Improving physical activity in COPD: towards a new paradigm

Abstract

Chronic obstructive pulmonary disease (COPD) is a debilitating disease affecting patients in daily life, both physically and emotionally. Symptoms such as dyspnea and muscle fatigue, lead to exercise intolerance, which, together with behavioral issues, trigger physical inactivity, a key feature of COPD. Physical inactivity is associated with adverse clinical outcomes, including hospitalization and all-cause mortality. Increasing activity levels is crucial for effective management strategies and could lead to improved long-term outcomes. In this review we summarize objective and subjective instruments for evaluating physical activity and focus on interventions such as pulmonary rehabilitation or bronchodilators aimed at increasing activity levels. To date, only limited evidence exists to support the effectiveness of these interventions. We suggest that a multimodal approach comprising pulmonary rehabilitation, pharmacotherapy, and counselling programs aimed at addressing emotional and behavioural aspects of COPD may be an effective way to increase physical activity and improve health status in the long term.

Figure 1

The vicious cycle of inactivity and symptoms.

Figure 2

Regular physical activity reduces hospital admissions (upper panel A) and all-cause death (lower panel B) [50]. Kaplan-Meier curves according to level of regular physical activity during follow-up. Patients with COPD from the Copenhagen City Heart Study (n=2386), recruited from 1981 and followed to 2000. Reproduced from [50] with permission from BMJ Publishing Group Ltd.

Figure 3

Change in morning activities (absolute scores) over treatment period with budesonide/formoterol plus tiotropium versus placebo plus tiotropium [74]. CDLM: Capacity of Daily Living during the Morning questionnaire; dotted line represents budesonide/formoterol plus tiotropium; solid line represents placebo plus tiotropium; CDLM score at run-in budesonide/formoterol plus tiotropium: 4.09, placebo plus tiotropium: 4.13; ^†treatment comparison from randomization to first week of treatment; ^‡treatment comparison from randomization to last week of treatment. Reprinted with permission of the American Thoracic Society. Copyright © 2013 American Thoracic Society. Welte T, Miravitlles M, Hernandez P, Eriksson G, Peterson S, Polanowski T, et al: Efficacy and tolerability of budesonide/formoterol added to tiotropium in patients withchronic obstructive pulmonary disease. Am J Respir Crit Care Med 2009, 180:741–750. Official journal of the American Thoracic Society.