Yu Tsung, Frei Anja, Ter Riet Gerben, Puhan Milo A
Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland.
Respiration. 2016;92(2):72-9. doi: 10.1159/000447975. Epub 2016 Jul 13.
Although many studies examined determinants of physical activity in patients with chronic obstructive pulmonary disease (COPD), most were cross-sectional and focused on single determinants only.
The aim of this study was to determine how COPD patients' physical activity changes over time and to identify the determinants of physical activity using multivariable and longitudinal methods.
In a prospective cohort study, 409 primary care patients with COPD in the Netherlands and Switzerland were followed for up to 5 years. Physical activity was assessed at baseline and every 6 months using the Longitudinal Aging Study Amsterdam Physical Activity Questionnaire (LAPAQ) adapted to a 0- to 23-point scale. We studied the associations between determinants at baseline and patients' long-term physical activity levels using linear mixed models.
Unadjusted analysis showed an overall gradual decline in physical activity (0.22 points of the LAPAQ scale every 6 months, 95% CI: 0.17-0.28; p < 0.001). In multivariable analyses, baseline determinants that were independently associated (p ≤ 0.05) with lower long-term physical activity levels included (starting from coefficients with the smallest p value) lower exercise capacity, older age, working, more smoking pack-years, more fatigued, male sex, lower educational levels, previously not in fitness programs, more depressed, lower lung function, lower overall health status, and more prescription drug use.
We found that physical activity of COPD patients may decline more than reported in the healthy elderly. Longitudinal analysis identified independent determinants of physical activity, which allows the identification of patients having low physical activity levels and who may benefit from physical activity interventions.
尽管许多研究探讨了慢性阻塞性肺疾病（COPD）患者身体活动的决定因素，但大多数研究为横断面研究，且仅关注单一决定因素。
本研究旨在确定COPD患者的身体活动如何随时间变化，并使用多变量和纵向方法确定身体活动的决定因素。
在一项前瞻性队列研究中，对荷兰和瑞士的409例初级保健COPD患者进行了长达5年的随访。使用改编为0至23分制的阿姆斯特丹纵向衰老研究身体活动问卷（LAPAQ）在基线和每6个月评估一次身体活动。我们使用线性混合模型研究了基线时的决定因素与患者长期身体活动水平之间的关联。
未经调整的分析显示身体活动总体呈逐渐下降趋势（LAPAQ量表每6个月下降0.22分，95%CI：0.17 - 0.28；p < 0.001）。在多变量分析中，与较低长期身体活动水平独立相关（p≤0.05）的基线决定因素包括（从p值最小的系数开始）运动能力较低、年龄较大、有工作、吸烟包年数更多、更疲劳、男性、教育水平较低、以前未参加健身项目、更抑郁、肺功能较低、总体健康状况较差以及使用处方药较多。
我们发现COPD患者的身体活动下降可能比健康老年人报告的情况更严重。纵向分析确定了身体活动的独立决定因素，这有助于识别身体活动水平较低且可能从身体活动干预中受益的患者。
