Predictors and changes of physical activity in idiopathic pulmonary fibrosis

Abstract

Background Different clinical predictors of physical activity (PA) have been described in idiopathic pulmonary fibrosis (IPF), but studies are lacking evaluating the potential role of muscle strength and anxiety and depression symptoms in PA limitation. Moreover, little is known about the impact of changes in PA in the course of the disease. The aim of the present study was to investigate the relationship between baseline PA and a wide range of variables in IPF, to assess its longitudinal changes at 12 months and its impact on progression free-survival. Methods PA was assessed by accelerometer and physiological, clinical, psychological factors and health-related quality of life were evaluated in subjects with IPF at baseline and at 12 month follow-up. Predictors of PA were determined at baseline, evolution of PA parameters was described and the prognostic role of PA evolution was also established. Results Forty participants with IPF were included and 22 completed the follow-up. At baseline, subjects performed 5765 (3442) daily steps and spent 64 (44) minutes/day in moderate to vigorous PA. Multivariate regression models showed that at baseline, a lower six-minute walked distance, lower quadriceps strength (QMVC), and a higher depression score in the Hospital Anxiety and Depression scale were associated to lower daily step number. In addition, being in (Gender-Age-Physiology) GAP III stage, having a BMI ≥ 25 kg/m2 and lower QMVC or maximum inspiratory pressure were factors associated with sedentary behaviour. Adjusted for age, gender and forced vital capacity (FVC) (%pred.) a lower progression-free survival was evidenced in those subjects that decreased PA compared to those that maintained, or even increased it, at 12 months [HR 12.1 (95% CI, 1.9–78.8); p = 0.009]. Conclusion Among a wide range of variables, muscle strength and depression symptoms have a predominant role in PA in IPF patients. Daily PA behaviour and its evolution should be considered in IPF clinical assessment and as a potential complementary indicator of disease prognosis.

The preventative effects of statin on lung cancer development in patients with idiopathic pulmonary fibrosis using the National Health Insurance Service Database in Korea

“…Decreased physical activity was associated with lower progression-free survival (HR 12.1, 95% CI, 1.9–78.8, P = 0.009) in IPF patients. Lower quadriceps strength and higher depression scores contribute to lower physical activity [ 62 ]. Pulmonary rehabilitation using exercise training is effective for improving exercise capacity, dyspnea, and quality of life in IPF patients [ 63 ].…”

Physical activity in idiopathic pulmonary fibrosis: Longitudinal change and minimal clinically important difference

“…Moreover, the range of decline in IPF patients to a MCID of 570-1358 steps in our study appears more consistent with the range shown in COPD patients after a medical event. 19 Considering together that physical activity decline is associated with worse survival in COPD and IPF patients, 7,45 judicious evaluation of physical activity may be required to optimize clinical management in IPF patients. Pulmonary rehabilitation and other interventions to promote physical activity may prove advantageous as reflected by an increase step counts per day following these interventions.…”

“…Two studies have investigated longitudinal declines of physical activity in patients with IPF. 7 , 43 Bahmer et al 43 reported that daily step count was declined 3017 steps over 3-years follow-up period in 26 patients. Badenes-Bonet et al 7 observed 784 decline of step count during 12 months in 22 patients.…”

“…6 To date, longitudinal studies have shown that decline of these clinical measurements are associated with higher mortality rates in patients with IPF. 3,[7][8][9] Therefore, evaluation of longitudinal changes in these clinical outcomes is important for refinement of clinical decision making.…”

Treatment of idiopathic pulmonary fibrosis and progressive pulmonary fibrosis: A position statement from the Thoracic Society of Australia and New Zealand 2023 revision

“… 261 A higher HADS has been associated with reduced physical activity in people with IPF. 262 There are no studies evaluating the efficacy of anti‐depressant pharmacotherapies specifically in people with ILD, however, they are an important consideration in people with clinical depression, after taking into account drug interactions (e.g., fluvoxamine greatly increases levels of pirfenidone).…”