AJRCCM Articles in Press. Published on 28-May-2015 as 10.1164/rccm.201501-0081OC
Page 1 of 64
Disease progression and changes in physical activity in patients with COPD Benjamin Waschki1,2, Anne M. Kirsten1, Olaf Holz3, Kai-Christian Mueller2, Miriam Schaper1, Anna-Lena Sack1, Thorsten Meyer4, Klaus F. Rabe2, Helgo Magnussen1, Henrik Watz1
1
Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research
Center North (ARCN), Member of the German Center for Lung Research, Grosshansdorf, Germany 2
LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of
the German Center for Lung Research, Grosshansdorf, Germany 3
Fraunhofer Institute for Toxicology and Experimental Medicine, BREATH, Member
of the German Center for Lung Research, Hannover, Germany 4
Institute for Epidemiology, Social Medicine and Health System Research, Hannover
Medical School, Hannover, Germany
Corresponding author and reprint requests: Dr. med. Benjamin Waschki, LungenClinic Grosshansdorf, Woehrendamm 80, 22927 Grosshansdorf, Germany. Phone: ++49-4102-601-6756, Fax: ++49-4102-601-7002, Email: [email protected].
1
Copyright © 2015 by the American Thoracic Society
AJRCCM Articles in Press. Published on 28-May-2015 as 10.1164/rccm.201501-0081OC
Author contributions: BW and HW contributed to conception and study design, acquisition, analysis and interpretation of data, and wrote the article. AMK, OH, and KCM contributed to conception, acquisition and interpretation of data and revision prior to submission. MS and ALS contributed to acquisition of data and revision prior to submission. TM contributed to analysis and interpretation of data and revision prior to submission. KFR contributed to interpretation of data and revision prior to submission. HM contributed to conception and study design, interpretation of data, and revision prior to submission. Funding source: This study was supported by the German Center for Lung Research and the German Statutory Pension Insurance (Deutsche Rentenversicherung Nord). For former cross-sectional analyses, some baseline measurements were supported by an unrestricted research grant from AstraZeneca Germany. Short running title: COPD progression and changes in physical activity Descriptor number: 9.9 (COPD: General) Total word count: 4048 words
2
Copyright © 2015 by the American Thoracic Society
Page 2 of 64
AJRCCM Articles in Press. Published on 28-May-2015 as 10.1164/rccm.201501-0081OC
Page 3 of 64
At a Glance Commentary Scientific knowledge on this subject: Cross-sectional studies have shown that physical activity of patients with COPD is associated with pulmonary and systemic disease components. What this study adds to the field: Longitudinally, physical activity decreases across all severity stages of COPD, along with a coexisting worsening of airflow obstruction and health status. In addition, a sustained low level of physical activity over time is associated with an accelerated progression of exercise intolerance and muscle depletion.
3
Copyright © 2015 by the American Thoracic Society
AJRCCM Articles in Press. Published on 28-May-2015 as 10.1164/rccm.201501-0081OC
ABSTRACT Background: Little is known about the role of physical activity in the course of COPD. The aim of this study was to assess changes in physical activity in COPD in relation to severity stages and changes in other disease components, and to evaluate the longitudinal association between sustained physical inactivity and disease progression. Methods: In this prospective cohort study, we measured physical activity (multisensory armband), airflow obstruction (FEV1), health status (St. George’s Respiratory Questionnaire [SGRQ]), exercise capacity (6-minute walk distance [6MWD]), muscle mass (fat-free mass [FFM]), and systemic inflammation (fibrinogen and high-sensitivity C-reactive protein) over a 3-year period in 137 patients with COPD and 26 with chronic bronchitis (normal spirometry). Results: Independent of baseline disease severity, steps per day, total daily energy expenditure, and (daily) physical activity level (PAL) decreased by 393, 76 kcal, and 0.04 per year, respectively. The decline in PAL was significantly associated with a decline in FEV1 and an increase in SGRQ total score. Changes in 6MWD, FFM, and inflammatory markers were not associated with changes in PAL. Independent of FEV1, sustained physical inactivity (i.e., PALT0andT1 0.2). Data are given for the total cohort (n=163). There are missing values for: FFM (n=7) and fibrinogen (n=2).
