Garcia-Aymerich Judith, Serra Ignasi, Gómez Federico P, Farrero Eva, Balcells Eva, Rodríguez Diego A, de Batlle Jordi, Gimeno Elena, Donaire-Gonzalez David, Orozco-Levi Mauricio, Sauleda Jaume, Gea Joaquim, Rodriguez-Roisin Robert, Roca Josep, Agustí Àlvar G, Antó Josep M
Centre for Research in Environmental Epidemiology, Barcelona, Spain.
Centro de Investigación Biomédica en Red Epidemiologia y Salud Pública (CIBERESP) [Dr. de Batlle], Barcelona, Spain.
Chest. 2009 Jul;136(1):62-70. doi: 10.1378/chest.08-2532. Epub 2009 Mar 2.
The mechanisms underlying the benefits of regular physical activity in the evolution of COPD have not been established. Our objective was to assess the relationship between regular physical activity and the clinical and functional characteristics of COPD.
Three hundred forty-one patients were hospitalized for the first time because of a COPD exacerbation in nine teaching hospitals in Spain. COPD diagnosis was confirmed by spirometry under stable conditions. Physical activity before the first COPD hospitalization was measured using the Yale questionnaire. The following outcome variables were studied under stable conditions: dyspnea, nutritional status, complete lung function tests, respiratory and peripheral muscle strength, bronchial colonization, and systemic inflammation.
The mean age was 68 years (SD, 9 years), 93% were men, 43% were current smokers, and the mean postbronchodilator FEV(1) was 52% predicted (SD, 16% predicted). Multivariate linear regression models were built separately for each outcome variable and adjusted for potential confounders (including remaining outcomes if appropriate). When patients with the lowest quartile of physical activity were compared to patients in the other quartiles, physical activity was associated with significantly higher diffusing capacity of the lung for carbon monoxide (Dlco) [change in the second, third, and fourth quartiles of physical activity, compared with first quartile (+ 6%, + 6%, and + 9% predicted, respectively; p = 0.012 [for trend])], expiratory muscle strength (maximal expiratory pressure [Pemax]) [+ 7%, + 5%, and + 9% predicted, respectively; p = 0.081], 6-min walking distance (6MWD) [+ 40, + 41, and + 45 m, respectively; p = 0.006 (for trend)], and maximal oxygen uptake (Vo(2)peak) [+ 55, + 185, and + 81 mL/min, respectively; p = 0.110 (for trend)]. Similarly, physical activity reduced the risk of having high levels of circulating tumor necrosis factor alpha (odds ratio, 0.78, 0.61, and 0.36, respectively; p = 0.011) and C-reactive protein (0.70, 0.51, and 0.52, respectively; p = 0.036) in multivariate logistic regression.
More physically active COPD patients show better functional status in terms of Dlco, Pemax, 6MWD, Vo(2)peak, and systemic inflammation.
规律体育活动在慢性阻塞性肺疾病（COPD）发展过程中产生益处的潜在机制尚未明确。我们的目的是评估规律体育活动与COPD临床及功能特征之间的关系。
341例因COPD急性加重首次在西班牙9家教学医院住院的患者。在病情稳定条件下通过肺量计确诊COPD。使用耶鲁问卷测量首次COPD住院前的体育活动情况。在病情稳定条件下研究以下结局变量：呼吸困难、营养状况、完整肺功能测试、呼吸及外周肌肉力量、支气管定植及全身炎症。
平均年龄为68岁（标准差9岁），93%为男性，43%为当前吸烟者，支气管扩张剂后第1秒用力呼气容积（FEV₁）平均为预测值的52%（标准差为预测值的16%）。针对每个结局变量分别建立多变量线性回归模型，并对潜在混杂因素进行校正（如合适，包括其余结局变量）。将体育活动处于最低四分位数的患者与其他四分位数的患者进行比较时，体育活动与一氧化碳肺弥散量（Dlco）显著更高相关[体育活动第二、第三和第四四分位数与第一四分位数相比的变化，分别为（预测值增加6%、6%和9%；趋势p = 0.012）]、呼气肌力量（最大呼气压力[Pemax]）[分别为预测值增加7%、5%和9%；p = 0.081]、6分钟步行距离（6MWD）[分别增加40、41和45米；趋势p = 0.006]以及最大摄氧量（Vo₂peak）[分别增加55、185和81毫升/分钟；趋势p = 0.110]。同样，在多变量逻辑回归中，体育活动降低了循环肿瘤坏死因子α水平升高的风险（比值比分别为0.78、0.61和0.36；p = 0.011）以及C反应蛋白水平升高的风险（分别为0.70、0.51和0.52；p = 0.036）。
体育活动较多的COPD患者在Dlco、Pemax、6MWD、Vo₂peak及全身炎症方面表现出更好的功能状态。
