Thais Sant'Anna

Relationship between pulmonary function and physical activity in daily life in patients with COPD

BACKGROUND It remains unclear how closely the physical inactivity observed in patients with Chronic Obstructive Pulmonary Disease (COPD) relates to the severity of their airflow limitation. Furthermore, it is unknown whether spirometric variables such as maximal voluntary ventilation (MVV) and inspiratory capacity (IC) reflect the level of physical activity in daily life better than the forced expiratory volume in the first second (FEV(1)), the main spirometric variable used to determine the severity of COPD. The objective of the present study was to investigate the relationship between physical activity in daily life and the severity of COPD assessed by different spirometric variables: MVV, IC and FEV(1). METHODS Forty patients with COPD (21 men; 68+/-7 years; FEV(1) 41+/-14% predicted) were performed spirometry and assessment of the physical activity level in daily life using an accelerometer (SenseWear Armband). RESULTS MVV was significantly correlated to total energy expenditure per day, energy expenditure per day in activities demanding more than 3 metabolic equivalents (METs), number of steps per day and time spent per day in moderate and vigorous activities (0.42<or=r<or=0.52; p<0.01 for all). Correlation of these variables with IC and especially FEV(1) was more modest, borderline or not statistically significant. There was no difference in time spent in vigorous activities among patients classified according to the FEV(1)-based GOLD stages II, III and IV, differently than that observed when patients were classified in groups according to their MVV. CONCLUSION In COPD patients, MVV better reflects the physical activity level in daily life than FEV(1) and IC.

Step Counting and Energy Expenditure Estimation in Patients With Chronic Obstructive Pulmonary Disease and Healthy Elderly: Accuracy of 2 Motion Sensors

OBJECTIVE To compare the accuracy of 2 motion sensors (a pedometer and a multisensor) in terms of step counting and estimation of energy expenditure (EE) in patients with chronic obstructive pulmonary disease (COPD) and in healthy elderly. DESIGN In this descriptive study, all participants wore both motion sensors while performing a treadmill walking protocol at 3 different speeds corresponding to 30%, 60%, and 100% of the average speed achieved during a six-minute walk test. As criterion methods, EE was estimated by indirect calorimetry, and steps were registered by videotape. SETTING Research laboratory at a university hospital. PARTICIPANTS Patients with COPD (n=30; 17 men; mean age +/- SD, 67+/-8 y; mean forced expiratory volume in the first second [FEV(1)] predicted +/- SD, 46%+/-17%; mean body mass index [BMI] +/- SD, 24+/-4 kg.m(2)) and matched healthy elderly (n=30; 15 men; mean age +/- SD, 68+/-7 y; mean FEV(1) predicted +/- SD, 104%+/-21%; mean BMI +/- SD, 25+/-3 kg.m(2)). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Step counting and EE estimation during a treadmill walking protocol. RESULTS The pedometer was accurate for step counting and EE estimation in both patients with COPD and healthy elderly at the higher speed. However, it showed significant underestimation at the 2 slower speeds in both groups. The multisensor did not detect steps accurately at any speed, although it accurately estimated EE at all speeds in healthy elderly and at the intermediate and higher speeds in patients with COPD. CONCLUSIONS In both patients with COPD and healthy elderly, the multisensor showed better EE estimates during most walking speeds than the pedometer. Conversely, for step counting, accuracy is observed only with the pedometer during the higher walking speed in both groups.

Comparison of daily physical activity between COPD patients from Central Europe and South America

BACKGROUND In healthy elderly and adults, lower physical activity level in daily life has been associated with lower socio-economic level and non-Caucasian race. The objective of this study was to determine if this is also applicable in chronic obstructive pulmonary disease (COPD) by comparing physical activity levels in daily life in stable patients from two countries (Austria and Brazil) with different socio-economic and ethnic characteristics. METHODS Physical activity in daily life was objectively assessed in 40 Austrian and 40 Brazilian COPD patients. Groups were matched for age, gender, body mass index, disease severity, smoking history, presence of concomitant heart disease, lung function, dyspnea and functional exercise capacity. In addition, climatic conditions were similar during the period of data collection in the two groups. RESULTS In comparison to Brazilian patients, Austrian patients had a significantly lower walking time (p=0.04), higher sitting time (p=0.02) and lower movement intensity (p=0.0001). The proportion of patients who did not reach an average of 30min of walking per day was 48% in the Austrian group and 23% in the Brazilian group. CONCLUSIONS Austrian patients with COPD showed a significantly lower daily physical activity level in comparison to matched Brazilian patients. Socio-economic and ethnic factors appear to influence stable COPD patients differently than described in previous studies including healthy subjects.

