Factors Associated with Reduction of Sedentary Time Following Tiotropium/Olodaterol Therapy in Treatment-Naïve Chronic Obstructive Pulmonary Disease

Abstract

Background: Prolonged sedentary behavior is associated with worse prognosis in patients with chronic obstructive pulmonary disease (COPD). Our previous study found that first-line dual therapy with tiotropium/olodaterol significantly reduces sedentary time compared to tiotropium monotherapy in Japanese patients with treatment-naïve COPD, although the characteristics of responders to dual-therapy versus monotherapy for COPD are still unclear. Methods: Patients with treatment-naïve COPD were randomized to receive either tiotropium or tiotropium/olodaterol treatment for 12 weeks. Physical activity was assessed using a triaxle accelerometer for 2 weeks before and after treatment. This analysis focused on the change in sedentary time, indicated by physical activity of 1.0-1.5 metabolic equivalents (METs), with stratification for the following factors: age, body mass index (BMI), pulmonary function, COPD assessment test (CAT), the 6-minute walk distance (6MWD), and physical activity level at study entry. Results: Thirty-five patients received tiotropium/olodaterol and 34 patients received tiotropium. In patients with lower inspiratory capacity at study entry, a significant reduction in sedentary time was observed in the tiotropium/olodaterol group compared with the tiotropium group (Tio: −12.8 ± 13.5 min, Tio/Olo: −65.1 ± 21.0 min, mean difference, −52.2 min, 95% CI −103.6 to 0.88, p = 0.046). In patients with a shorter duration of physical activity of ≥2 METs at study entry, a significant reduction of sedentary time was observed in the tiotropium/olodaterol group compared with the tiotropium group (Tio: −3.3 ± 17.5 min, Tio/Olo: −72.9 ± 23.1 min, mean difference, −69.7 min, 95% CI −128.7 to −10.6, p = 0.02). There were no differences in terms of age, BMI, CAT score, 6MWD, FEV1, FVC, VC, and physical activity of 1.0-1.5 METs and ≥3.0 METs. Conclusion:This study showed that COPD patients with lower inspiratory capacity or shorter active time of ≥2.0 METs at study entry are likely to exhibit significantly greater reduction in sedentary time with tiotropium/olodaterol treatment.

Clinical Impacts of Interventions for Physical Activity and Sedentary Behavior on Patients with Chronic Obstructive Pulmonary Disease

“…Other parameters, such as changes of forced expiratory volume in 1 s and the transient dyspnea index, were more improved by dual therapy than monotherapy. We also reported that COPD patients with lower inspiratory capacity or shorter time spent on activity of more than 2.0 METs before dual therapy had a significantly greater reduction in sedentary time after dual therapy [ 118 ]. These data showed that sedentary behavior time was reduced because of improvement of decreased inspiratory capacity, which contributes to shortness of breath and dyspnea, by dual bronchodilator therapy.…”

Objective Measurement of Physical Activity and Sedentary Behavior in Patients with Chronic Obstructive Pulmonary Disease: Points to Keep in Mind during Evaluations

“…ST can be more strongly influenced by the wearing time than the duration of PA, simply because ST accounts for the majority of the measurement time. The minimum required wearing time was reported to be set to 8 [31], 10 [130,132-134], or 12 h [67,128,131,135] in previous studies, and the wearing time tended to be longer for SB assessments than for PA assessments. Further research is needed to confirm the optimal wearing time for evaluating ST.…”

Reliability and Effectiveness of the Japanese Version of the Mobilization Quantification Score

“…Physical activity (PA) in patients with respiratory failure is a significant prognostic factor for mortality due to severe exacerbation [ 8 , 9 ]. In particular, PA in patients with severe respiratory failure tends to decrease due to disease management [ 10 ].…”