Université Laval, Québec, Canada.
Phys Sportsmed. 2013 Feb;41(1):66-80. doi: 10.3810/psm.2013.02.2001.
Chronic obstructive pulmonary disease (COPD) reduces patients' exercise capacities and their abilities to perform daily physical activities, thereby increasing morbidity and mortality rates. The cycle of dyspnea, deconditioning, and declining physical activity not only accelerates the progression of COPD but also increases the risk for developing or aggravating metabolic and cardiovascular diseases. Cardiovascular and metabolic comorbidities also limit physical function, and their disabling effects in combination with COPD may be greater than the effects of each disease alone. The impact of COPD and its treatment on the ability to exercise, and the degree of physical activity in daily life, can be measured by field-based tests (eg, the 6-minute walk test or incremental and endurance shuttle-walk test), laboratory-based tests (eg, incremental or constant work-rate treadmill and cycle-ergometer tests), and physical activity assessments (eg, questionnaires and accelerometers). Walking tests increase oxygen consumption and desaturation in patients with COPD more than cycling tests with similar work-rate profiles and may more closely resemble patients' normal activities. Despite the questionable relevance of exercise testing to patients' daily functionality, exercise parameters remain important predictors of survival in patients with COPD. Treatment of COPD (pharmacotherapy, pulmonary rehabilitation, or both) can increase exercise capacity and physical activity in daily life, which potentially slows the decline of lung function, reduces the frequencies of exacerbations and hospitalizations, decreases mortality, slows the progression of comorbidities, improves health-related quality of life, and increases the activity reserve for routine function. This article examines the interactions of reduced physical activity and decreased exercise capacity with the progression of COPD, comorbidities, and mortality. The article also describes the available exercise tests for patients with COPD and reviews the evidence indicating that treating COPD improves exercise capacity. Notably, it appears that even mild COPD reduces exercise capacity and daily physical activity, indicating the need for early intervention.
慢性阻塞性肺疾病（COPD）降低了患者的运动能力和进行日常体力活动的能力，从而增加了发病率和死亡率。呼吸困难、身体不适和活动减少的循环不仅加速了 COPD 的进展，还增加了发生或加重代谢和心血管疾病的风险。心血管和代谢合并症也限制了身体功能，它们与 COPD 的联合致残作用可能大于每种疾病单独的作用。COPD 及其治疗对运动能力和日常生活中体力活动的影响，可以通过现场测试（例如，6 分钟步行测试或递增和耐力穿梭步行测试）、实验室测试（例如，递增或恒定工作率跑步机和功率自行车测试）和体力活动评估（例如，问卷和加速度计）来测量。与具有相似工作率的自行车测试相比，步行测试增加了 COPD 患者的耗氧量和饱和度下降，并且可能更接近患者的正常活动。尽管运动测试与患者的日常功能相关性存在争议，但运动参数仍然是 COPD 患者生存的重要预测指标。COPD 的治疗（药物治疗、肺康复或两者兼用）可以增加运动能力和日常生活中的体力活动，这可能会减缓肺功能下降的速度，减少恶化和住院的频率，降低死亡率，减缓合并症的进展，改善健康相关的生活质量，并增加日常功能的活动储备。本文探讨了体力活动减少和运动能力下降与 COPD 进展、合并症和死亡率的相互作用。本文还描述了 COPD 患者可用的运动测试，并回顾了表明治疗 COPD 可以改善运动能力的证据。值得注意的是，即使是轻度 COPD 也会降低运动能力和日常体力活动，这表明需要早期干预。
