The impact of pulmonary rehabilitation on severe physical inactivity in patients with chronic obstructive pulmonary disease: a pilot study

Mimi Thyregod, Anders Løkke, Uffe Bodtger

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Abstract

Introduction: In patients with COPD, severe physical inactivity (SPI, which is defined as total daily energy expenditure/resting energy expenditure; physical activity level [PAL] ratio, <1.4) is associated with increased morbidity and mortality. Pulmonary rehabilitation (PR) increases physical capacity in COPD, but the impact on SPI is unknown. In this study, we aimed at elucidating the prevalence of SPI in COPD patients attending standard PR, the impact of PR on SPI prevalence, and the relationship between SPI and time spent in moderate physical activity thus whether American College of Sports Medicine (ACSM) recommendations are clinically useful in excluding SPI in COPD.

Methods: This is a prospective non-interventional pilot study on patients with COPD completing PR, consenting to wear an accelerometer (Sensewear © Armband) for a week before and after completing PR to assess changes in energy expenditure, time spent in physical activity, and number of daily steps. Low level of daily physical activity was not an inclusion criterion.

Results: In total, 57 patients completed the study and 31 (54%) had SPI at baseline. In patients with SPI, baseline median FEV 1 was 48 (range, 28-86) % of predicted and GOLD B, n=11 (35%)/GOLD D, n=20 (65%). Surprisingly, 31 of SPI patients (97%) spent ≥150 minutes/week in moderate physical activity. After rehabilitation, 24 (78%) did not change activity level and were persistently SPI. We observed no differences at baseline between patient responding (n=7) vs not responding (n=24) to PR. Responders increased number of daily steps and time spent in lighter but not moderate physical activity during rehabilitation.

Conclusion: In this pilot study, SPI was prevalent, and PR had limited impact. Contraintui-tively, most patients with SPI complied with general recommendations of weekly hours spent in moderate physical activity. Our study highlights that increasing time spent in light activity rather than improving time spent in moderate activity is important in COPD patients with chronic dyspnea.

Original languageEnglish
JournalInternational Journal of Chronic Obstructive Pulmonary Disease
Volume13
Pages (from-to)3359-3365
ISSN1178-2005
DOIs
Publication statusPublished - 24. Oct 2018

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Chronic Obstructive Pulmonary Disease
Lung
Exercise
Energy Metabolism

Keywords

  • Chronic obstructive pulmonary disease (COPD)
  • Pulmonary rehabilitation
  • Physical activity
  • severe physical inactivity
  • Randomised controlled trial
  • Multicenter Study
  • Activity level
  • Severe physical inactivity
  • COPD
  • Sensewear©
  • Prospective Studies
  • Humans
  • Middle Aged
  • Male
  • Activities of Daily Living
  • Dyspnea/diagnosis
  • Exercise
  • Female
  • Accelerometry/instrumentation
  • Treatment Outcome
  • Physical Endurance/physiology
  • Pulmonary Disease, Chronic Obstructive/diagnosis
  • Pilot Projects
  • Energy Metabolism
  • Denmark
  • Aged

Cite this

@article{d5fb5995d2a2410f9047f47e16ce8d2f,
title = "The impact of pulmonary rehabilitation on severe physical inactivity in patients with chronic obstructive pulmonary disease: a pilot study",
abstract = "Introduction: In patients with COPD, severe physical inactivity (SPI, which is defined as total daily energy expenditure/resting energy expenditure; physical activity level [PAL] ratio, <1.4) is associated with increased morbidity and mortality. Pulmonary rehabilitation (PR) increases physical capacity in COPD, but the impact on SPI is unknown. In this study, we aimed at elucidating the prevalence of SPI in COPD patients attending standard PR, the impact of PR on SPI prevalence, and the relationship between SPI and time spent in moderate physical activity thus whether American College of Sports Medicine (ACSM) recommendations are clinically useful in excluding SPI in COPD.Methods: This is a prospective non-interventional pilot study on patients with COPD completing PR, consenting to wear an accelerometer (Sensewear {\circledC} Armband) for a week before and after completing PR to assess changes in energy expenditure, time spent in physical activity, and number of daily steps. Low level of daily physical activity was not an inclusion criterion. Results: In total, 57 patients completed the study and 31 (54{\%}) had SPI at baseline. In patients with SPI, baseline median FEV 1 was 48 (range, 28-86) {\%} of predicted and GOLD B, n=11 (35{\%})/GOLD D, n=20 (65{\%}). Surprisingly, 31 of SPI patients (97{\%}) spent ≥150 minutes/week in moderate physical activity. After rehabilitation, 24 (78{\%}) did not change activity level and were persistently SPI. We observed no differences at baseline between patient responding (n=7) vs not responding (n=24) to PR. Responders increased number of daily steps and time spent in lighter but not moderate physical activity during rehabilitation. Conclusion: In this pilot study, SPI was prevalent, and PR had limited impact. Contraintui-tively, most patients with SPI complied with general recommendations of weekly hours spent in moderate physical activity. Our study highlights that increasing time spent in light activity rather than improving time spent in moderate activity is important in COPD patients with chronic dyspnea.",
keywords = "Chronic obstructive pulmonary disease (COPD), Pulmonary rehabilitation, Physical activity, severe physical inactivity, Randomised controlled trial, Multicenter Study, Activity level, Severe physical inactivity, COPD, Sensewear{\circledC}, Prospective Studies, Humans, Middle Aged, Male, Activities of Daily Living, Dyspnea/diagnosis, Exercise, Female, Accelerometry/instrumentation, Treatment Outcome, Physical Endurance/physiology, Pulmonary Disease, Chronic Obstructive/diagnosis, Pilot Projects, Energy Metabolism, Denmark, Aged",
author = "Mimi Thyregod and Anders L{\o}kke and Uffe Bodtger",
year = "2018",
month = "10",
day = "24",
doi = "10.2147/COPD.S174710",
language = "English",
volume = "13",
pages = "3359--3365",
journal = "International Journal of Chronic Obstructive Pulmonary Disease",
issn = "1178-2005",
publisher = "Dove Medical Press Ltd.",

}

The impact of pulmonary rehabilitation on severe physical inactivity in patients with chronic obstructive pulmonary disease : a pilot study. / Thyregod, Mimi; Løkke, Anders; Bodtger, Uffe.

