Thyregod Mimi, Løkke Anders, Bodtger Uffe
Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark,
Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark,
Int J Chron Obstruct Pulmon Dis. 2018 Oct 12;13:3359-3365. doi: 10.2147/COPD.S174710. eCollection 2018.
In patients with COPD, severe physical inactivity (SPI, which is defined as total daily energy expenditure/resting energy expenditure; physical activity level [PAL] ratio, <1.4) is associated with increased morbidity and mortality. Pulmonary rehabilitation (PR) increases physical capacity in COPD, but the impact on SPI is unknown. In this study, we aimed at elucidating the prevalence of SPI in COPD patients attending standard PR, the impact of PR on SPI prevalence, and the relationship between SPI and time spent in moderate physical activity thus whether American College of Sports Medicine (ACSM) recommendations are clinically useful in excluding SPI in COPD.
This is a prospective non-interventional pilot study on patients with COPD completing PR, consenting to wear an accelerometer (Sensewear Armband) for a week before and after completing PR to assess changes in energy expenditure, time spent in physical activity, and number of daily steps. Low level of daily physical activity was not an inclusion criterion.
In total, 57 patients completed the study and 31 (54%) had SPI at baseline. In patients with SPI, baseline median FEV was 48 (range, 28-86) % of predicted and GOLD B, n=11 (35%)/GOLD D, n=20 (65%). Surprisingly, 31 of SPI patients (97%) spent ≥150 minutes/week in moderate physical activity. After rehabilitation, 24 (78%) did not change activity level and were persistently SPI. We observed no differences at baseline between patient responding (n=7) vs not responding (n=24) to PR. Responders increased number of daily steps and time spent in lighter but not moderate physical activity during rehabilitation.
In this pilot study, SPI was prevalent, and PR had limited impact. Contraintui-tively, most patients with SPI complied with general recommendations of weekly hours spent in moderate physical activity. Our study highlights that increasing time spent in light activity rather than improving time spent in moderate activity is important in COPD patients with chronic dyspnea.
在慢性阻塞性肺疾病（COPD）患者中，严重身体活动不足（SPI，定义为每日总能量消耗/静息能量消耗；身体活动水平[PAL]比值<1.4）与发病率和死亡率增加相关。肺康复（PR）可提高COPD患者的身体能力，但对SPI的影响尚不清楚。在本研究中，我们旨在阐明参加标准PR的COPD患者中SPI的患病率、PR对SPI患病率的影响，以及SPI与中度身体活动时间之间的关系，从而确定美国运动医学学院（ACSM）的建议在排除COPD患者的SPI方面是否具有临床实用性。
这是一项针对完成PR的COPD患者的前瞻性非干预性试点研究，患者同意在完成PR前后佩戴一周的加速度计（Sensewear臂带），以评估能量消耗、身体活动时间和每日步数的变化。低水平的日常身体活动不是纳入标准。
共有57例患者完成了研究，31例（54%）在基线时有SPI。在有SPI的患者中，基线时FEV的中位数为预测值的48%（范围为28%-86%），GOLD B级，n = 11（35%）/GOLD D级，n = 20（65%）。令人惊讶的是，31例SPI患者中有97%每周进行中度身体活动的时间≥150分钟。康复后，24例（78%）的活动水平没有变化，仍然存在SPI。我们观察到对PR有反应（n = 7）与无反应（n = 24）的患者在基线时没有差异。有反应者在康复期间增加了每日步数和在轻度而非中度身体活动中花费的时间。
在这项试点研究中，SPI很普遍，且PR的影响有限。矛盾的是，大多数SPI患者符合每周进行中度身体活动时间的一般建议。我们的研究强调，对于有慢性呼吸困难的COPD患者，增加轻度活动时间而非改善中度活动时间很重要。
