ISGlobal, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
Physiotherapy Department, Faculty of Health Sciences, University of Deusto, Donostia-San Sebastián, Spain.
Environ Res. 2022 Nov;214(Pt 2):113956. doi: 10.1016/j.envres.2022.113956. Epub 2022 Jul 22.
Physical activity and exercise capacity are key prognostic factors in chronic obstructive pulmonary disease (COPD) but their environmental determinants are unknown.
To test the association between urban environment and objective physical activity, physical activity experience and exercise capacity in COPD.
We studied 404 patients with mild-to-very severe COPD from a multi-city study in Catalonia, Spain. We measured objective physical activity (step count and sedentary time) by the Dynaport MoveMonitor, physical activity experience (difficulty with physical activity) by the Clinical visit-PROactive (C-PPAC) instrument, and exercise capacity by the 6-min walk distance (6MWD). We estimated individually (geocoded to the residential address) population density, pedestrian street length, slope of terrain, and long-term (i.e., annual) exposure to road traffic noise, nitrogen dioxide (NO) and particulate matter (PM). We built single- and multi-exposure mixed-effects linear regressions with a random intercept for city, adjusting for confounders.
Patients were 85% male, had mean (SD) age 69 (9) years and walked 7524 (4045) steps/day. In multi-exposure models, higher population density was associated with fewer steps, more sedentary time and worse exercise capacity (-507 [95% CI: 1135, 121] steps, +0.2 [0.0, 0.4] h/day and -13 [-25, 0] m per IQR). Pedestrian street length related with more steps and less sedentary time (156 [9, 304] steps and -0.1 [-0.1, 0.0] h/day per IQR). Steeper slope was associated with better exercise capacity (15 [3, 27] m per IQR). Higher NO levels related with more sedentary time and more difficulty in physical activity. PM and noise were not associated with physical activity or exercise capacity.
Population density, pedestrian street length, slope and NO exposure relate to physical activity and capacity of COPD patients living in highly populated areas. These findings support the consideration of neighbourhood environmental factors during COPD management and the attention to patients with chronic diseases when developing urban and transport planning policies.
体力活动和运动能力是慢性阻塞性肺疾病（COPD）的关键预后因素，但它们的环境决定因素尚不清楚。
检测城市环境与 COPD 患者的客观体力活动、体力活动体验和运动能力之间的关系。
我们研究了来自西班牙加泰罗尼亚多城市研究的 404 名轻度至重度 COPD 患者。我们使用 Dynaport MoveMonitor 测量客观体力活动（步数和久坐时间），使用临床就诊-PROactive（C-PPAC）仪器测量体力活动体验（体力活动困难），使用 6 分钟步行距离（6MWD）测量运动能力。我们分别估计（根据居住地址进行地理编码）人口密度、步行街长度、地形坡度以及长期（即每年）道路交通噪声、二氧化氮（NO）和颗粒物（PM）暴露。我们构建了单暴露和多暴露混合效应线性回归模型，每个城市的随机截距用于调整混杂因素。
患者中 85%为男性，平均（标准差）年龄为 69（9）岁，每天行走 7524（4045）步。在多暴露模型中，较高的人口密度与较少的步数、更多的久坐时间和更差的运动能力相关（每增加一个 IQR，减少 507 步[95%CI：1135，121]、增加 0.2[0.0，0.4]小时/天和减少 13[-25，0]米）。步行街长度与更多的步数和更少的久坐时间相关（每增加一个 IQR，增加 156[9，304]步和减少 0.1[-0.1，0.0]小时/天）。坡度越陡与更好的运动能力相关（每增加一个 IQR，增加 15[3，27]米）。较高的 NO 水平与更多的久坐时间和更多的体力活动困难相关。PM 和噪声与体力活动或运动能力无关。
人口密度、步行街长度、坡度和 NO 暴露与生活在人口密集地区的 COPD 患者的体力活动和能力有关。这些发现支持在 COPD 管理期间考虑邻里环境因素，并在制定城市和交通规划政策时关注慢性疾病患者。
