• No results found

Daily physical activity in patients with a pulmonary disease

N/A
N/A
Protected

Academic year: 2021

Share "Daily physical activity in patients with a pulmonary disease"

Copied!
182
0
0

Bezig met laden.... (Bekijk nu de volledige tekst)

Hele tekst

(1)

University of Groningen

Daily physical activity in patients with a pulmonary disease

Bossenbroek, Linda

IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from

it. Please check the document version below.

Document Version

Publisher's PDF, also known as Version of record

Publication date:

2018

Link to publication in University of Groningen/UMCG research database

Citation for published version (APA):

Bossenbroek, L. (2018). Daily physical activity in patients with a pulmonary disease. Rijksuniversiteit

Groningen.

Copyright

Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).

Take-down policy

If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.

Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum.

(2)

Daily Physical Activity in Patients

with a Pulmonary Disease

(3)

Colofon

Daily Physical Activity in Patients with a Pulmonary Disease Linda Bossenbroek

ISBN: 978-94-034-0522-3

Copyright © 2018 Linda Bossenbroek

All rights reserved. No part of this thesis may be reproduced, stored or transmitted in any way or by any means without the prior permission of the author, or when applicable, of the publishers of the scientific papers.

The studies described in this thesis were financially supported by: University Medical Center Groningen and Boehringer Ingelheim.

Printing of this thesis was financially supported by:

Rijksuniversiteit Groningen, University Medical Center Groningen, Boehringer Ingelheim and Stichting AstmaBestrijding.

Layout and design by Alex Wesselink, persoonlijkproefschrift.nl. Printed by Ipskamp Printing, proefschriften.net.

(4)

Daily Physical Activity in Patients

with a Pulmonary Disease

Proefschrift

ter verkrijging van de graad van doctor aan de Rijksuniversiteit Groningen

op gezag van de

rector magnificus prof. dr. E. Sterken en volgens besluit van het College voor Promoties.

De openbare verdediging zal plaatsvinden op

woensdag 16 mei 2018 om 12.45 uur

door

Linda Bossenbroek geboren op 14 juli 1981

(5)

Promotor

Prof. dr. H.A.M. Kerstjens

Copromotores Dr. N.H.T. ten Hacken Dr. M.H.G. de Greef Dr. J.B. Wempe Beoordelingscommissie Prof. dr. R. Sanderman Prof. dr. M.A. Spruit Prof. dr. C.P. van der Schans

(6)

Paranimfen

Kim van Soest-Meijer Merel Hoozemans-Strik

(7)
(8)

CONTENTS

Chapter 1 General Introduction 9

Chapter 2 Daily physical activity in patients with COPD; a review 23 COPD: Journal of chronic obstructive pulmonary disease, 2011

Chapter3 Determinants of daily physical activity in patients with COPD 55 Respiratory Medicine, 2013

Chapter 4 Enhancing daily physical activity in patients with COPD 73 Patient education and counselling, 2009

Chapter 5 Daily physical activity in lung transplant patients 87 Journal of heart and lung transplantation, 2009

Chapter 6 Obesity and overweight in lung transplant patients 103 Respiration, 2011

Chapter 7 Sleep timing in asthma and COPD patients 119

Chapter 8 Validation of the DynaPort MiniMod during Sleep 139 Perceptual and motor skills, 2010

Chapter 9 Summary, Discussion and Future Perspectives 153

Chapter 10 Nederlandse Samenvatting 167

(9)
(10)

GENERAL INTRODUCTION

(11)

GENERAL INTRODUCTION

Some 1 million people in the Netherlands suffer from chronic pulmonary diseases. These chronic diseases impose a great burden on patients, caregivers and society, and are associated with many day to day problems. Of these, lack of physical activity is explored in more detail in this thesis, expecially focussing on COPD.

Chronic obstructive pulmorary disease

Chronic obstructive pulmorary disease (COPD) is defined in 2017 by the Global Initiative for Chronic Obstructive Pulmonary Disease as follows:

“Chronic obstructive pulmonary disease (COPD), a common preventable and treatable disease, is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammation response in the airways and the lung to noxious particles or gases. Exacerbations and comorbidities contribute to the overall severity in individual patients.” (1) Patients with COPD often suffer from symptoms like cough, phlegm, dyspnoea, decreased exercise tolerance, possibly resulting in exacerbations and low health-related quality of life. Patients increasingly experience problems in their daily living as the disease progresses to more advanced stages (1). One of the most common symptoms of COPD is shortness of breath or dyspnoea, and most specifically on exertion. Dyspnoea can be induced by every day tasks. As a consequence of dyspnoea patients with COPD may avoid daily physical activities and therefore may enter a downward spiral of symptom-induced immobility leading to lack of fitness, depression and social isolation (1).

The classification of COPD used to be based only on severity of airflow limitation, divided in four categories of severity (GOLD I-IV) according to the degree of airflow limitation measured with spirometry. Recently, the classification of COPD severity has been extended; new GOLD guidelines now grade patients (GOLD A-D) based on symptoms, airflow obstruction, and exacerbation history (1).

COPD cannot be cured; however management of COPD can limit the disease progression, reduce symptoms and exacerbation frequency, improve health status and quality of life, and possibly reduce mortality. The management of COPD consists of four components: 1) assess and monitor disease; 2) reduce risk factors; 3) manage stable COPD and 4) manage exacerbations. The management of COPD differs per stage but also per patient. In the first stages of the disease, management involves the prevention of disease progression by the avoidance of risk factors and pharmacotherapy to control symptoms. As the disease progresses, patients with

(12)

COPD often require an expansion of the treatment options like pulmonary rehabilitation, long-term oxygen therapy, surgical treatment or lung transplantation (1).

Pulmonary rehabilitation has been shown to reduce breathlessness, increase exercise capacity, and to improve health related quality of life (2). Although pulmonary rehabilitation is an effective strategy in reconditioning of patients with COPD, there is a considerable loss of effect in a relatively short period of time (6 months) (3). This loss of effect was also shown after long term home rehabilitation (4).

An important focus and outcome of pulmonary rehabilitation should be the enhancement or maintenance of daily physical activity. However, in most rehabilitation programmes daily physical activity is not a primary outcome, even though a physically active lifestyle is a predictor of pulmonary function and health related quality of life (2;5). Furthermore, there are strong indications that daily physical activity has significant implications for disease progression, systemic inflammation, and quality of life in COPD (6-8). It has been shown that patients with COPD who are regularly physically active have a lower risk of both COPD related hospital admissions and mortality (9). Despite the high prevalence of COPD there is little information about the daily physical activity level of patients with COPD in various stages of their disease (10;11).

Physical activity

Physical activity can be defined as ‘any bodily movement producedby the skeletal muscles that requires energy expenditure’. This includes all movements in everyday life, including work, recreation, exercise and sporting activities (12). Regular physical activity supports overall physical and psychosocial health and fitness, and contributes to the primary and secondary prevention of several chronic diseases (13).

Physical activity guidelines

To maintain fitness in adults, the American College of Sports Medicine (ACSM) states that a minimum of 30 minutes of physical activity of moderate intensity, is necessary on top of instrumental activity of daily living (14). The level of physical activity can also be expressed in a number of steps taken per day. Recommendations for healthy adults are to walk 10.000 steps per day. The number of steps per day is thought to reflect the level of daily physical activity: sedentary (<5,000), low-active (5,000–7,499),somewhat active (7,500–9,999), active (≥10,000), and veryactive (>12,500) (15).

(13)

Assessing physical activity

There are several different measurement tools to assess daily physical activity (Table 1). Performance based instruments, questionnaires and interviews provide different, yet complementary information.

Table 1. Instruments to assess daily physical activity

Instrument Description Advantage Disadvantage

Interview Everything concerning

the main subject can be discussed

Time consuming Obtained data is difficult to compare with each other.

Questionnaires Quantification of daily

physical activities during a fixed recall period Can be used in a large group

Attendance for wishful answers

Presence of recall bias

Performance-based instruments (Activity monitors)

Uni-axial pedometers record the total number of steps per day Multi-axial accelerometers also record intensity of physical activity and energy expenditure

Performance based recording

High validity, also in older subjects and chronic diseases

Upper-extremity and static activities are not measured

No specific information is recorded about the type of activity Expensive

An extensive review on how to measure physical activity in COPD concluded that the selection of which instrument to use for quantification of physical activity in daily life should depend mainly on the purpose of its use (16).

Accurate measurement, monitoring, as well as treatment of the daily physical activities of patients with COPD may be relevant for the prevention of the above-described downward spiral of symptom-induced inactivity.

Enhancing daily physical activity

To prevent or reverse the downward spiral of inactivity it is probably important to prevent the decrease in daily physical activity or even to enhance it. The physical activity goals from guidelines for healthy adults, a minimum of 30 minutes of physical activity of moderate intensity on top of instrumental activity of daily living, might not be feasible for all patients with COPD. Physical activities of moderate intensity can cause dyspnoea in patients with COPD. Also, muscle deconditioning and muscle fatigue are frequently present in patients with COPD. Consequently, patients with COPD often avoid moderate intense physical activities.

