Shioya Takanobu, Sato Susumu, Iwakura Masahiro, Takahashi Hitomi, Terui Yoshino, Uemura Sachiko, Satake Masahiro
Akita University Graduate School of Health Sciences, Department of Physical Therapy, Akita, Japan.
Kyoto University Hospital, Department of Rehabilitation & Pulmonary Medicine, Kyoto, Japan.
Respir Investig. 2018 Jul;56(4):292-306. doi: 10.1016/j.resinv.2018.05.002. Epub 2018 Jun 11.
Physical activity (PA) is defined as bodily movement produced by skeletal muscles with energy expenditure beyond resting levels. PA is closely related to reduced morbidity and mortality in chronic obstructive pulmonary disease (COPD). Self-report questionnaires are often subject to recall bias, correlating poorly with objectively qualified PA, and do not provide an accurate estimate of free-living energy expenditure. PA may be objectively evaluated by newly developed tri-axial accelerometers by quantifying steps or body movements over a period of time. Low-intensity, home-based pulmonary rehabilitation (PR) using pedometer feedback improves PA. Improvement in physiological factors correlates with increased walking time in stable elderly COPD patients. This review focuses on the effects of PR and pharmacological treatment on PA in COPD patients. We selected 32 studies from our literature search evaluating the effects of PR and 11 studies examining the effects of pharmacological treatment on PA. Findings in both categories were inconsistent. Nineteen studies showed a positive effect with PR whereas 13 showed no effect. Eight studies showed a positive effect, while three revealed no effect from pharmacological intervention. As both interventions increase exercise capacity without a consistent effect on PA, counseling with behavioral changes may be necessary to achieve a significant and lasting increase in PA. Changing PA behavior in COPD patients requires an interdisciplinary approach involving specialists in respiratory medicine, rehabilitation, social, and behavioral sciences. Future research in this area is warranted to advance our knowledge in this area, specifically with regard to the interaction of pharmacological and non-pharmacological interventions.
身体活动（PA）被定义为骨骼肌产生的、能量消耗超过静息水平的身体运动。PA与慢性阻塞性肺疾病（COPD）发病率和死亡率的降低密切相关。自我报告问卷常常存在回忆偏倚，与客观测定的PA相关性较差，并且不能准确估计日常活动中的能量消耗。可以通过新开发的三轴加速度计，通过量化一段时间内的步数或身体运动来客观评估PA。使用计步器反馈的低强度居家肺康复（PR）可改善PA。在稳定的老年COPD患者中，生理因素的改善与步行时间的增加相关。本综述重点关注PR和药物治疗对COPD患者PA的影响。我们从文献检索中筛选出32项评估PR效果的研究以及11项研究药物治疗对PA影响的研究。这两类研究的结果均不一致。19项研究显示PR有积极效果，而13项研究显示无效果。8项研究显示药物干预有积极效果，而3项研究显示无效果。由于这两种干预措施都能提高运动能力，但对PA没有一致的影响，因此可能需要进行行为改变咨询，以实现PA的显著且持久的增加。改变COPD患者的PA行为需要一种跨学科方法，涉及呼吸医学、康复、社会和行为科学方面的专家。该领域未来的研究有必要推进我们在这方面的知识，特别是关于药物和非药物干预措施之间的相互作用。