Evaluation of a New Motion Sensor in Patients With Chronic Obstructive Pulmonary Disease

OBJECTIVE To assess the criterion validity and reproducibility of a new pedometer in patients with chronic obstructive pulmonary disease (COPD). DESIGN Cross-sectional study. SETTING Outpatient physiotherapy clinic from a university hospital. PARTICIPANTS Patients with COPD (N=30; 17 men; forced expiratory volume in the first second, 44±17% predicted) were videotaped while performing 2 protocols: one including 2 slow and 2 fast 5-minute walks, and another including a circuit of activities of daily living (ADLs). Concomitantly, patients wore 2 motion sensors: the new pedometer and a multisensor accelerometer. INTERVENTIONS None. MAIN OUTCOME MEASURES Step counting (SC), energy expenditure (EE), walking distance (WD), activity time (AT), and walking intensity (WI) registered by the pedometer were compared with video and the multisensor as criterion methods. RESULTS Correlations between the pedometer and the criterion method were high for SC during slow and fast walking (r=.79 and r=.95) and for EE during fast walking (r=.83). Correlation was more modest for EE during slow walking (r=.65) and for WD and WI during both speeds (.47<r<.68). The agreement between methods was also good, according to Bland-Altman plots. The device was reproducible for registering SC, WD, and EE during slow walking and for all variables during fast walking (intraclass correlation coefficient >.79 for all). During the ADLs circuit, the pedometer underestimated AT by an average of 55% but provided an acceptable EE estimation in a group basis (average difference of 6% with the multisensor). CONCLUSIONS In patients with COPD, the new pedometer analyzed in the present study is reproducible for most outcomes and highly valid for SC during slow and fast walking and EE during fast walking. The devices validity is more limited for EE during slow walking, and WD and WI at both speeds. Furthermore, during the performance of ADLs, it significantly underestimates activity time but provides an acceptable estimation of EE in a group basis.

Londrina Activities of Daily Living Protocol: Reproducibility, Validity, and Reference Values in Physically Independent Adults Age 50 Years and Older

BACKGROUND: It is important to assess activities of daily living (ADL) in older adults due to impairment of independence and quality of life. However, there is no objective and standardized protocol available to assess this outcome. Thus, the aim of this study was to verify the reproducibility and validity of a new protocol for ADL assessment applied in physically independent adults age ≥50 y, the Londrina ADL protocol, and to establish an equation to predict reference values of the Londrina ADL protocol. METHODS: Ninety-three physically independent adults age ≥50 y had their performance in ADL evaluated by registering the time spent to conclude the protocol. The protocol was performed twice. The 6-min walk test, which assesses functional exercise capacity, was used as a validation criterion. A multiple linear regression model was applied, including anthropometric and demographic variables that correlated with the protocol, to establish an equation to predict the protocols reference values. RESULTS: In general, the protocol was reproducible (intraclass correlation coefficient 0.91). The average difference between the first and second protocol was 5.3%. The new protocol was valid to assess ADL performance in the studied subjects, presenting a moderate correlation with the 6-min walk test (r = −0.53). The time spent to perform the protocol correlated significantly with age (r = 0.45) but neither with weight (r = −0.17) nor with height (r = −0.17). A model of stepwise multiple regression including sex and age showed that age was the only determinant factor to the Londrina ADL protocol, explaining 21% (P < .001) of its variability. The derived reference equation was: Londrina ADL protocolpred (s) = 135.618 + (3.102 × age [y]). CONCLUSIONS: The Londrina ADL protocol was reproducible and valid in physically independent adults age ≥50 y. A reference equation for the protocol was established including only age as an independent variable (r2 = 0.21), allowing a better interpretation of the protocols results in clinical practice.