(14)

There are no current guidelines for the enhancement of physical activity in COPD. Due to the increase of symptoms as the disease progresses, one single guideline might not be feasible. Enhancing physical activity in patients with COPD requires an individualized or tailored approach. In healthy older adults, enhancement of low-to-moderate-intensity physical activity has been proven to be effective in strengthening health-related fitness and quality of life (17;18). Low to moderate intensity physical activities, like daily physical activities such as walking at moderate pace, also have been proven to enhance physical fitness in patients with COPD (19).

To monitor (enhancement of) daily physical activity pedometers have been shown to be effective in healthy people as well as in various patient groups (20-23). Pedometers are not only useful monitoring instruments of daily physical activity, but are also relevant in triggering enhancement of daily physical activity (24-27). Besides monitoring daily physical activity, individual goal setting has been shown to be effective in enhancing daily physical activity (28). A combination of these techniques might be effective in enhancing daily physical activity in patients with COPD.

Determinants of daily physical activity in COPD

For healthy subjects a lower level of daily physical activity is associated with higher age, being female, lower socio-economic status, and higher body-mass index (29). In patients with COPD, disease specific factors such as decreased pulmonary function, dyspoea, decreased exercise tolerance, exacerbations and low health-related quality of life could also play a role in determining the level of physical activity. The question arises if the physical activity level of patients with severe COPD is greatly affected by disease specific factors, next to ‘normal’ psychosocial factors like motivation to be physically active.

Another important determinant of physical activity in COPD might be sleep quality and sleep timing. Sleep abnormalities are common in patients with obstructive airway diseases like asthma and COPD. These abnormalities have been attributed to respiratory symptoms (cough, sputum production, wheezing), nocturnal oxygen desaturation, hypercapnia, and circadian changes in airway caliber and resistance, and side effects of medications (30). In asthma, the worst symptoms generally occur in the early morning hours. In many asthma and COPD patients, a combination of the mentioned abnormalities could contribute to sleep disruption. Disruptions in sleep could also affect the amount of physical activity during the day and the perceived quality of life (31). To examine sleep problems it is relevant to register disruptions in the sleep/wake cycle and movements during the night. The measurement of body movement during rest is not commenly used in research.

The preferred timing of the sleep-wake rhythm is described in chronotypes. Chronotypes represent the preferences in the timing of sleep and wake and are, at least partly, based on

(15)

genetics (32). Early types are more likely to have earlier bedtimes, sleep midpoints, and wake times. Late chronotypes are more likely to have late bedtimes, sleep midpoints, and wake times. Not surprisingly, there is a large interindividual variation in chronotypes (32;33). Late types report psychological and psychosomatic disturbance more often than do early types and experience more mental exhaustion in the evening. Depressed moods shows a high incidence in particularly late chronotypes, and late chronotypes consume more stimulants (alcohol and coffee) and are more often habitual smokers than are early types (34;35). For all chronotypes, the amount of time spent outdoors in broad daylight significantly affects the timing of sleep (32). A low level of daily physical activity could be related to little time spent outside in the daylight; in other words the level of daily physical activity could be related to one’s chronotype.

Daily physical activity in patients with COPD after lung transplantation

Lung transplantation is a treatment option to be considered in those patients with end-stage COPD for whom an alternative treatment modality is no longer available (36;37). To assess the effects of lung transplantation, survival, pulmonary function, physical fitness and health-related quality of life before and after lung transplantation are frequently compared (38).

After lung transplantation, pulmonary functioning is significantly improved. However, physical fitness frequently remains diminished due to peripheral muscle limitations after lung transplantation (37;39;40). Peripheral muscle force may be limited due to post-transplantation factors such as immunosuppressive medication, which might affect both skeletal muscles and the cardiovascular system (41). Despite this limitation in physical fitness, lung transplant recipients have shown significant improvements on the physical functioning scale of health related quality of life questionnaires (42-44). Consequently, the question rises whether lung transplantation actually improves the level of daily physical activity in patients with COPD. As daily physical activity probably is relevant for the perception of patient’s quality of life, it might be another clinically important outcome variable of lung transplantation.

Obesity after lung transplantation

After lung transplantation, overweight or obesity (body mass index (BMI) >25 kg/m2) is present in 30 percent of the living lung transplant recipients of the University Medical Center Groningen. Overweight and obesity-related diseases such as type II diabetes, hypertension and cardiovascular disorders affect post lung transplantation survival (45-49). In the general population, the principal factors for developing overweight and obesity are limited physical activity, excessive food intake and low resting energy expenditure (50-53). In lung transplant recipients, there is only scarce information about the contributing factors of the development of overweight. Ongoing administration of immunosuppressive therapy is associated with (steroid) myopathy and reduced skeletal muscle function in lung transplant recipients. Consequently this

(16)

may in the long term lead to limited exercise capacity (54-58), reduced daily physical activity, and reduced energy expenditure. Ongoing corticosteroid intake may also stimulate appetite and lead to increased BMI, as demonstrated in kidney and heart transplant recipients (59;60). A decreased resting energy expenditure may theoretically also contribute to increased BMI, as was shown in liver transplant recipients (61). To prevent or to treat the development of overweight, we believe it is very important to understand the underlying factors and their relationship.

AIM OF THE THESIS

The overall aim of this thesis is to examine daily physical activity in patients with COPD and to determine which determinants contribute to the variation in the level of daily physical activity in patients with a pulmonary disease, especially COPD.

AIMS

To examine:

1. the level of daily physical activity in COPD (Chapter 2 & 3) 2. the enhancement of daily physical activity in COPD (Chapter 4)

3. the level of daily physical activity in COPD after lung transplantation (Chapter 5 & 6) 4. the determinants of daily physical activity in COPD (Chapter 2-6)

5. sleep timing and sleep quality in relation to daily physical activity in patients with obstructive airway diseases (Chapter 7 & 8)

Chapter 2 Daily physical activity in patients with COPD; a review

In this chapter we perform a systematic review of the literature on the level, intensity and type of physical activity in patients with COPD as compared to controls, taking into account the whole range of physical activities (household-, sports-, leisure time- and work-related physical activity), assessed with performance-based as well as self-reported instruments. Furthermore, Chapter 2 focuses on the relationship of daily physical activity with pulmonary function, physical fitness, systemic inflammation and quality of life. Further insight in the amount and determinants of daily physical activity of patients with COPD could provide important clues to promote daily physical activity.

Chapter 3 Determinants of daily physical activity in patients with COPD

Variables reflecting functional capacity as well as psychological variables may influence daily physical activity. Accurate insight in these determinants of daily physical activity of patients with COPD may be relevant for the prevention of the downward spiral of symptom-induced immobility. Chapter 3 focuses on daily physical activity and the association with functional and psychological

(17)

variables in patients with COPD recruited from the primary (general practitioner), secondary (hospital outpatient clinic) and tertiary (pulmonary rehabilitation centre) healthcare setting.

Chapter 4 Enhancing daily physical activity in patients with COPD

In chapter 4 the enhancement of daily physical activity in patients with COPD is examined by a behavioral modification strategy, including a lifestyle physical activity counseling program with feedback of a pedometer. In chapter 4 we hypothesize that an individual exercise counseling program combined with a pedometer is a feasible and effective method to increase daily physical activities like walking, cycling, stair-climbing and gardening in out clinic patients with COPD.

Chapter 5 Daily physical activity in lung transplant patients

In chapter 5, the daily physical activity status of COPD lung transplant patients in relation to pulmonary function, physical fitness, fear of physical activity and motivation to exercise is examined. We hypothesize that lung transplant recipients as compared to lung transplant candidates show a higher level of daily physical activity, physical fitness, are more motivated to move and have less fear of movement.

Chapter 6 Obesity and overweight in lung transplant patients

In chapter 6 we examine the possible determinants of large increases in weight after lung transplantation. The role of daily physical activity, resting energy expenditure and daily food intake is examined in lung transplant recipients with the most prevalent underlying lung conditions; COPD and lung fibrosis.

Chapter 7 Sleep timing in asthma and COPD patients

In chapter 7 we examine the variation of midsleep and chronotype distribution between asthma and COPD compared to a large general control group. Furthermore the association of chronotypes with severity/control of disease, nocturnal complaints, sleep quality, physical activity, smoking, and medication is assessed within asthma and COPD patients.

Chapter 8 Validation of the Dynaport MiniMod during Sleep

In chapter 8 we examine the feasibility and validity of 3-axial accelerometer (DynaPort MiniMod) in accessing body posture and physical activity during sleep. Study A focuses on the correlation between the movement times measured by the DynaPort MiniMod and the Actiwatch and Study B focusses on the correlation between the posture registration of the DynaPort MiniMod and polysomnography.

Chapter 9 Summary, Discussion and Future Perspectives

(18)

REFERENCES

1. Global Initiative for Chronic Obstructive Pulmonary Disease. Global stategy for diagnosis, management, and prevention of COPD. 2017.

2. Ries AL, Bauldoff GS, Carlin BW, Casaburi R, Emery CF, Mahler DA, et al. Pulmonary

Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines. Chest 2007 May;131(5 Suppl):4S-42S.

