The impact of obesity on walking and cycling performance and response to pulmonary rehabilitation in COPD

Abstract

BackgroundWe examined the influence of overweight and obesity on pulmonary function, exercise tolerance, quality of life and response to pulmonary rehabilitation in COPD.Methods261 patients with COPD were divided into three groups: normal body mass index (BMI), overweight and obese. Baseline and post rehabilitation pulmonary function, 6-min walking test (6MWT), endurance time during a constant workrate exercise test (CET) and St. George's Respiratory Questionnaire (SGRQ) scores were compared between all three classes of BMI.ResultsAt baseline, obese and overweight patients had less severe airflow obstruction compared to normal BMI patients. There was no baseline difference in CET performance or SGRQ scores across BMI classes and 6MWT was reduced in the presence of obesity (p < 0.01). Compared to baseline, post-rehabilitation 6MWT, CET performance and SGRQ scores improved significantly in each group (p < 0.01), but 6MWT was still significantly lower in the presence of obesity.ConclusionsWalking, but not cycling performance was worse in obese patients. This difference was maintained post rehabilitation despite significant improvements. Weight excess may counterbalance the effect of a better preserved respiratory function in the performance of daily activities such as walking. However, obesity and overweight did not influence the magnitude of improvement after pulmonary rehabilitation.

The association between co-morbidities and physical performance in people with chronic obstructive pulmonary disease

“…The findings of this systematic review indicate that the presence of co-morbid anxiety (in two crosssectional studies 10,25 ), osteoporosis (one intervention study 24 ) or obesity (in two cross-sectional studies 26,27 , one retrospective 26 ) were associated with reduced physical performance in people with COPD. Associations with reduced physical performance were reported for metabolic disease, 23 higher Charlson index 23 and depression 25,28,29 but not found in other included studies of the same co-morbidities.…”

“…15,24 Obesity did not have an effect on the outcome of PR but was associated with lower baseline 6MWD. 26,27 The presence of co-morbid conditions is increasingly recognised as a major clinical consideration in the management of people with COPD, influencing both therapeutic management and clinical outcomes. 34 Recommendations made in clinical guidelines for 6 Chronic Respiratory Disease Table 2.…”

“…29 The OR of the two studies on the effect of obesity on performance could not be calculated, however both authors concluded that obesity had a negative association with physical performance in COPD patients. 26,27 On the other hand, heart disease had a positive association with physical performance (OR ¼ 2.86, 95% CI ¼ 1.85-3.01). 23 These associations are complicated by two issues.…”

“…15 Other studies that examined obesity and multiple co-morbidities did not examine mental health issues. 23,24,26,27 If anxiety or depression were present in these patient populations, it may have had a confounding effect on physical performance outcomes. Anxiety and depression are common comorbidities in people with COPD, with prevalence rates as high as 75% for anxiety and 71% for depression.…”

“…Co-morbidities were not identified in a uniform manner across studies included in this systematic review, except for obesity which was defined consistently with the body mass index. 26,27 Heterogeneous study designs and statistical analyses in the included studies prevented meta-analysis of associations with physical performance even for the same co-morbid condition. Associations with co-morbidity were reported in some studies with baseline measures of physical performance, and in other studies with improvement gained after a PR program.…”