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The difficulties of measuring and improving physical activity in COPD.

Aguilaniu B, Roche N - NPJ Prim Care Respir Med (2014)

View Article: PubMed Central - PubMed

Affiliation: Faculté de Médecine de Grenoble-Université Joseph Fourrier, Grenoble, France.

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In the linked paper, Troosters et al. report the results of a randomised placebo-controlled trial assessing the effect of the long-acting anti-muscarinic agent tiotropium on lung function, physical activity (PA), health status and productivity in chronic obstructive pulmonary disease (COPD) patients with moderate lung function impairment (Global Initiative for Chronic Obstructive Lung Disease stage II) and no previous maintenance treatment... Major determinants of quality of life impairment in COPD patients include handicap in daily life, and exacerbations... Handicap in daily life is the result of limitations in exercise capacity and/or tolerance, mostly as a consequence of ventilatory impairment (increased respiratory workload and decreased efficiency of inspiratory muscles), gas exchange abnormalities, and quantitative and qualitative peripheral muscle dysfunction (loss of muscle mass and enzymatic capacities)... Altogether, results were inconsistent, especially in the long term... Accordingly, a recent systematic review by the PROactive consortium concluded that the evidence regarding deleterious consequences of low PA was convincing, while the level of evidence regarding determinants of PA including treatment effects was low... Similarly, evidence from therapeutic studies was inconsistent... Of note, inconsistency was found not only for long-term effects but also for PA at the end of the rehabilitation programme... There might be several explanations for the lack of robust effect of treatments on PA in patients with COPD... The linked study by Troosters et al. addressed this question by using several complementary approaches to assess PA in patients with moderate COPD... Although tiotropium did not statistically significantly increase the number of daily steps, the ‘global assessment of health’ by the patient and the physician were statistically improved after a few weeks of tiotropium treatment... Thus, relieving respiratory functional impairment may not be enough to increase daily PA, although at the beginning of disease progression, the deterioration of lung function may have been one of the main determinants of the reduction of walking activities, at least in some patients... Disappointingly, a lifestyle activity intervention did not prove to be superior to traditional exercise training in COPD patients... Similarly, long-term supervised exercise programmes following rehabilitation do not seem to improve quality of life (or PA, although specifically measured in only one of the analysed studies) as compared to rehabilitation alone... Ultimately, in COPD patients, as in the general population, increasing PA likely requires much more than increasing physical capacities; both individually tailored and global public health actions are also necessary, as comprehensively outlined in recent reviews (see Figure 2).

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A putative model to improve physical activity levels in chronic obstructive pulmonary disease (COPD). Green zones contain triggers and blue zones contain facilitators.
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fig2: A putative model to improve physical activity levels in chronic obstructive pulmonary disease (COPD). Green zones contain triggers and blue zones contain facilitators.

Mentions: Ultimately, in COPD patients, as in the general population, increasing PA likely requires much more than increasing physical capacities; both individually tailored and global public health actions are also necessary, as comprehensively outlined in recent reviews20,21 (see Figure 2).


The difficulties of measuring and improving physical activity in COPD.

Aguilaniu B, Roche N - NPJ Prim Care Respir Med (2014)

A putative model to improve physical activity levels in chronic obstructive pulmonary disease (COPD). Green zones contain triggers and blue zones contain facilitators.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4373312&req=5

fig2: A putative model to improve physical activity levels in chronic obstructive pulmonary disease (COPD). Green zones contain triggers and blue zones contain facilitators.
Mentions: Ultimately, in COPD patients, as in the general population, increasing PA likely requires much more than increasing physical capacities; both individually tailored and global public health actions are also necessary, as comprehensively outlined in recent reviews20,21 (see Figure 2).

View Article: PubMed Central - PubMed

Affiliation: Faculté de Médecine de Grenoble-Université Joseph Fourrier, Grenoble, France.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

In the linked paper, Troosters et al. report the results of a randomised placebo-controlled trial assessing the effect of the long-acting anti-muscarinic agent tiotropium on lung function, physical activity (PA), health status and productivity in chronic obstructive pulmonary disease (COPD) patients with moderate lung function impairment (Global Initiative for Chronic Obstructive Lung Disease stage II) and no previous maintenance treatment... Major determinants of quality of life impairment in COPD patients include handicap in daily life, and exacerbations... Handicap in daily life is the result of limitations in exercise capacity and/or tolerance, mostly as a consequence of ventilatory impairment (increased respiratory workload and decreased efficiency of inspiratory muscles), gas exchange abnormalities, and quantitative and qualitative peripheral muscle dysfunction (loss of muscle mass and enzymatic capacities)... Altogether, results were inconsistent, especially in the long term... Accordingly, a recent systematic review by the PROactive consortium concluded that the evidence regarding deleterious consequences of low PA was convincing, while the level of evidence regarding determinants of PA including treatment effects was low... Similarly, evidence from therapeutic studies was inconsistent... Of note, inconsistency was found not only for long-term effects but also for PA at the end of the rehabilitation programme... There might be several explanations for the lack of robust effect of treatments on PA in patients with COPD... The linked study by Troosters et al. addressed this question by using several complementary approaches to assess PA in patients with moderate COPD... Although tiotropium did not statistically significantly increase the number of daily steps, the ‘global assessment of health’ by the patient and the physician were statistically improved after a few weeks of tiotropium treatment... Thus, relieving respiratory functional impairment may not be enough to increase daily PA, although at the beginning of disease progression, the deterioration of lung function may have been one of the main determinants of the reduction of walking activities, at least in some patients... Disappointingly, a lifestyle activity intervention did not prove to be superior to traditional exercise training in COPD patients... Similarly, long-term supervised exercise programmes following rehabilitation do not seem to improve quality of life (or PA, although specifically measured in only one of the analysed studies) as compared to rehabilitation alone... Ultimately, in COPD patients, as in the general population, increasing PA likely requires much more than increasing physical capacities; both individually tailored and global public health actions are also necessary, as comprehensively outlined in recent reviews (see Figure 2).

Show MeSH
Related in: MedlinePlus