3. Ries AL, Kaplan RM, Limberg TM, Prewitt LM. Effects of pulmonary rehabilitation on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease. Ann Intern Med 1995 Jun 1;122(11):823-32.

4. Wijkstra PJ, van der Mark TW, Kraan J, van Altena R, Koeter GH, Postma DS. Long-Term Effects of Home Rehabilitation on Physical Performance in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 1996;153:1234-41.

5. Lacasse Y, Goldstein R, Lasserson TJ, Martin S. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2006;(4):CD003793.

6. Garcia-Aymerich J, Lange P, Benet M, Schnohr P, Anto JM. Regular physical activity modifies smoking-related lung function decline and reduces risk of chronic obstructive pulmonary disease: a population-based cohort study. Am J Respir Crit Care Med 2007 Mar 1;175(5):458-63.

7. Garcia-Aymerich J, Serra I, Gomez FP, Farrero E, Balcells E, Rodriguez DA, et al. Physical Activity and Clinical and Functional Status in COPD. Chest 2009 Jul;136(1):62-70.

8. Watz H, Waschki B, Boehme C, Claussen M, Meyer T, Magnussen H. Extrapulmonary effects of chronic obstructive pulmonary disease on physical activity: a cross-sectional study. Am J Respir Crit Care Med 2008 Apr 1;177(7):743-51.

9. Garcia-Aymerich J, Lange P, Benet M, Schnohr P, Anto JM. Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study. Thorax 2006 Sep;61(9):772-8.

10. Watz H, Waschki B, Meyer T, Magnussen H. Physical activity in patients with COPD. Eur Respir J. 2009 Feb;33(2):262-72.

11. Hartman JE, Boezen HM, de Greef MH, Ten Hacken NH. Physical and psychosocial factors associated with physical activity in patients with chronic obstructive pulmonary disease. Arch Phys Med Rehabil. 2013 Dec;94(12):2396-402.

12. The World Health Organization. 2011.

13. Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence. CMAJ. 2006 Mar 14;174(6):801-9.

14. Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995 Feb 1;273(5):402-7.

15. Tudor-Locke C, Bassett DR, Jr. How many steps/day are enough? Preliminary pedometer indices for public health. Sports Med 2004;34(1):1-8.

16. Pitta F, Troosters T, Probst VS, Spruit MA, Decramer M, Gosselink R. Quantifying physical activity in daily life with questionnaires and motion sensors in COPD. Eur Respir J 2006 May;27(5):1040-55.

(19)

17. Dunn AL, Marcus BH, Kampert JB, Garcia ME, Kohl HW, III, Blair SN. Comparison of lifestyle and structured interventions to increase physical activity and cardiorespiratory fitness: a randomized trial. JAMA 1999 Jan 27;281(4):327-34.

18. Kahn EB, Ramsey LT, Brownson RC, Heath GW, Howze EH, Powell KE, et al. The effectiveness of interventions to increase physical activity. A systematic review. Am J Prev Med 2002 May;22(4 Suppl):73-107.

19. Dressendorfer RH, Haykowski MJ, Eves M. Exercise for persons with COPD, ACSM 2002. 2011. 20. Tudor-Locke C, Williams JE, Reis JP, Pluto D. Utility of pedometers for assessing physical activity:

construct validity. Sports Med 2004;34(5):281-91.

21. Croteau KA. A preliminary study on the impact of a pedometer-based intervention on daily steps. Am J Health Promot 2004 Jan;18(3):217-20.

22. Swartz AM, Strath SJ, Bassett DR, Moore JB, Redwine BA, Groer M, et al. Increasing daily walking improves glucose tolerance in overweight women. Prev Med 2003 Oct;37(4):356-62.

23. Lindberg R. Active living: on the road with the 10,000 Steps program. J Am Diet Assoc 2000 Aug;100(8):878-9.

24. Crouter SE, Schneider PL, Karabulut M, Bassett DR, Jr. Validity of 10 electronic pedometers for measuring steps, distance, and energy cost. Med Sci Sports Exerc 2003 Aug;35(8):1455-60. 25. Schneider PL, Crouter SE, Lukajic O, Bassett DR, Jr. Accuracy and reliability of 10 pedometers for

measuring steps over a 400-m walk. Med Sci Sports Exerc 2003 Oct;35(10):1779-84. 26. Schneider PL, Crouter SE, Bassett DR. Pedometer measures of free-living physical activity:

comparison of 13 models. Med Sci Sports Exerc 2004 Feb;36(2):331-5.

27. Tudor-Locke C, Bassett DR, Swartz AM, Strath SJ, Parr BB, Reis JP, et al. A preliminary study of one year of pedometer self-monitoring. Ann Behav Med 2004 Dec;28(3):158-62.

28. Bravata DM, Smith-Spangler C, Sundaram V, Gienger AL, Lin N, Lewis R, et al. Using pedometers to increase physical activity and improve health: a systematic review. JAMA 2007 Nov

21;298(19):2296-304.

29. Tudor-Locke C, Ham SA, Macera CA, Ainsworth BE, Kirtland KA, Reis JP, et al. Descriptive epidemiology of pedometer-determined physical activity. Med Sci Sports Exerc 2004 Sep;36(9):1567-73.

30. Lewis DA. Sleep in patients with respiratory disease. Respir Care Clin N Am 1999 Sep;5(3):447-60, ix.

31. Kutty K. Sleep and chronic obstructive pulmonary disease. Curr Opin Pulm Med 2004 Mar;10(2):104-12.

32. Roenneberg T, Wirz-Justice A, Merrow M. Life between clocks: daily temporal patterns of human chronotypes. J Biol Rhythms 2003 Feb;18(1):80-90.

33. Zavada A, Gordijn MC, Beersma DG, Daan S, Roenneberg T. Comparison of the Munich Chronotype Questionnaire with the Horne-Ostberg’s Morningness-Eveningness Score. Chronobiol Int 2005;22(2):267-78.

34. Adan A. Chronotype and personality factors in the daily consumption of alcohol and psychostimulants. Addiction 1994 Apr;89(4):455-62.

(20)

35. Taillard J, Philip P, Bioulac B. Morningness/eveningness and the need for sleep. J Sleep Res 1999 Dec;8(4):291-5.

36. Pochettino A, Kotloff RM, Rosengard BR, Arcasoy SM, Blumenthal NP, Kaiser LR, et al. Bilateral versus single lung transplantation for chronic obstructive pulmonary disease: intermediate-term results. Ann Thorac Surg 2000 Dec;70(6):1813-8.

37. van der Woude FJ, Kager PA, Weits J, van der Jagt EJ, Van Son WJ, Sloof MJ, et al. Strongyloides stercoralis hyperinfection as a consequence of immunosuppressive treatment. Neth J Med 1985;28(8):315-7.

38. Groen H, van der BW, Koeter GH, TenVergert EM. Cost-effectiveness of lung transplantation in relation to type of end-stage pulmonary disease. Am J Transplant 2004 Jul;4(7):1155-62. 39. Lands LC, Smountas AA, Mesiano G, Brosseau L, Shennib H, Charbonneau M, et al. Maximal

exercise capacity and peripheral skeletal muscle function following lung transplantation. J Heart Lung Transplant 1999 Feb;18(2):113-20.

40. Reinsma GD, ten Hacken NH, Grevink RG, van der BW, Koeter GH, van Weert E. Limiting factors of exercise performance 1 year after lung transplantation. J Heart Lung Transplant 2006 Nov;25(11):1310-6.

41. Kjaer M, Beyer N, Secher NH. Exercise and organ transplantation. Scand J Med Sci Sports 1999 Feb;9(1):1-14.

42. Rodrigue JR, Baz MA, Kanasky WF, Jr., MacNaughton KL. Does lung transplantation improve health-related quality of life? The University of Florida experience. J Heart Lung Transplant 2005 Jun;24(6):755-63.

43. Smeritschnig B, Jaksch P, Kocher A, Seebacher G, Aigner C, Mazhar S, et al. Quality of life after lung transplantation: a cross-sectional study. J Heart Lung Transplant 2005 Apr;24(4):474-80. 44. Vasiliadis HM, Collet JP, Poirier C. Health-related quality-of-life determinants in lung

transplantation. J Heart Lung Transplant 2006 Feb;25(2):226-33.

45. Adeseun GA, Rivera ME, Thota S, Joffe M, Rosas SE. Metabolic syndrome and coronary artery calcification in renal transplant recipients. Transplantation 2008 Sep 15;86(5):728-32.

46. Gonzalez-Castro A, Llorca J, Suberviola B, az-Reganon G, Ordonez J, Minambres E. Influence of nutritional status in lung transplant recipients. Transplant Proc 2006 Oct;38(8):2539-40. 47. Isomaa B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissen M, et al. Cardiovascular morbidity and

mortality associated with the metabolic syndrome. Diabetes Care 2001 Apr;24(4):683-9. 48. James PT, Leach R, Kalamara E, Shayeghi M. The worldwide obesity epidemic. Obes Res 2001

Nov;9 Suppl 4:228S-33S.

49. Kanasky WF, Jr., Anton SD, Rodrigue JR, Perri MG, Szwed T, Baz MA. Impact of body weight on long-term survival after lung transplantation. Chest 2002 Feb;121(2):401-6.

