Clarenbach Christian F, Sievi Noriane A, Haile Sarah R, Brack Thomas, Brutsche Martin H, Frey Martin, Irani Sarosh, Leuppi Jörg D, Thurnheer Robert, Kohler Malcolm
Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland.
Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Respirology. 2017 Aug;22(6):1133-1139. doi: 10.1111/resp.13035. Epub 2017 Mar 30.
Daily physical activity (PA) is reduced in patients with COPD. Previous cross-sectional analyses indicate various predictors for a low level of PA including airway obstruction, exacerbations and co-morbidities. However, information from longitudinal studies evaluating PA in the context of disease progression, survival and co-morbidities is scant.
In a heterogeneous cohort of COPD patients, we annually assessed the number of steps per day over 1 week and potential determinants including lung function, exacerbations and co-morbidities. Univariable and multivariable mixed effect models were used to investigate associations between the change in steps per day (dependent variable) and possible predictors and their annual changes.
A total of 177 COPD patients (46% GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage 1/2, 38% stage 3 and 16% stage 4) with a mean (min/max) follow-up time of 2.7 (1/5) years were annually assessed. The number of steps per day decreased significantly over time (P < 0.001) with a mean annual change of -508 steps. The decrease in activity was significantly associated with forced expiratory volume in 1 s (FEV ) % predicted (P = 0.020) but not with annual changes in FEV . Hyperinflation, exacerbations, co-morbidities and their annual changes, and survival did not significantly affect change in PA.
COPD patients have a substantial decrease of PA over time. This decrease seems to be determined by the degree of airflow limitation. However, patients with a greater annual decline in lung function did not show a greater decrease in PA. The rate of decline in PA did not differ between survivors and non-survivors in this cohort.
慢性阻塞性肺疾病（COPD）患者的日常身体活动（PA）减少。既往横断面分析表明，PA水平低的各种预测因素包括气道阻塞、急性加重和合并症。然而，关于在疾病进展、生存和合并症背景下评估PA的纵向研究信息很少。
在一组异质性COPD患者中，我们每年评估1周内每天的步数以及潜在决定因素，包括肺功能、急性加重和合并症。采用单变量和多变量混合效应模型研究每天步数变化（因变量）与可能的预测因素及其年度变化之间的关联。
共对177例COPD患者（46%为全球慢性阻塞性肺疾病倡议（GOLD）1/2期，38%为3期，16%为4期）进行了年度评估，平均（最小/最大）随访时间为2.7（1/5）年。每天的步数随时间显著减少（P<0.001），平均每年减少508步。活动量的减少与预测的1秒用力呼气容积（FEV）%显著相关（P=0.020），但与FEV的年度变化无关。肺过度充气、急性加重、合并症及其年度变化以及生存情况对PA变化无显著影响。
COPD患者的PA随时间大幅下降。这种下降似乎由气流受限程度决定。然而，肺功能年度下降较大的患者PA下降幅度并未更大。该队列中幸存者和非幸存者的PA下降速率无差异。
