose of physical activity required to gain mortality benefit in this population is not yet known. This aim of this study was to examine the associations of total and type-specific physical activity with mortality risk in people with COPD.MethodsPeople with COPD aged ≥40 years were identified from the 1997 Health Survey for England and the 1998 and 2003 Scottish Health Survey cohorts. Self-reported total physical activity, moderate-vigorous intensity physical activity (MVPA), walking, domestic physical activity, and sport/exercise were assessed at baseline. Cox proportional hazards models were used to examine the associations between physical activity and mortality risk.ResultsTwo thousand three hundred ninety-eight participants with COPD were included in the analysis and followed up for a mean 8.5 (SD 3.9) years. For both total physical activity and MVPA, we observed dose-response associations with all-cause and cardiovascular disease (CVD) mortality risk, and with respiratory mortality risk to a lesser extent. Compared to those who reported no physical activity, participants who met the physical activity guidelines demonstrated the greatest reductions in all-cause (HR 0.56, 95% CI 0.45–0.69), CVD (HR 0.48, 95% CI 0.32–0.71) and respiratory mortality risk (HR 0.40, 95% CI 0.24–0.67). Participants who reported a level of physical activity of at least half the dosage recommended by the guidelines also had a reduced risk of all-cause (HR 0.75, 95% CI 0.56–1.00) and CVD mortality (HR 0.48, 95% CI 0.26–0.88). Dose-response associations with mortality risk were demonstrated for walking and sport/exercise, but not domestic physical activity.ConclusionsWe found a dose-response association between physical activity and all-cause and CVD mortality risk in people with COPD, with protective effects appearing at levels considerably lower than the general physical activity recommendations. People with COPD may benefit from engagement in low levels of physical activity, particularly walking and structured exercise.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5167-5) contains supplementary material, which is available to authorized users.

Dose–response relationship between physical activity and mortality in adults with noncommunicable diseases: a systematic review and meta-analysis of prospective observational studies

“…Detailed information on the measurement instruments for physical activity assessment can be found in Supplementary file 3 . Exposure categories were presented as the volume of physical activity in MET-h/week [ 14 , 28 – 32 , 34 – 42 , 44 – 46 , 52 ], calorie expenditure [ 49 ], duration of physical activity [ 43 ], frequency of physical activity [ 51 ], and nominal categories [ 13 , 33 , 47 , 48 , 50 , 53 ].…”

“… Questionnaire MET-h/week: 0–5.1 5.2–12.0 12.1–21.7 21.8–37.1 ≥37.2 1 0.88 (0.64–1.21) 0.64 (0.45–0.91) 0.64 (0.45–0.90) 0.65 (0.45–0.93) BMI, alcohol intake, smoking status, family history of myocardial infarction, use of vitamin E supplements, diabetes duration, diabetes medication, dietary intake of trans fat, saturated fat, fiber, and folate, history of angina and coronary artery bypass graft (CABG), hypertension at baseline, high serum cholesterol at baseline. Moderate Chronic obstructive pulmonary disease Cheng 2018 [ 14 ], HSE and SES, prospective cohort study, England and Scotland n = 2398/ m-f 571 cases Mean (SD), y = 8.5 (3.9) Confirmed by spirometry according to GOLD criteria; National Health Service mortality data. Questionnaire MET-h/week: 0 < 3.75 3.75- < 7.5 ≥ 7.5 1 0.86 (0.67–1.10) 0.75 (0.56–1) 0.56 (0.45–0.69) Age, gender, BMI, COPD severity, history of CVD, cancer and diabetes, self-reported longstanding illness, smoking status, alcohol consumption, education.…”

“…Thirteen authors of the selected studies were contacted for additional data on physical activity. However the original data from two authors did not allow for an estimation of physical activity levels in MET-h/week (meaning that these studies were excluded), and two authors provided information on physical activity dosage [13,14].…”

“…Physical activity was associated with lower mortality rates in persons with breast cancer, T2D, COPD and IHD. For every 10 MET-h increase of physical activity per week, the summary hazard ratio (SHR) decreased by 22% in people with breast cancer (HR, 0.78; 95% CI: 0.71, 0.86; n = 12) [28,30,32,[34][35][36][37][38][39][40][41][42], by 12% in people with IHD (HR, 0.88; 95% CI: 0.83, 0.93; n = 8) [13,29,[48][49][50][51][52][53], and by 30% in people with COPD (HR, 0.70; 95% CI: 0.45, 1.09; n = 2) [14,47]. The mortality rates in people with T2D reduced by 4% for every 10 MET-h/week (HR, 0.96; 95% CI: 0.93, 0.99; n = 6) [31,33,[43][44][45][46].…”

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

“…The selection of the control variables was based on past literature [37,38]. Sociodemographic variables included age, sex, education and marital status.…”