50. Brown A, Siahpush M. Risk factors for overweight and obesity: results from the 2001 National Health Survey. Public Health 2007 Aug;121(8):603-13.

51. Lahti-Koski M, Pietinen P, Heliovaara M, Vartiainen E. Associations of body mass index and obesity with physical activity, food choices, alcohol intake, and smoking in the 1982-1997 FINRISK Studies. Am J Clin Nutr 2002 May;75(5):809-17.

52. Blair SN, Brodney S. Effects of physical inactivity and obesity on morbidity and mortality: current evidence and research issues. Med Sci Sports Exerc 1999 Nov;31(11 Suppl):S646-S662.

(21)

53. Ravussin E, Bogardus C. A brief overview of human energy metabolism and its relationship to essential obesity. Am J Clin Nutr 1992 Jan;55(1 Suppl):242S-5S.

54. Ambrosino N, Bruschi C, Callegari G, Baiocchi S, Felicetti G, Fracchia C, et al. Time course of exercise capacity, skeletal and respiratory muscle performance after heart-lung transplantation. Eur Respir J 1996 Jul;9(7):1508-14.

55. Lands LC, Smountas AA, Mesiano G, Brosseau L, Shennib H, Charbonneau M, et al. Maximal exercise capacity and peripheral skeletal muscle function following lung transplantation. J Heart Lung Transplant 1999 Feb;18(2):113-20.

56. Reinsma GD, ten Hacken NH, Grevink RG, van der BW, Koeter GH, van WE. Limiting factors of exercise performance 1 year after lung transplantation. J Heart Lung Transplant 2006 Nov;25(11):1310-6.

57. Levy RD, Ernst P, Levine SM, Shennib H, Anzueto A, Bryan CL, et al. Exercise performance after lung transplantation. J Heart Lung Transplant 1993 Jan;12(1 Pt 1):27-33.

58. McKenna MJ, Fraser SF, Li JL, Wang XN, Carey MF, Side EA, et al. Impaired muscle Ca2+ and K+ regulation contribute to poor exercise performance post-lung transplantation. J Appl Physiol 2003 Oct;95(4):1606-16.

59. Jezior D, Krajewska M, Madziarska K, Kurc-Darak B, Janczak D, Patrzalek D, et al. Posttransplant overweight and obesity: myth or reality? Transplant Proc 2007 Nov;39(9):2772-5.

60. Grady KL, Costanzo-Nordin MR, Herold LS, Sriniavasan S, Pifarre R. Obesity and hyperlipidemia after heart transplantation. J Heart Lung Transplant 1991 May;10(3):449-54.

61. Richardson RA, Garden OJ, Davidson HI. Reduction in energy expenditure after liver transplantation. Nutrition 2001 Jul;17(7-8):585-9.

(22)
(23)
(24)

DAILY PHYSICAL ACTIVITY

IN PATIENTS WITH CHRONIC

OBSTRUCTIVE PULMONARY

DISE A SE: A RE VIE W

CHAPTER 2

Adapted from: Daily physical activity in patients with chronic obstructive pulmonary disease: a systematic review

Linda Bossenbroek

Mathieu H.G. de Greef Johan B. Wempe Wim P. Krijnen Nick H.T. ten Hacken

COPD. 2011 Aug;8(4):306-19.

(25)

ABSTRACT

Patients with chronic obstructive pulmonary disease (COPD) are often limited in their daily physical activity. However, the level, type and intensity of daily physical activity are not known, nor there is a clear insight in the contributing factors. The aim of this review is to describe daily physical activity of COPD patients, and to examine its relationship with demographic factors, pulmonary function, physical fitness, systemic inflammation and quality of life. A systematic literature search was conducted, including studies assessing daily physical activity in all stages of COPD by various different types of measurement techniques. In total 47 studies were selected; 17 performance-, 20 questionnaire-, and 12 interview-based. Two studies used both a performance- and questionnaire-based method. Overall, COPD patients have a lower level and intensity of daily physical activity compared to healthy controls. This was reported by performance- as well as questionnaire-based studies, yet with a large variation (42-86% and 28-97%, respectively). Reduced daily physical activity is associated with higher levels of airway obstruction, higher levels of systemic inflammation, and lower levels of physical fitness. The association between daily physical activity and quality of life is less clear. In conclusion, this is the first review that examined the level, type and determinants of daily physical activity in COPD. It demonstrates that reduced daily physical activity frequently occurs in COPD patients, yet with a large variation. Methods of measuring and reporting daily physical activity should be more standardized.

(26)

INTRODUCTION

Daily physical activity can be defined as the actual level of physical performance one adopts in daily living (1). For healthy subjects a lower level of daily physical activity is associated with higher age, being female, lower socio-economic status, and higher body-mass index (2). Daily physical activity is related to, but not synonymous with functional capacity status. Functional capacity is defined as the maximal performance potential of an individual, usually determined by physical fitness and limited by disease-related impairments such as dyspnoea (1). COPD patients frequently report dyspnoea induced by daily physical activity. Consequently, patients with COPD may avoid daily physical activity and end up in a downward spiral of symptom-induced immobility leading to a decrease of muscle strength and endurance, social isolation and depression (3). Accurate measurement, monitoring, as well as treatment of the daily physical activities of patients with COPD may be relevant for the prevention of this downward spiral of symptom-induced immobility.

A method to assess daily physical activity level in COPD patients is by questionnaires, which enquires patients to quantify their daily physical activities during a fixed recall period. Possible disadvantages of this method are the attendance for wishful answers or presence of a recall bias (4). Another method to assess daily physical activity is by interviews. The advantage of this method is that everything concerning the main subject can be discussed because the participants are encouraged to talk freely. Possible disadvantages are that this method is time consuming and retrieved data is difficult to compare with each other. Nowadays, daily physical activity in COPD patients is increasingly measured by accelerometers or pedometers. These devices assess daily physical activity in a performance-based way. Uni-axial pedometers are able to record the total number of steps per day, while multi-axial accelerometers also record intensity of physical activity and energy expenditure. Possible disadvantages of performance-based methods are that upper-extremity activities are not measured, and no specific information is recorded about the type of activity (5), while this might be especially important from the patients perspective. In contrast, this specific information could be assessed with questionnaires or interviews. Performance-based instruments, questionnaires and interviews provide different, yet complementary information.

There are strong indications that daily physical activity has significant implications for disease progression, systemic inflammation, and quality of life in COPD (6-8). For example, COPD patients who are regularly physically active have a lower risk of both COPD related hospital admissions and mortality (9). Further insight in the amount and determinants of daily physical activity of COPD patients could provide important clues to promote daily physical activity. The aim of this review is to examine the level, intensity and type of physical activity in

(27)

patients with COPD as compared to controls, taking into account the whole range of physical activities (household-, sports-, leisure time- and work-related physical activity), assessed with performance-based as well as self-reported instruments. Furthermore, this study focuses on the relationship of daily physical activity with pulmonary function, physical fitness, systemic inflammation and quality of life.

METHODS

Data sources and search strategy

Studies were included in which movement detection devices, questionnaires and structured, semi-structured or unstructured interviews were used to assess daily physical activity. To detect these studies, a literature search was carried out using Pubmed (MEDLINE), CINAHL and Cochrane, and relevant references were checked in the selected articles. Studies between 1995 and 2009 were selected. Main inclusion criteria were chronic obstructive pulmonary disease (GOLD stage I to IV) and assessment of daily physical activity.

We excluded intervention studies without information about baseline daily physical activity, studies without a clear description of the daily physical activity measurement, studies without a measure of lung function (except for interview-based studies), and studies with healthy controls matched on daily physical activity level. Moreover, we did not include studies which used quality of life instruments to assess daily physical activity. There were no restrictions concerning sample size or study design. Language was limited to English. To select relevant literatureabout the level, type, and intensity of physical activities, we used the followingkeywords in combination with ‘COPD’: ‘physical activity’, ‘daily physical activity’, ‘activities of daily living’, ‘pedometer’, ‘accelerometer’, ‘physical activity questionnaire’ and ‘interview’.

Selection of studies

All articles were independently selected for inclusion by two reviewers. If no consensus could be achieved between the two reviewers, a third reviewer was consulted. Studies were selected when 1) there was a description of the daily physical activity level of COPD compared to healthy, and/or 2) there was a description of daily physical activity type of COPD patients, and/or 3) there was an analysis of the determinants of daily physical activity.

Unlike randomized controlled trials, there are no lists of appropriate quality assessment for observational studies. In this review, the quality assessment of the studies was performed at the inclusion: Articles had to contain a measure of pulmonary function and a diagnosis of COPD, with exception of the interview-based. In all, the instrument used to measure daily physical activity

(28)

had to be described. In the selected articles including determinants of daily physical activity, the statistical analysis had to be described.

Figure 1. Flow chart of the inclusion process.

Data extraction

Information was extracted from the included studies and tabulated. The characteristics considered in each study were: patient characteristics (sample size, percentage of males, age and FEV1), daily physical activity method and outcomes, secondary outcome measures (FEV1, physical fitness, systemic inflammation and quality of life) and daily physical activity in relation to the secondary outcome measures.

