Pneumology, LungenClinic Grosshansdorf, Grosshansdorf, Germany.
Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany.
Respiration. 2018;95(1):18-26. doi: 10.1159/000481827. Epub 2017 Nov 9.
Little is known about physical activity in daily life among patients with sarcoidosis. Fatigue is a frequent and disabling symptom that might negatively affect physical activity levels.
In patients with sarcoidosis, we measured physical activity (steps per day) by accelerometry (SenseWear Armband) for 1 week. We assessed lung function (DLCO, FVC), exercise capacity (6-min walking distance [6MWD]), health-related quality of life (St George's Respiratory Questionnaire [SGRQ]), generic quality of life (12-Item Short-Form Health Survey [SF-12]), and fatigue (Multidimensional Fatigue Inventory [MFI-20]).
We investigated 57 patients with sarcoidosis (mean age 50 years, 56% male, mean DLCO 73% predicted, mean FVC 91% predicted, mean 6MWD 525 m, mean steps per day 7,490), of whom n = 14 (25%) had severe fatigue. The MFI-20 subscales "reduced activity" and "physical fatigue" were weakly associated with steps per day on a bivariate level (Spearman ρ = -0.274 and ρ = -0.277, respectively; p < 0.05), while the other subscales and the total score were not. 6MWD, SGRQ score, and SF-12 (physical health) score showed stronger associations with steps per day in bivariate analyses (Pearson r = 0.499, r = -0.386, and r = 0.467, respectively; p < 0.01), and were independent predictors of steps per day in multivariate linear regression analyses adjusting for confounders (p < 0.05). In ROC curve analyses, 6MWD, SGRQ score, and SF-12 (physical health) score properly identified sedentary patients (steps per day <5,000; AUROC 0.90, 0.81, and 0.80, respectively; p < 0.01). Fatigue was less predictive (MFI-20 subscale "general fatigue," AUROC 0.70; p = 0.03).
While exercise capacity and quality of life measurements were robust predictors of physical activity in patients with sarcoidosis, associations of objectively measured physical activity with fatigue were surprisingly weak. In sarcoidosis, fatigue might not preclude affected patients from being physically active, although this symptom is subjectively perceived as highly disabling.
关于结节病患者日常生活中的体力活动，我们知之甚少。疲劳是一种常见且使人虚弱的症状，可能会对体力活动水平产生负面影响。
我们通过加速度计（SenseWear Armband）对结节病患者进行了为期一周的日常体力活动（步数）测量。我们评估了肺功能（DLCO、FVC）、运动能力（6 分钟步行距离[6MWD]）、健康相关生活质量（圣乔治呼吸问卷[SGRQ]）、一般生活质量（12 项简短健康调查[SF-12]）和疲劳（多维疲劳量表[MFI-20]）。
我们共调查了 57 例结节病患者（平均年龄 50 岁，56%为男性，平均 DLCO 为预计值的 73%，平均 FVC 为预计值的 91%，平均 6MWD 为 525m，平均步数为 7490 步），其中 n = 14（25%）患者存在严重疲劳。MFI-20 量表中的“活动减少”和“身体疲劳”两个亚量表在双变量水平上与步数呈弱相关（Spearman ρ=-0.274 和 ρ=-0.277，p＜0.05），而其他亚量表和总分则没有相关性。6MWD、SGRQ 评分和 SF-12（身体健康）评分在双变量分析中与步数的相关性更强（Pearson r=0.499、r=-0.386 和 r=0.467，分别；p＜0.01），并且是调整混杂因素后的多元线性回归分析中步数的独立预测因素（p＜0.05）。在 ROC 曲线分析中，6MWD、SGRQ 评分和 SF-12（身体健康）评分可以正确识别出久坐不动的患者（步数＜5000 步；AUROC 分别为 0.90、0.81 和 0.80；p＜0.01）。而疲劳的预测能力则较差（MFI-20 量表的“一般疲劳”亚量表，AUROC 为 0.70；p=0.03）。
虽然运动能力和生活质量测量是结节病患者体力活动的可靠预测指标，但体力活动与疲劳的相关性令人惊讶地较弱。在结节病中，尽管患者主观上认为疲劳严重致残，但疲劳可能不会阻止受影响的患者进行身体活动。