Copyright © 2015 by the American Thoracic Society
AJRCCM Articles in Press. Published on 28-May-2015 as 10.1164/rccm.201501-0081OC
Page 56 of 64
Table E4 Adjusted effects of sustained physical inactivity (based on minutes of moderate activity) on changes in COPD manifestations during 3 years
Effect of sustained inactivity on baseline value
Sustained physical inactivity (MMAT0andT180)
Mean (95% CI) n = 39
Mean (95% CI) n = 124
Adjusted p*
1.04 (0.79 to 1.28) –0.180 (–0.259 to –0.100)
1.85 (1.70 to 2.01) –0.165 (–0.216 to –0.113)
Page 1 of 64
Disease progression and changes in physical activity in patients with COPD Benjamin Waschki1,2, Anne M. Kirsten1, Olaf Holz3, Kai-Christian Mueller2, Miriam Schaper1, Anna-Lena Sack1, Thorsten Meyer4, Klaus F. Rabe2, Helgo Magnussen1, Henrik Watz1
1
Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research
Center North (ARCN), Member of the German Center for Lung Research, Grosshansdorf, Germany 2
LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of
the German Center for Lung Research, Grosshansdorf, Germany 3
Fraunhofer Institute for Toxicology and Experimental Medicine, BREATH, Member
of the German Center for Lung Research, Hannover, Germany 4
Institute for Epidemiology, Social Medicine and Health System Research, Hannover
Medical School, Hannover, Germany
Corresponding author and reprint requests: Dr. med. Benjamin Waschki, LungenClinic Grosshansdorf, Woehrendamm 80, 22927 Grosshansdorf, Germany. Phone: ++49-4102-601-6756, Fax: ++49-4102-601-7002, Email: [email protected].
1
Copyright © 2015 by the American Thoracic Society
AJRCCM Articles in Press. Published on 28-May-2015 as 10.1164/rccm.201501-0081OC
Author contributions: BW and HW contributed to conception and study design, acquisition, analysis and interpretation of data, and wrote the article. AMK, OH, and KCM contributed to conception, acquisition and interpretation of data and revision prior to submission. MS and ALS contributed to acquisition of data and revision prior to submission. TM contributed to analysis and interpretation of data and revision prior to submission. KFR contributed to interpretation of data and revision prior to submission. HM contributed to conception and study design, interpretation of data, and revision prior to submission. Funding source: This study was supported by the German Center for Lung Research and the German Statutory Pension Insurance (Deutsche Rentenversicherung Nord). For former cross-sectional analyses, some baseline measurements were supported by an unrestricted research grant from AstraZeneca Germany. Short running title: COPD progression and changes in physical activity Descriptor number: 9.9 (COPD: General) Total word count: 4048 words
2
Copyright © 2015 by the American Thoracic Society
Page 2 of 64
AJRCCM Articles in Press. Published on 28-May-2015 as 10.1164/rccm.201501-0081OC
Page 3 of 64
At a Glance Commentary Scientific knowledge on this subject: Cross-sectional studies have shown that physical activity of patients with COPD is associated with pulmonary and systemic disease components. What this study adds to the field: Longitudinally, physical activity decreases across all severity stages of COPD, along with a coexisting worsening of airflow obstruction and health status. In addition, a sustained low level of physical activity over time is associated with an accelerated progression of exercise intolerance and muscle depletion.
3
Copyright © 2015 by the American Thoracic Society
AJRCCM Articles in Press. Published on 28-May-2015 as 10.1164/rccm.201501-0081OC
ABSTRACT Background: Little is known about the role of physical activity in the course of COPD. The aim of this study was to assess changes in physical activity in COPD in relation to severity stages and changes in other disease components, and to evaluate the longitudinal association between sustained physical inactivity and disease progression. Methods: In this prospective cohort study, we measured physical activity (multisensory armband), airflow obstruction (FEV1), health status (St. George’s Respiratory Questionnaire [SGRQ]), exercise capacity (6-minute walk distance [6MWD]), muscle mass (fat-free mass [FFM]), and systemic inflammation (fibrinogen and high-sensitivity C-reactive protein) over a 3-year period in 137 patients with COPD and 26 with chronic bronchitis (normal spirometry). Results: Independent of baseline disease severity, steps per day, total daily energy expenditure, and (daily) physical activity level (PAL) decreased by 393, 76 kcal, and 0.04 per year, respectively. The decline in PAL was significantly associated with a decline in FEV1 and an increase in SGRQ total score. Changes in 6MWD, FFM, and inflammatory markers were not associated with changes in PAL. Independent of FEV1, sustained physical inactivity (i.e., PALT0andT1 0.2). Data are given for the total cohort (n=163). There are missing values for: FFM (n=7) and fibrinogen (n=2).
Copyright © 2015 by the American Thoracic Society
AJRCCM Articles in Press. Published on 28-May-2015 as 10.1164/rccm.201501-0081OC
Page 56 of 64
Table E4 Adjusted effects of sustained physical inactivity (based on minutes of moderate activity) on changes in COPD manifestations during 3 years
Effect of sustained inactivity on baseline value
Sustained physical inactivity (MMAT0andT180)
Mean (95% CI) n = 39
Mean (95% CI) n = 124
Adjusted p*
1.04 (0.79 to 1.28) –0.180 (–0.259 to –0.100)
1.85 (1.70 to 2.01) –0.165 (–0.216 to –0.113)