(29)

Examination of data

Daily physical activity was divided into the categories performance-, questionnaire-, and interview-based. Per category, we examined the daily physical activity level of COPD patients compared to healthy controls. We examined the daily physical activity type, divided in two groups; activities that could or could not be performed anymore and activities that were difficult to perform. Next, we examined whether daily physical activity was related to measures of airflow obstruction, physical fitness, systemic inflammation and quality of life.

RESULTS

In total 47 studies were included (Figure 1). There were 752 studies found after database searching and other search strategies. Of these, 695 did not meet the inclusion criteria. Main exclusion criteria were the absence of a lung function measurement and the absence of a daily physical activity measure. After excluding articles, 47 studies remained for analysis. Daily physical activity was assessed in a performance-based way in 17 studies (Table 1-3); in a questionnaire-based way in 20 studies (Table 4-6) and in an interview-based way in 12 studies (Table 7). Two studies used both a performance- and questionnaire-based method.

Performance-based daily physical activity

Daily physical activity was assessed in a performance-based way in 17 studies (Tables 1-3). Different devices were used to assess the daily physical activity level. The most frequent used device was the DynaPort accelerometer (eight studies). The number of patients per study ranged between 10 and 170. When mentioned, the majority of patients were male. The mean age of the COPD patients was above sixty years, except for 2 studies.

Daily physical activity level

Daily physical activity in COPD patients was compared with healthy controls in a performance-based way in 5 studies (Table 1). Out of these, 4 determined daily physical activity with an accelerometer and one study with a pedometer. The number of included patients ranged between 11 and 50, and was low overall. The mean age was above 55 years (mean age range COPD patients 56-67; Controls 53-70 years). The majority of the COPD patients was male in all 5 studies (total 78 males versus 35 females), while the healthy controls were more equally divided (total 48 males versus 41 females). The daily physical activity level of COPD patients compared to the healthy controls was significantly lower in all 5 studies (t-test and Mann-Whitney U-test, all p<0.01). The intensity of physical activity was also significantly lower in COPD patients (t-test, all p<0.004) (10-12). In total, when the daily physical activity level of

(30)

Ta b le 1 . D ai ly p hy si ca l a cti vi ty l ev el ; P er fo rm an ce -b as ed St u d y Sub je ct s N ; % m al e A ge ye ar s F E V1 % p red ic ted D ev ic e (u ni t) D ail y p h ys ic al a ct iv it y l ev el P it ta (1 1) 5 0 ; 7 2 % C o n tr o ls 2 5 ; 6 8 % 6 4 ±7 6 6± 5 4 3 ±1 8 D yn aP o rt A cti vi ty M o ni to r (min ut es /d ay) 4 4 ± 2 6 w al ki n g, 4 ± 8 c yc lin g, 1 9 1 ± 9 9 s ta n d in g, 3 74 ± 1 3 9 s it ti n g, 8 7 ± 9 7 l yi n g In te n si ty o f w al ki n g: 1 .8 ± 0 .3 m /s 2 8 1 ± 2 6 w al ki n g, 5 ± 1 4 c yc lin g, 2 9 5 ± 1 0 9 s ta n d in g, 3 0 6 ± 1 0 8 s it ti n g, 2 9 ± 3 3 lyi n g In te n si ty o f w al ki n g: 2 .4 ± 0 .5 m /s 2 W al ke r (1 2 ) 1 2 ; 7 5 % C o n tr o ls 1 8 ; 4 4 % 6 3 ±7 0 ± 6 3 3 ±1 2 D yn aP o rt M ini M o d (% t im e, 2 d ay s) A ct iwa tch (c ou nt s/h ) 1 4 ± 4 % t ot al ; 3 .6 ± 2 .8 w al ki n g, 3 2 .1 ± 1 5 .2 s ta n d in g, 5 8 .7 ± 1 7. 6 s it ti n g, 5 .3 ± 4 .9 l yi n g Int en sit y d u ri n g m ove m ent : 1 .4 8 ± 0 .2 1m /s 2 A cti vi ty : 1 2 3 ± 1 1 0 x 1 0 3, I n te n si ty : 1 9 0 ± 1 6 2 x 1 0 3 A cti vi ty : 1 4 3 ± 61 x 1 0 3, I n te n si ty : 2 3 2 ± 9 0 x 1 0 3 Co ro n ado (1 0 ) 1 5 ; 8 7 % C o n tr o ls 1 0 ; 4 0 % 6 7± 9 5 7± 5 5 4 ±1 6 A DX L 0 5 (%) In ac ti ve : 8 2 ± 5 % Lo w i n te n si ty : 1 3 ± 4 % , M ed iu m i n te n si ty : 4 ± 4 % In ac ti ve : 6 8 ± 1 4 % Lo w i n te n si ty : 2 2 ± 7 % , M ed iu m i n te n si ty : 1 1 ± 9 % M er ck en (1 3 ) 1 1 ; 5 5 % C o n tr o ls 1 1 ; 4 5 % 5 7± 2 6 0 ±2 39 ± 4 P AM AM 1 0 0 (P A M s co re) 1 4 .5 ± 2 .5 34 .2 ± 6 .8 S chö n ho fe r ( 1 4 ) 2 5 ; 5 6 % C o n tr o ls 2 5 ; 5 6 % 5 6 ±1 2 5 3 ± 14 4 7± 9 F it ty 3 (s te ps /d ay) 3 7 8 1 ±2 3 20 8 5 90 ± 4 0 6 0 N u m b er o f s ub je ct in n u m b er s; p er ce nt ag e o f m al es . A ge in y ea rs , F E V1 % p re di ct ed , a n d d ai ly p hy si ca l a ct iv it y m ea su re m en ts a s m ea n ± s ta n da rd d ev ia ti o n . U ni ts o f d ai ly p hy si ca l a cti vi ty p er m ea su re m en t w er e i n d ic at ed b el o w t h e m ea su re m en t t o o l. Chapter 2

(31)

healthy controls was set on 100%, the daily physical activity level of COPD patients expressed as a percentage of the daily physical activity level of healthy controls, was diminished to 57% (range studies 42-86%).

Daily physical activity type

Seven studies quantified the type of daily physical activity in a performance-based way by using a DynaPort accelerometer and reported the outcomes in minutes per day (Table 2). One study compared mild to severe patients with healthy controls, revealing that COPD patients spend significantly less time on walking and standing, and show a higher sitting and lying time (11). In all studies, patients with COPD walk less than an hour a day. Inactive patients walked for less time and more slowly than active patients (t-test, p < 0.05) (15).

Daily physical activity determinants Pulmonary function

Airflow limitation expressed as the percentage of predicted FEV1 ranged between 32-90% (Table 3). Seven studies determined a (baseline) association between daily physical activity and FEV1 (8;11;14;15;20-22). The correlations ranged between 0.28 and 0.62, all significant (p<0.01). One study reported a non-significant correlation between steps per day and FEV1 (r=0.25, p-value not mentioned) (23). In one study inactive patients showed a lower mean FEV1 compared to the mean ofactive patients (t-test, p<0.05) (15). One study reported significant main effect on steps per day from two-way ANOVA of GOLD stages (8).

Physical fitness

Physical fitness was assessed in 8 performance-based studies (Table 3). As measurement tools of physical fitness, the 6-minute walk test (6MWT) (7 studies), quadriceps strength (3 studies), handgrip strength (3 studies), cycle ergometry (1 studies), and steady state exercise test (1study) were used. Five out of 7 studies using the 6-minute walk test, demonstrated a moderate to strong correlation with daily physical activity (range r=0.49-0.76, p< 0.002) (11;15;21;22;24). Two other studies reported no such association (10;23). Only one study reported a significant association between daily physical activity and muscle strength (r quadriceps= 0.45, p< 0.01, r handgrip= 0.44, p< 0.01) (11). Inactive patients showed a lower exercise tolerance compared to active patients (p<0.05) (15).

