日常步数预测美国 COPD 队列中的急性加重。
Daily step count predicts acute exacerbations in a US cohort with COPD.
机构信息
Department of Veteran Affairs, Veterans Health Administration, Rehabilitation Research and Development Service, Washington, DC, United States of America.
出版信息
PLoS One. 2013 Apr 4;8(4):e60400. doi: 10.1371/journal.pone.0060400. Print 2013.
BACKGROUND
COPD is characterized by variability in exercise capacity and physical activity (PA), and acute exacerbations (AEs). Little is known about the relationship between daily step count, a direct measure of PA, and the risk of AEs, including hospitalizations.
METHODS
In an observational cohort study of 169 persons with COPD, we directly assessed PA with the StepWatch Activity Monitor, an ankle-worn accelerometer that measures daily step count. We also assessed exercise capacity with the 6-minute walk test (6MWT) and patient-reported PA with the St. George's Respiratory Questionnaire Activity Score (SGRQ-AS). AEs and COPD-related hospitalizations were assessed and validated prospectively over a median of 16 months.
RESULTS
Mean daily step count was 5804±3141 steps. Over 209 person-years of observation, there were 263 AEs (incidence rate 1.3±1.6 per person-year) and 116 COPD-related hospitalizations (incidence rate 0.56±1.09 per person-year). Adjusting for FEV1 % predicted and prednisone use for AE in previous year, for each 1000 fewer steps per day walked at baseline, there was an increased rate of AEs (rate ratio 1.07; 95%CI = 1.003-1.15) and COPD-related hospitalizations (rate ratio 1.24; 95%CI = 1.08-1.42). There was a significant linear trend of decreasing daily step count by quartiles and increasing rate ratios for AEs (P = 0.008) and COPD-related hospitalizations (P = 0.003). Each 30-meter decrease in 6MWT distance was associated with an increased rate ratio of 1.07 (95%CI = 1.01-1.14) for AEs and 1.18 (95%CI = 1.07-1.30) for COPD-related hospitalizations. Worsening of SGRQ-AS by 4 points was associated with an increased rate ratio of 1.05 (95%CI = 1.01-1.09) for AEs and 1.10 (95%CI = 1.02-1.17) for COPD-related hospitalizations.
CONCLUSIONS
Lower daily step count, lower 6MWT distance, and worse SGRQ-AS predict future AEs and COPD-related hospitalizations, independent of pulmonary function and previous AE history. These results support the importance of assessing PA in patients with COPD, and provide the rationale to promote PA as part of exacerbation-prevention strategies.
背景
COPD 的特点是运动能力和体力活动（PA）以及急性加重（AE）的变异性。关于日常步数（PA 的直接测量）与 AE 风险（包括住院）之间的关系，知之甚少。
方法
在一项 169 名 COPD 患者的观察性队列研究中，我们使用脚踝佩戴的加速度计 StepWatch Activity Monitor 直接评估 PA，该计步器可测量日常步数。我们还使用 6 分钟步行测试（6MWT）评估运动能力，使用圣乔治呼吸问卷活动评分（SGRQ-AS）评估患者报告的 PA。在中位数为 16 个月的时间内，前瞻性地评估 AE 和 COPD 相关住院情况，并进行验证。
结果
平均每日步数为 5804±3141 步。在 209 人年的观察期间，共发生 263 次 AE（发生率为 1.3±1.6 人年）和 116 次 COPD 相关住院（发生率为 0.56±1.09 人年）。在调整了 FEV1 %预测值和前一年 AE 中使用的泼尼松后，与基线时每天少走 1000 步相比，AE 发生率增加（比率比 1.07；95%CI=1.003-1.15）和 COPD 相关住院率增加（比率比 1.24；95%CI=1.08-1.42）。按 quartiles 划分，每日步数呈显著线性下降趋势，AE（P=0.008）和 COPD 相关住院率（P=0.003）的比率比增加。6MWT 距离每减少 30 米，AE 的比率比增加 1.07（95%CI=1.01-1.14），与 COPD 相关的住院率增加 1.18（95%CI=1.07-1.30）。SGRQ-AS 恶化 4 分，AE 的比率比增加 1.05（95%CI=1.01-1.09），与 COPD 相关的住院率增加 1.10（95%CI=1.02-1.17）。
结论
较低的日常步数、较短的 6MWT 距离和较差的 SGRQ-AS 预测未来的 AE 和 COPD 相关住院，独立于肺功能和既往 AE 史。这些结果支持评估 COPD 患者 PA 的重要性，并为促进 PA 作为预防加重策略的一部分提供了依据。
Zotero 插件