In: International Journal of Chronic Obstructive Pulmonary Disease, Vol. 13, 24.10.2018, p. 3359-3365.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - The impact of pulmonary rehabilitation on severe physical inactivity in patients with chronic obstructive pulmonary disease

T2 - a pilot study

AU - Thyregod, Mimi

AU - Løkke, Anders

AU - Bodtger, Uffe

PY - 2018/10/24

Y1 - 2018/10/24

N2 - Introduction: In patients with COPD, severe physical inactivity (SPI, which is defined as total daily energy expenditure/resting energy expenditure; physical activity level [PAL] ratio, <1.4) is associated with increased morbidity and mortality. Pulmonary rehabilitation (PR) increases physical capacity in COPD, but the impact on SPI is unknown. In this study, we aimed at elucidating the prevalence of SPI in COPD patients attending standard PR, the impact of PR on SPI prevalence, and the relationship between SPI and time spent in moderate physical activity thus whether American College of Sports Medicine (ACSM) recommendations are clinically useful in excluding SPI in COPD.Methods: This is a prospective non-interventional pilot study on patients with COPD completing PR, consenting to wear an accelerometer (Sensewear © Armband) for a week before and after completing PR to assess changes in energy expenditure, time spent in physical activity, and number of daily steps. Low level of daily physical activity was not an inclusion criterion. Results: In total, 57 patients completed the study and 31 (54%) had SPI at baseline. In patients with SPI, baseline median FEV 1 was 48 (range, 28-86) % of predicted and GOLD B, n=11 (35%)/GOLD D, n=20 (65%). Surprisingly, 31 of SPI patients (97%) spent ≥150 minutes/week in moderate physical activity. After rehabilitation, 24 (78%) did not change activity level and were persistently SPI. We observed no differences at baseline between patient responding (n=7) vs not responding (n=24) to PR. Responders increased number of daily steps and time spent in lighter but not moderate physical activity during rehabilitation. Conclusion: In this pilot study, SPI was prevalent, and PR had limited impact. Contraintui-tively, most patients with SPI complied with general recommendations of weekly hours spent in moderate physical activity. Our study highlights that increasing time spent in light activity rather than improving time spent in moderate activity is important in COPD patients with chronic dyspnea.

AB - Introduction: In patients with COPD, severe physical inactivity (SPI, which is defined as total daily energy expenditure/resting energy expenditure; physical activity level [PAL] ratio, <1.4) is associated with increased morbidity and mortality. Pulmonary rehabilitation (PR) increases physical capacity in COPD, but the impact on SPI is unknown. In this study, we aimed at elucidating the prevalence of SPI in COPD patients attending standard PR, the impact of PR on SPI prevalence, and the relationship between SPI and time spent in moderate physical activity thus whether American College of Sports Medicine (ACSM) recommendations are clinically useful in excluding SPI in COPD.Methods: This is a prospective non-interventional pilot study on patients with COPD completing PR, consenting to wear an accelerometer (Sensewear © Armband) for a week before and after completing PR to assess changes in energy expenditure, time spent in physical activity, and number of daily steps. Low level of daily physical activity was not an inclusion criterion. Results: In total, 57 patients completed the study and 31 (54%) had SPI at baseline. In patients with SPI, baseline median FEV 1 was 48 (range, 28-86) % of predicted and GOLD B, n=11 (35%)/GOLD D, n=20 (65%). Surprisingly, 31 of SPI patients (97%) spent ≥150 minutes/week in moderate physical activity. After rehabilitation, 24 (78%) did not change activity level and were persistently SPI. We observed no differences at baseline between patient responding (n=7) vs not responding (n=24) to PR. Responders increased number of daily steps and time spent in lighter but not moderate physical activity during rehabilitation. Conclusion: In this pilot study, SPI was prevalent, and PR had limited impact. Contraintui-tively, most patients with SPI complied with general recommendations of weekly hours spent in moderate physical activity. Our study highlights that increasing time spent in light activity rather than improving time spent in moderate activity is important in COPD patients with chronic dyspnea.

KW - Chronic obstructive pulmonary disease (COPD)

KW - Pulmonary rehabilitation

KW - Physical activity

KW - severe physical inactivity

KW - Randomised controlled trial

KW - Multicenter Study

KW - Activity level

KW - Severe physical inactivity

KW - COPD

KW - Sensewear©

KW - Prospective Studies

KW - Humans

KW - Middle Aged

KW - Male

KW - Activities of Daily Living

KW - Dyspnea/diagnosis

KW - Exercise

KW - Female

KW - Accelerometry/instrumentation

KW - Treatment Outcome

KW - Physical Endurance/physiology

KW - Pulmonary Disease, Chronic Obstructive/diagnosis

KW - Pilot Projects

KW - Energy Metabolism

KW - Denmark

KW - Aged

U2 - 10.2147/COPD.S174710

DO - 10.2147/COPD.S174710

M3 - Journal article

C2 - 30349239

AN - SCOPUS:85055195157

VL - 13

SP - 3359

EP - 3365

JO - International Journal of Chronic Obstructive Pulmonary Disease

JF - International Journal of Chronic Obstructive Pulmonary Disease

SN - 1178-2005

ER -