(32)

Ta b le 2 . D ai ly p hy si ca l a cti vi ty t yp e; P er fo rm an ce -b as ed S tu d y Sub je ct s N ; % m al e A ge ye ar s F E V1 % p red ic ted ‘P er fo rm in g’ m ea su re d w it h t h e D yn aP o rt Ac ti vi ty M o n it o r P it ta (1 1) 50 : 7 2% 6 4 ±7 4 3 ±1 8 4 4 ± 2 6 w al ki n g, 4 ± 8 c yc lin g, 1 9 1 ± 9 9 s ta n d in g, 3 74 ± 1 3 9 s it ti n g, 8 7 ± 9 7 l yi n g m in u te /d ay P it ta (1 6 ) 1 3 ; 7 7 % 61 ± 8 3 3 ±1 0 4 5 ± 2 0 w al ki n g, 4 ± 9 c yc lin g, 1 9 1 ± 8 5 s ta n d in g, 3 9 0 ± 1 61 s it ti n g, 8 8 ± 1 41 l yi n g m in u te /d ay P it ta (1 7) 4 0 ; 4 5 % 4 0 ; 5 3 % 6 6 ±8 6 3 ±7 4 6 ±1 7 4 8 ±1 7 5 6 ± 3 2 w al ki n g, 2 4 6 ± 1 2 2 s ta n d in g, 2 9 6 ± 1 0 9 s it ti n g m in u te /d ay 4 0 ± 3 6 w al ki n g, 1 9 2 ± 1 8 2 s ta n d in g, 3 8 8 ± 2 0 8 s it ti n g m in u te /d ay P it ta (1 5) 2 3 ; 7 0 % 61 (5 9 -6 9 ) 3 9, 3 4 -5 3 5 7 ( 3 4 -7 1 ) w al ki n g, 0 ( 0 -6 ) c yc lin g, 2 0 8 ( 1 3 9 -2 9 3 ) s ta n d in g, 3 3 8 ( 2 9 9 -4 5 7 ) s it ti n g, 3 9 ( 1 5 -9 2 ) l yi n g m in u te /d ay P it ta (1 8) 2 9 ; 7 9 % 6 7± 8 4 6 ±1 6 5 5 ± 2 6 w al ki n g, 2 2 7 ± 9 2 s ta n d in g, 3 5 5 ± 1 2 1 s it ti n g, 7 7 ± 8 7 l yi n g m in u te /d ay W al ke r (1 2 ) 1 2 ; 7 5 % 6 3 ±7 3 3 .±1 2 3 .6 ± 2 .8 w al ki n g, 3 2 .1 ± 1 5 .2 s ta n d in g, 5 8 .7 ± 1 7. 6 s it ti n g, 5 .3 ± 4 .9 l yi n g d o w n ( % o f ti m e m o vi n g o ve r 2 da ys C am ill o (1 9 ) 3 1 ; 5 2 % 6 6 ±8 4 6 ±1 6 5 7 ± 3 0 w al ki n g, 2 41 ± 9 9 s ta n d in g m in /d ay N um b er o f s ub je ct in n um b er s; p er ce nt ag e o f m al es . A ge in y ea rs , F E V1 % p re di ct ed , d ai ly p hy si ca l a cti vi ty m ea su re m en ts a s m ea n ± s ta n da rd d ev ia ti o n . W h en t h e s ta n da rd d ev ia ti o n w as n ot m en ti o n ed , t h e r an ge w as g iv en b et w ee n b ra ck et s. U ni ts o f d ai ly p hy si ca l a cti vi ty p er m ea su re m en t w er e i n d ic at ed b el o w t h e m ea su re m en t t o o l. Chapter 2

(33)

Systemic inflammation.

There were 2 performance-based studies focusing on systemic inflammation (Table 3). The first study found an association between reduced daily physical activity and higher values of systemic inflammation (high-sensitivity C-reactive protein and fibrogen), independent of GOLD stage or BODE-index (8). Another study demonstrated an inverse relation between daily physical activity and markers of systemic inflammation such as high-sensitivity C-reactive protein (r=-0.18, p=0.01), interleukin-6 (r=-0.23, p<0.001) and fibrinogen (r=-0.25, p<0.001) (25).

Quality of life

Quality of life was measured in 6 studies, using the Saint George Respiratory Questionnaire (4 studies), the SF36 (2 studies), and the Chronic Respiratory Disease Questionnaire (2 studies) (Table 3). Two out of 4 studies using the Saint George Respiratory Questionnaire reported the results of their associations. One study reported a negative association between daily physical activity and quality of life (r=-0.28, p<0.01) (20), whereas the other study reported no association (10), One out of 2 studies using the SF36 reported that the physical subscale of the health status questionnaire was significant positively correlated with daily physical activity (r=0.40, p<0.001) (21), whereas correlation with the mental subscale was not (r=0.15, not significant) (21), One study using the Chronic Respiratory Disease Questionnaire reported a non significant correlation with daily physical activity (r=0.17, not significant) (21), The other study that used this questionnaire did not report any difference between inactive COPD patients and active COPD patients (groups based on compliance with the guideline: minimum of 30 minutes of walking per day) (15).

Questionnaire-based daily physical activity

Daily physical activity was assessed by various questionnaires in 20 studies (Tables 4-6). The most frequent used questionnaire was the Baecke Physical Questionnaire for the elderly (7 studies). The number of patients per study ranged between 9 and 3608. When mentioned, the majority of patients were male. The mean age of the COPD patients in the studies was above 60 years, except for 2 studies.

Daily physical activity level

Daily physical activity in COPD patients was compared with healthy controls in a questionnaire-based way in 7 studies (Table 4) (26-32). The number of included patients ranged between 9 and 68, and was low overall. The mean age was above 58 years (mean age range COPD patients 58-68; Controls 58-64 years). The male/female ratio was not mentioned in all studies, but when mentioned the majority of the COPD patients was male, except for 1 study (total 120 males versus 68 females), which also holds for healthy controls (total 115 males versus 86 females). The daily physical activity level of COPD patients compared to the healthy controls is significantly

(34)

lower in 5 out of 7 studies (t-test, Fisher exact probability test, and Mann-Whitney U-test, all p<0.05) (26-29;32). In total, when the activity level of healthy controls was set on 100%, the daily physical activity level of COPD patients expressed as a percentage of the daily physical activity level of healthy controls, was diminished to 70% (range 28-97%).

Daily physical activity type

Daily physical activity type was assessed in a questionnaire-based way in 4 studies (Table 5). The activities that could not be performed anymore were: sports (27;33), work (27;34), and leisure-time physical activities (27). Patients with a higher level of airflow obstruction (FEV1<50%) reported the worst dysfunction in everyday life, defined as walking, eating, home management and recreation (27). COPD patients differed from healthy controls in walking activities and mobility (27).

(35)

Ta b le 3 . D ai ly p hy si ca l A cti vi ty D et er mi n an ts ; P er fo rm an ce -b as ed St u d y Sub je ct s N ; % m al e A ge ye ar s D ev ic e (u ni t) D ail y p hy si ca l a ct iv it y l ev el Se co nd ar y me as u re me n ts Se co nd ar y o u tco m es A sso ci at io n s P it ta (1 1) 5 0 ; 7 2 % 6 4 ±7 D yn aP o rt A cti vi ty M o ni to r (min ut es /d ay) 4 4 ± 2 6 w al ki n g, 4 ± 8 c yc lin g, 1 9 1 ± 9 9 s ta n d in g, 3 74 ± 1 3 9 si tti n g, 8 7 ± 9 7 l yi n g FE V1 % p re di cte d Q ua d ri ce p s f o rc e H an d gri p f o rc e 6M W T 4 3 ± 1 8 % p re d 5 6 ± 1 9 % p re d 9 2 ± 2 4 % p re d 6 2 ± 2 2 % p re d r = 0 .2 8 , p < 0 .0 5 r = 0 .4 5 , p < 0 .0 1 r = 0 .4 4 , p < 0 .0 1 r = 0 .7 6 , p < 0 .0 0 0 1 Co ro n ado (1 0 ) 1 5 ; 8 7 % 6 7± 9 A DX L 0 5 (%) In ac ti ve : 8 2 ± 5 % Lo w i n te n si ty : 1 3 ± 4 % , M edi u m in te n si ty : 4 ± 4 % FE V1 % p re di cte d H an d gri p s tr en gh t Q ua d ri ce p s s tr eng h t 6M W T S G RQ 5 4 ±1 6 0. 76 ± 0. 2 0 6 3± 1 3 (% pr ed ) 41 1 ± 9 0 4 2 ± 11 N ot c o rre la te d Sc hö nho fe r ( 14 ) 2 5 ; 5 6 % 5 6 ±1 2 F it ty 3 (s te ps /d ay) 3 7 8 1 ±2 3 20 FE V1 % p re di cte d 4 mi n s te ad y s ta te ex erc is e t es t S G RQ 4 7± 9 7. 4 ± 2 .3 6 0 ±1 3 r= 0. 5 4 , p = 0. 0 0 6 B el za (2 1) 6 3 ; 9 5 % 6 5 ± 8 Tri tr ac R 3 D (V M U /m in ) 6 5 .5 ± 31 .7 FE V1 % p re di cte d 6M W T CR Q SF 3 6 P hy si ca l SF 3 6 M en ta l 3 6 ±1 6 1 1 4 3 ± 4 41 8 4 .2 ±1 8 .4 2 9. 7 ±20 .4 6 9. 9 ±20 .8 r = . 0 .3 7, p < 0 .0 1 r = . 0 .6 0 , p < 0 .0 1 r = 0 .1 7, N S r = 0 .4 0 , p < 0 .0 1 r = 0 .1 5 , N S Ste el e ( 2 2 ) 4 7 ; 9 4 % 6 6 ±8 Tri tr ac R 3 D (V M U /m in ) 4 6 ± 25 42 ± 2 5 3 9 ± 27 FE V1 % p re di cte d 6M W T 3 7± 1 6 1 1 5 2 ± 41 0 r = 0 .6 2 ; p < 0 .0 0 1 r = 0 .7 4 ; p < 0 .0 0 1 P it ta (1 5) 2 3 ; 7 0 % 61 (59 -6 9 ) D yn aPo rt (min ut es /d ay) 5 7 ( 3 4 -7 1 ) w al ki n g, 0 ( 0 -6 ) c yc lin g, 2 0 8 ( 1 3 9 -2 9 3 ) s ta n d in g, 3 3 8 ( 2 9 9 -4 5 7 ) s it ti n g, 3 9 ( 1 5 -9 2 ) l yi n g FE V1 % p re di cte d Q ua d ri ce p s f o rc e C yc le e rg o m et er 6M W T CR Q 3 9, 3 4 -5 3 76 ( 5 6 -9 0 ) 5 3 (4 1 -7 3 ) 7 1 (54 -77) 8 4 ( 6 5 -9 0 ) as so ci at ed , p < 0 .0 5 as so ci at ed , p < 0 .0 5 W at z (8) 1 7 0 ; 7 5 % 6 4 ±7 S ens ew ea r (s te ps /d ay) (T EE /R EE ) 3 7 % w as d ifi n ed a s a cti ve (P A L > 1 .7 0 ) 5 .8 82 ± 3 .6 8 4 1 .5 0± 0 .2 8 FE V1 % p re di cte d H an d gri p h s tr en g th F ib ro n og en mg /d L H s-C R P, m g /L 5 6 .3 ±22 .2 35 .3 ±9 .6 4 3 6 ± 97 2 .8 (i n te rq ua rti le ra n ge 1 .2-6 .0 ) r= 0. 4 9 *, p < 0. 0 0 1 , 0. 0 2 8 , 0. 8 6 r= 0. 3 3 *, p = 0. 0 0 1