Physical activity patterns and clusters in 1001 patients with COPD

We described physical activity measures and hourly patterns in patients with chronic obstructive pulmonary disease (COPD) after stratification for generic and COPD-specific characteristics and, based on multiple physical activity measures, we identified clusters of patients. In total, 1001 patients with COPD (65% men; age, 67 years; forced expiratory volume in the first second [FEV1], 49% predicted) were studied cross-sectionally. Demographics, anthropometrics, lung function and clinical data were assessed. Daily physical activity measures and hourly patterns were analysed based on data from a multisensor armband. Principal component analysis (PCA) and cluster analysis were applied to physical activity measures to identify clusters. Age, body mass index (BMI), dyspnoea grade and ADO index (including age, dyspnoea and airflow obstruction) were associated with physical activity measures and hourly patterns. Five clusters were identified based on three PCA components, which accounted for 60% of variance of the data. Importantly, couch potatoes (i.e. the most inactive cluster) were characterised by higher BMI, lower FEV1, worse dyspnoea and higher ADO index compared to other clusters (p < 0.05 for all). Daily physical activity measures and hourly patterns are heterogeneous in COPD. Clusters of patients were identified solely based on physical activity data. These findings may be useful to develop interventions aiming to promote physical activity in COPD.

Physical Activity of Patients with COPD from Regions with Different Climatic Variations

ABSTRACT Seasonal changes in physical activity in daily life (PADL) of patients with Chronic Obstructive Pulmonary Disease (COPD) living in regions of the world with contrasting (i.e., mild or marked) weather variations have not been yet investigated. We aimed to quantify PADL and compare its variability caused by seasonality in patients with COPD who live in world regions with different summer-winter climatic variations (i.e. Londrina, Brazil and Leuven, Belgium). In a longitudinal, prospective and observational study, patients with COPD from Brazil and Belgium wore the SenseWear Armband for 7 days in summer and 7 days in winter. Active time (≥2METs) was the primary outcome. PADL data were matched day-by-day with weather information. Regarding the two assessment moments, median (min;max) temperatures were 11 (−5.5;27.2)°C in Leuven and 21 (7;27)°C in Londrina. Patients in Brazil (n = 19, 69 ± 7 years, FEV1 47 ± 15%pred) and Belgium (n = 18, 69 ± 6 years, FEV1 50 ± 15%pred) decreased their active time in winter compared to summer (p < 0.05), and this reduction was more pronounced in Brazil (p = 0.01, between group). Mean, minimum and maximum temperature, daylight duration and relative humidity were significantly related to active time. Patients with COPD decrease their PADL in winter even in a region with milder climatic variation.

Do patients with COPD who live alone present better functional status than those who do not

Background: Dyspnea and fatigue are common symptoms in patients with chronic obstructive pulmonary disease (COPD) and often limit the performance of activities of daily living, also known as functional status. However, it is unknown whether patients with COPD who live alone present a better functional status than those who live with their relatives or carers. Objective: To compare the functional status of patients with COPD who live alone with those who do not. Methods: Twenty-eight patients with COPD were divided into two groups: patients who live alone (LA, n=14) and patients who live with their relatives or carers (LRC, n=14). Functional status was evaluated by two questionnaires: London Chest Activity of Daily Living scale (LCADL) and Pulmonary Functional Status and Dyspnea Questionnaire – modified version (PFSDQ-M). Results: No differences were observed in age, lung function, and functional exercise capacity between the groups ( P ≥0.05). Regarding functional status, there were no differences between the groups in any domain of the LCADL [Self-care ( P =0.68); Domestic ( P =0.46); Physical ( P =0.63); Leisure ( P =0.28)], as well as in total score (LA=27 [19-28] vs. LRC=30 [19-37] points; P =0.35). Additionally, no difference was observed in any domain of the PFSDQ-M either: dyspnea ( P =0.31), fatigue ( P =0.25) and symptoms ( P =0.58). Conclusion: Despite not having family support to perform their activities of daily living, patients with COPD who live alone do not present a better functional status than those who live with their relatives and carers, suggesting that physiological mechanisms may play a more important role in patients9 functional limitation than their housing situation.