Insight into Physical Activity Patterns in Patients with Chronic Obstructive Pulmonary Disease
data of activity patterns (daily trends). Furthermore, patients kept a diary in which they recorded their activities.
So far, 15 patients have completed all measurements. Steps per day ranged from 1,608 to nearly 12,000. Only two patients reached the recommended 10,000 steps per day.8
Five patients failed to reach
even reach 3,000 steps per day. Daily activity patterns were very variable in terms of the duration and frequency of activities, body positions and movement intensities. Patients who could be classified overall as equally active (27 % versus 26 % during the day) showed a very different activity pattern. We illustrate this using two patients (with no co-morbidities) as an example (see Figure 1).
Patient 1 (less pulmonary obstruction, but more dyspnoea and poorer functional capacity) was, on average, highly active during one period of the day (cycling for 20 minutes) and was relatively inactive during the rest of the day. By contrast, patient 2 (more pulmonary obstruction, less dyspnea and a better functional capacity) had a lower movement intensity during his activities, but had active moments in all periods of the day.
Discussion
Our pilot study confirms physical inactivity in patients with COPD, and activity patterns varied a lot in terms of their duration, frequency, intensity and activity type. For research purposes, it is interesting to quantify physical activities in patients with COPD and then compare them with healthy individuals or to use them as an outcome measure of therapeutic interventions. For individual patients, there should also be more benefits.
Physical activity measurement could be a feedback instrument that facilitates coaching strategies and optimises an exercise training programme. For the patient, this could lead to improvement in awareness of their own physical activity. For example, according to the data from our two patients detailed above, the first patient should increase their frequency of physical activities during the day. By contrast, the other patient should try to perform their activities or exercise training programme with more intensity.
In the elderly, it is assumed that regular, moderate-intensity physical activity has other health benefits compared with more strenuous exercises. The former is considered to exert its effects on whole-body metabolism and reductions in risk factors for chronic diseases and all-cause mortality.9 additional effects on skeletal muscle.10
The latter exerts Musculoskeletal fitness
appears to be particularly important for elderly people and their ability to maintain functional independence. In fact, many activities of daily living do not require a large aerobic output, but instead depend on one or more of the musculoskeletal fitness components.11,12
We support the statement by Morgan,13 in which he describes
spontaneous daily activity to be a different domain of outcome assessment from the traditional measures of airway function, functional exercise capacity and quality of life. He also suggests that we should be able to develop greater insights into the lives of people who are disabled by breathlessness and offer treatment that really gets to the heart of the matter.13
We elaborate on this
discussion by adding that reliable information about physical activity patterns of patients with COPD will result in more insight
EUROPEAN RESPIRATORY DISEASE
Figure 1: Two Examples of Physical Activity Patterns of Patients with Chronic Obstructive Pulmonary Disease
General Information Relative active, sedentary and not worn time Patient 1
Age 42 BMI 25 FEV1%pred 68 MRC 3 6MWD%pred 52
20% 40% 60% 80% 71%
2% Lying 46% 27% 2% Night
0.02g 0.04g 0.06g
0:00 3:00 6:00 9:00 12:00 15:00 18:00 21:00 24:00 General Information Relative active, sedentary and not worn time Patient 1
Age 66 BMI 31 FEV1%pred 51 MRC 2 6MWD%pred 73
20% 40% 60% 80% 73%
2% Lying 33% 26% 2% Sedentary Active Not worn Avtivity on Thu 10th Feb 2011 0.025g
0.005g 0.02g
0.015g 0.01g
0:00 3:00 percentage of predicted.
into their actual physical behaviour, for the clinician as well for the patient themselves.
This should be the starting point of a tailor-made advice and/or exercise training programme. As a consequence, the aims of the treatment should be relevant to the individual patient. Research endpoints will therefore meet the requirements of the patients with COPD. Finally, physical activity measurements could be used to fine-tune the referral for PR or a PETP and in the assessment of the effectiveness of treatment.
There is no doubt that the exercise training of patients with COPD should be based on current scientific knowledge.14
Preferably, the
results of a maximal ergometry test should be the base for the endurance component of a training programme. In addition, we propose to use data from daily activity patterns to ensure a tailor-made advice or exercise training programme for the individual patient, especially in primary care. A primary care setting is very close to the daily life situation of the patient and treatment can be applied to daily life easier than in other medical settings.
Conclusion
Insight into the physical activity patterns of patients with COPD could be a starting point for diagnosis and treatment, especially in primary care. However, further research is needed to underpin this point of view. n
135 6:00 9:00 12:00 15:00 18:00 21:00 24:00
BMI = body mass index; FEV1 = forced expiratory volume in 1 sec; MRC = Medical Research Council dyspnea scale; 6MWD = 6-minute walking distance; %pred. = percent predicted or
Night Morning Afternoon Evening 39% Sitting
4% Walking 20%
Sedentary Active Not worn Avtivity on Tue 24th August 2010 Afternoon
Morning 25% Sitting
10% Walking 15%
Evening
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