(36)

P it ta (2 3 ) 4 0 ; 5 3 % 6 8 ±7 S ens ew ea r (s te ps /d ay) (T EE ) 41 7 8 ± 3 0 0 7 1 2 3 5 ± 5 47 FE V1 % p re di cte d FE V1 lit er 6M W T 41 ± 1 4 0. 9 0 ± 0. 2 6 7 5 ±1 7 % p re d r T E E = 0 .3 7, p < 0 .0 1 r s te p s = 0 .2 5 , N S W at z (2 5) 1 6 5 ; 7 5 % 6 6 ± 6 6 3 ±7 6 3 ±7 6 4± 6 S ens ew ea r (T EE /R EE ) 1 .6 3 ± 0 .25 1. 6 2± 0 .2 7 1 .4 5 ± 025 1 .2 7± 0 .1 7 FE V1 % p re di cte d H s-C R P, m g /L In te rl eu ki n -6 p g /m L F ib ro n og en mg /d L 9 0 ± 8 .7 6 3 ± 8 .1 41 ± 5 .0 3 3 ± 11 .4 2. 0 (0 .9 -4. 3 ) 3 .0 (1 .6 -6 .0 ) 4 .0 ( 1 .8 -9 .4 ) 2. 1 (0 .9 -4. 4 ) 2 .2 (1 .6 -3 .1 ) 2. 8 (1 .6 -4. 5 ) 4 .1 (1 .9 -7 .1 ) 2. 8 (1 .5 -4. 7 ) 3 9 5 ± 6 4 4 31 ± 9 8 4 6 8 ± 11 5 444 ± 8 9 r = -0 .1 8 , p = 0 .0 1 r = -0 .2 3 , p < 0 .0 0 1 r = -0 .2 5 , p < 0 .0 0 1 W ew el (24 ) 2 1 ; 8 1 % 6 5 ± 9 A cti -t ra c M o ni to r (t ot al c ou nt s) P ed o m et er (c o u n ts) to ta l: 1 9 2 .6 1 4 ± 27 .2 4 7 p er h o u r: 1 0 61 ± 6 3 6 ( 1 4 da ys) to ta l: 3 1 .2 1 5 ± 2 3 .6 7 3 p er h o u r: 1 8 4 ± 1 1 9 ( 1 4 da ys) FE V1 % p re di cte d 6M W T S G RQ SF 36 - v it al it y - s o ci al a cti vi ty - p hy si ca l - p syc h o lo gi ca l 3 2 .3 ± 9. 4 3 7 9. 6 ± 1 1 5 .3 5 9 ( 51 ;6 4 ) 4 5 (3 0 -5 5 ) 6 3 (2 5 -8 8) 28 (2 5 -3 3 ) 47 (4 2 -5 4 ) r= 0 .4 9, p< 0 .0 0 2 M cGl o n e ( 2 0) 1 2 4 ; 6 0 % 70 ± 8 O m ro n H J0 0 3 (s te ps /d ay) 3 7 1 6 ( ra n ge 2 76 -1 4 51 1 ) FE V1 % p re di cte d S G RQ 4 5 ±1 5 4 7 ± 19 r = 0 .3 9, p < 0 .0 0 1 r = -0 .2 8 , p < 0 .0 1 N u m b er o f s u b je ct in n u m b er s; p er ce n ta ge o f m al es . A ge in ye ar s, dai ly p hy si ca l a cti vi ty an d se co n da ry m ea su re m en ts as m ea n ± st an da rd d ev ia ti o n . W h en th e st an da rd d ev ia ti o n w as n ot m en ti o n ed , t h e r an ge w as g iv en b et w ee n b ra ck et s. U ni ts o f d ai ly p hy si ca l a cti vi ty p er m ea su re m en t w er e i n di ca te d b el o w th e m ea su re m en t t o o l. V M U : V ec to r M ag ni tu e U ni ts ; T E E : T o ta l E n er g y E xp en d it u re ; R E E : R es ti n g E n er g y E xp en d it u re . A ss o ci ati o n s b et w ee n dai ly p hy si ca l a cti vi ty an d se co n da ry m ea su re m en ts w er e gi ve n w it h r an d p va lu e if p o ss ib le .* (p ar ti al ) c o rr el ati o n r ta ke n as th e ro ot o f R 2 = 0 .2 4 , R 2 = 0 .1 1 ch an ge fr o m m ul ti va ri at e re gr es si o n m o d el s; ad di ti o n al to se x, ag e, ar ti al h yp er te n si o n , B M I≥ 3 0 , a n d s ex , a ge , a rt eri al h yp er te n si o n , B M I≥ 3 0 , a s w el l a s G O LD , r es p ec ti ve ly . Chapter 2

(37)

Ta b le 4 . D ai ly p hy si ca l a cti vi ty l ev el ; Q u es ti o n n ai re -b as ed S tu d y Sub je ct s N ; % m al e A ge ye ar s F E V1 % p red ic ted Q u es ti o n n ai re D ail y p h ys ic al a ct iv it y l ev el C or on el (2 6 ) 36 cont ro ls 39 6 7± 8 6 5 ± 9 3 6 ± 14 9 2 ±7 B ae ck e P hy si ca l A cti vi ty Q u es ti o n n ai re (s co re ≤ 9 = l o w a cti vi ty l ev el) 1 3 .1 ± 6 .2 1 6 .3 ± 9. 8 S er re s (3 2 ) 1 7 8 co n tr o ls 62 ± 2 6 0 ±4 49 ± 4 10 3 ± 3 B ae ck e P hy si ca l A cti vi ty Q u es ti o n n ai re (s co re ≤ 9 = l o w a cti vi ty l ev el) 5 ±1 10± 2 G o ss el in g ( 3 0 ) 10 10 c o n tr o ls 58± 3 6 4± 2 5 7± 6 1 0 7± 4 B ae ck e P hy si ca l A cti vi ty Q u es ti o n n ai re (s co re ≤ 9 = l o w a cti vi ty l ev el) 9. 1 ± 2 1 1 .9 ± 2 Ja n au d is-Fe rr ei ra (3 1 ) 41 ; 3 7 % C o n tr o ls 5 2 ; 4 6 % mal e 6 6 ± 6 fe mal e 6 4 ± 5 mal e 6 7 ± 5 fe mal e 6 4 ± 6 5 0 ±1 2 5 6 ± 11 S el f-re p o rt ed P hy si ca l A cti vi ty l ev el (F ra n d il & G ri m b y) (r an ge 1 -6 , 6 = h ig h a cti vi ty l ev el) Mal e 3 .4 7 ± 0 .8 F em al e 3 .3 0 ± 0 .7 Mal e 3 .6 3 ± 1 F em al e 3 .3 6 ± 0 .7 G o sk er (2 9 ) 2 5 ; 6 4 % C o n tr o ls 3 6 ; 6 7 % 6 2 ±1 0 61 ± 6 3 2 ± 11 111 ± 1 7 P hy si ca l A cti vi ty s ca le f o r t h e e ld erl y (0 -3 6 0 , 3 6 0 = hi gh a cti vi ty l ev el) 89 ± 3 9 14 0 ± 6 4 E n gs tr o m ( 2 7 ) 6 8 ; 6 3 % C o n tr o ls 8 9 ; 5 6 % 6 5 ±7 6 3 ±8 4 0 ±1 7 1 0 3 ±1 3 Si ck n es s I m p ac t P ro fil e (% o f m ax im u m d ys fu n cti o ni n g) 2 2 % n o p hy si ca l d ys fu n cti o n 3 1 % m ar ke d d ys fu n cti o n 8 0 % n o p hy si ca l d ys fu n cti o n 2 % m ar ke d d ys fu n cti o n O zge (28) 5 4 ; 8 5 % C o n tr o ls 2 4 ; 7 1 % 6 5 ± 9 62 ± 8 3 5 ±1 2 P hy si ca l s el f m ai n ta n an ce s ca le (r an ge 6 -3 0 ) In st ru m en ta l a cti vi ti es o f d ai ly l iv in g s ca le (r an ge 8 -31 ) M o d ifi ed a cti vi ti es o f d ai ly l iv in g s ca le (r an ge 0 -1 6 ) (in a ll q u es ti o n n ai re s a h ig h s co re i n d ic at es hi gh er limi ta ti o n s) 6 .4 ±1 .1 0 .7 2 ± 1 .7 0. 3 ± 0. 8 6 .0 ± 0 .0 0. 1 ± 0. 6 0. 0 4 ± 0. 2 N u m b er o f s ub je ct in n u m b er s; p er ce nt ag e o f m al es . A ge in y ea rs , F E V1 % p re di ct ed , a n d d ai ly p hy si ca l a cti vi ty m ea su re m en ts a s m ea n ± s ta n da rd d ev ia ti o n . U ni ts o f d ai ly p hy si ca l a cti vi ty p er m ea su re m en t w er e i n d ic at ed b el o w t h e m ea su re m en t t o o l. I f t h er e w as n o m ea su re m en t u ni t, t h e q u es ti o n n ai re r an ge w as g iv en .

