Department of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia.
Lung. 2019 Feb;197(1):37-45. doi: 10.1007/s00408-018-0177-8. Epub 2018 Nov 14.
People with chronic obstructive pulmonary disease (COPD) present high prevalence of physical inactivity that leads to a negative effect on health-related quality of life (HRQoL). The present study investigated COPD phenotypes according to their levels of physical activity and sedentary behaviour, as well as body composition and skeletal muscle strength.
This is an observational and cross-sectional study. Anthropometric data and COPD clinical control were collected and all participants underwent assessments of lung function, HRQoL, dyspnoea, levels of physical activity and sedentary behaviour, body composition and skeletal muscle strength. Participants were classified using hierarchical cluster analysis. Age, dyspnoea and obstruction (ADO) index was used to determine prognosis and calculated for each cluster.
One hundred and fifty-two participants were included. Three distinct phenotypes were identified. Participants in phenotype 1 were more physically active, less sedentary and had better body composition and lower ADO index (p < 0.0001 for all variables). Overall, participants in phenotypes 2 and 3 were less physically active, more sedentary having a higher ADO index. However, participants in phenotype 2 were older, whereas participants in phenotype 3 had worse HRQoL, clinical control and body composition. Lung function did not differ across the three phenotypes.
Our results show that physical activity, sedentary behaviour and body composition should be considered to determine phenotypes in people with COPD and are involved in the prognosis of the disease. Less sedentary patients have better prognosis while age, body composition and clinical control seems to differentiate physically inactive patients.
患有慢性阻塞性肺疾病（COPD）的人群普遍存在身体活动不足的情况，这对健康相关生活质量（HRQoL）产生负面影响。本研究根据身体活动和久坐行为水平以及身体成分和骨骼肌力量，对 COPD 表型进行了研究。
这是一项观察性和横断面研究。收集了人体测量学数据和 COPD 临床控制数据，所有参与者都接受了肺功能、HRQoL、呼吸困难、身体活动和久坐行为水平、身体成分和骨骼肌力量评估。使用层次聚类分析对参与者进行分类。使用年龄、呼吸困难和阻塞（ADO）指数来确定预后，并为每个聚类计算。
共纳入 152 名参与者。确定了三种不同的表型。表型 1 的参与者身体活动更活跃、久坐时间更少、身体成分更好、ADO 指数更低（所有变量的 p 值均<0.0001）。总体而言，表型 2 和 3 的参与者身体活动较少，久坐时间更长，ADO 指数更高。然而，表型 2 的参与者年龄较大，而表型 3 的参与者 HRQoL、临床控制和身体成分更差。三种表型之间的肺功能没有差异。
我们的结果表明，身体活动、久坐行为和身体成分应被考虑用于确定 COPD 患者的表型，并与疾病的预后相关。较少久坐的患者预后更好，而年龄、身体成分和临床控制似乎可以区分不活跃的患者。