(38)

Ta b le 5 . D ai ly p hy si ca l a cti vi ty t yp e; Q u es ti o n n ai re -b as ed S tu d y Sub je ct N ; % m al e A ge ye ar s F E V1 % p red ic ted Q u es ti o n n ai re (N o t) p er fo rm in g/ d if fi cu lt ie s w it h p er fo rm in g E n gs tr o m ( 2 7 ) 6 8 ; 6 3 % C o n tr o ls 8 9 ; 5 6 % 6 5 ±7 6 3 ±8 4 0 ±1 7 1 0 3 ±1 3 Si ck n es s I m p ac t P ro fil e (% o f m ax im u m d ys fu n cti o ni n g) FE V1 <5 0 % d iff er ed f ro m c on tr ol s i n: w al ki n g, b o d y c ar e/ m o ve m en t, m o b ili ty , w o rk , h o m e ma na ge m ent a n d r ec re at io n /h o b b ie s FE V1 < 5 0 % d iff er ed f ro m F E V1 >5 0 % in : w al ki n g, m o b ili ty , h o m e m an ag em en t a n d r ec re ati o n / h o b b ie s - F E V1 > 5 0 % d iff er ed f ro m c on tr ol s i n: wa lk in g a n d m ob ili ty Ga rc ia -A m er ych (3 3 ) 3 4 6 ; 9 2 % 69 ± 9 3 5 ±1 6 M in n es ot a L ei su re T im e P hy si ca l A cti vi ty Q u es ti o n n ai re (%) N ot p er fo rm in g: w al ki n g d ai ly : 2 2 % cl im b in g s ta ir s: 4 9 % ot h er p hy si ca l a cti vi ti es : 9 0 % p ra cti ci n g s o m e p hy si ca l a cti vi ty : 1 7 % Sl in d e (3 4 ) 1 0 ; 5 0 % m al e: a ge r an ge : 4 7 -7 0 fe m ale ag e r ang e: 5 5 -7 2 3 3 (24 -4 4 ) Z u tp h en P hy si ca l A cti vi ty Q u es ti o n n ai re (%) M o st p er fo rm ed ; g ar d eni n g o r l ig h t-to -m o d er at e int en si ve h o b b ie s N ot p er fo rm in g: w o rk 8 0 % b ic yc lin g 9 0 % w alk in g 5 0 % ga rd eni n g 5 0 % P it ta (1 6 ) 1 3 ; 7 7 % 61 ± 8 3 3 ±1 0 F o lli ck d ia ry (m in ) 6 6 ± 4 7 w al ki n g, 3 ± 9 c yc lin g, 1 4 6 ± 7 1 s ta n d in g, 3 7 5 ± 1 3 4 si tti n g, 8 3 ± 8 3 l yi n g mi n /d ay N u m b er o f s u b je ct in n u m b er s; p er ce n ta ge o f m al es . A ge in y ea rs , F E V1 % p re d ic te d a s m ea n ± s ta n da rd d ev ia ti o n . D ai ly p hy si ca l a cti vi ty i n p er ce n ta ge s o f p ati en ts o r i n mi n u te s p er d ay . Chapter 2

(39)

Daily physical activity determinants Pulmonary function

Airflow obstruction, measured by FEV1% predicted, ranged between 32% and 78% (Table 6). Eleven questionnaire-based studies reported on the relation with daily physical activity. Nine out of 11 studies reported an association between severity of disease and decrease of daily physical activity level (range r=0.10-0.63, p<0.05) (7;9;21;32;35-39). One study used 2 daily physical activity questionnaires with a high score representing inactivity and reported a negative correlation between outcomes of the daily physical activity questionnaires and FEV1% predicted (r=-0.11 and r=-0.72, p=0.001) (28). Two other studies did not demonstrate a (significant) relation between daily physical activity and FEV1% predicted (29;40).

Physical fitness

Physical fitness was assessed in 8 studies (Table 6). Physical fitness was measured by the 6-minute walk test (3 studies), cycle ergometry (3 studies,) quadriceps strength (4 studies), handgrip strength (2 studies), and arm strength (1 study). When measured with the 6MWT, one study showed that physically active patients perform better on the 6MWT test (7). One study reported a positive correlation (r=0.35, p<0.01) (21). When measured with cycle ergo meter, one study reported a positive correlation with daily physical activity (r=0.60, p<0.01) (32), whereas two other studies did not report a significant association (29;40). There was no significant association reported between quadriceps strength and daily physical activity. One study reported a positive non-significant correlation (r=0.04, NS) (32), one a negative correlation (r=-0.32, NS) (41), and two other reported no association (26;29).

Systemic inflammation

One questionnaire-based study focussed on systemic inflammation (Table 6). In this study, Garcia-Aymerich demonstrate that more physically active COPD patients have lower levels of systemic inflammation (TNF-α, interleukin-6, interleukin-8 and C-reactive protein) (7). No differences were found in body-composition and weight between the physical activity groups.

Quality of life

Quality of life was measured in 5 studies using the Chronic Respiratory Disease Questionnaire (2 studies), the Clinical COPD Questionnaire (1 study), the Saint George Respiratory Questionnaire (1 studies), SF36/SF12 (1 study), and the Visual Analog Scale (1 study) (Table 6). Three studies demonstrated a significant positive association between daily physical activity and quality of life (total and individual domain scores) (range r= 0.17-0.48, p<0.01).(33;36;37) Whereas 1 study using 2 different quality of life questionnaires reported a non-significant negative association

(40)

with daily physical activity (CRQ r=-0.21, NS; SF36 physical and mental subdomains r=-0.01 and 0.02, NS) (21).

Interview-based type of daily physical activity

The type of daily physical activity was assessed by interview in 12 studies (Table 7). Most of these studies included small numbers of patients (range 6-100), apparently because the method is time consuming. Except for 2 studies, most patients were male. The mean age was above 60 years. In all included studies the FEV1 (when mentioned) was below 50% predicted or disease state was described as ‘moderate to very severe’. Activities that could not be performed anymore are: everyday tasks (including self-care) (44), household activities (45;46), traveling (44;47), social activities (46-48), hobbies (47), sports (45), and work (45;48). The activities difficult to perform are: everyday tasks (including self-care) (45;49-52), household activities (49;52;53), leisure time activities such as walking (54), traveling (52;54), and sports (47). In general, females report more performance difficulties in home management tasks and hobbies. They tend to hold on to household activities as long as possible and experience great difficulty dropping these.

Referenties

GERELATEERDE DOCUMENTEN

Buiten het verdriet dat we hebben om de zieken en de mensen die we door dat virus voor altijd moeten missen zijn de economi- sche, sociale en maatschappelijke gevolgen die corona

Trek met groen een kring rond een stukje dat laat zien dat deze mensen vrienden zijn..  Kun je deze stukjes terugvinden op

Zowel bij staal als goud (en dat zijn maar twee voorbeelden uit vele, wordt er nooit van kunst- stof gesproken hoewel de stoffen wel kunstmatig zijn verkregen... Dan de

Om de cumulatieve impact van de hier bovenstaande jaarlijkse kosten op de lange termijn winst te illustreren hebben we het resultaat berekend voor een periode van 10 jaar.. We gaan

In deze tweede stap wordt zo breed mogelijk gekeken naar hoe je ervoor kunt zorgen dat de persoon de activiteit die hij graag wil doen ook kan blijven doen: optimalisatie dus?.

De familieraad bestaat uit drie familieleden en/of andere naasten van de zorgvragers die momenteel bij Zorghuis Samen wonen of hier verbleven.. Tijdens het gezamenlijke

We stopten in Portland, hoofdstad van Maine, maar het was zo lelijk en raar dat we beslist hebben om niet aan land te gaan en verder te varen naar Portsmouth.. Daar ook viel het een

--- Sleep het gekozen blok naar het midden (tussen als en anders zet je: “Je kan het niet kopen”, en tussen anders en niks zet je “Je kan het kopen”)..