Physical activity and clinical and functional status in COPD.
BACKGROUND
The mechanisms underlying the benefits of regular physical activity in the evolution of COPD have not been established. Our objective was to assess the relationship between regular physical activity and the clinical and functional characteristics of COPD.


METHODS
Three hundred forty-one patients were hospitalized for the first time because of a COPD exacerbation in nine teaching hospitals in Spain. COPD diagnosis was confirmed by spirometry under stable conditions. Physical activity before the first COPD hospitalization was measured using the Yale questionnaire. The following outcome variables were studied under stable conditions: dyspnea, nutritional status, complete lung function tests, respiratory and peripheral muscle strength, bronchial colonization, and systemic inflammation.


RESULTS
The mean age was 68 years (SD, 9 years), 93% were men, 43% were current smokers, and the mean postbronchodilator FEV(1) was 52% predicted (SD, 16% predicted). Multivariate linear regression models were built separately for each outcome variable and adjusted for potential confounders (including remaining outcomes if appropriate). When patients with the lowest quartile of physical activity were compared to patients in the other quartiles, physical activity was associated with significantly higher diffusing capacity of the lung for carbon monoxide (Dlco) [change in the second, third, and fourth quartiles of physical activity, compared with first quartile (+ 6%, + 6%, and + 9% predicted, respectively; p = 0.012 [for trend])], expiratory muscle strength (maximal expiratory pressure [Pemax]) [+ 7%, + 5%, and + 9% predicted, respectively; p = 0.081], 6-min walking distance (6MWD) [+ 40, + 41, and + 45 m, respectively; p = 0.006 (for trend)], and maximal oxygen uptake (Vo(2)peak) [+ 55, + 185, and + 81 mL/min, respectively; p = 0.110 (for trend)]. Similarly, physical activity reduced the risk of having high levels of circulating tumor necrosis factor alpha (odds ratio, 0.78, 0.61, and 0.36, respectively; p = 0.011) and C-reactive protein (0.70, 0.51, and 0.52, respectively; p = 0.036) in multivariate logistic regression.


CONCLUSIONS
More physically active COPD patients show better functional status in terms of Dlco, Pemax, 6MWD, Vo(2)peak, and systemic inflammation.
Garcia-Aymerich
Judith
J
Centre for Research in Environmental Epidemiology, Barcelona, Spain. Electronic address: jgarcia@creal.cat.
Serra
Ignasi
I
Centro de Investigación Biomédica en Red Epidemiologia y Salud Pública (CIBERESP) [Dr. de Batlle], Barcelona, Spain.
Gómez
Federico P
FP
Servei de Pneumologia, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.
Farrero
Eva
E
Servei de Pneumologia, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Llobregat, Spain.
Balcells
Eva
E
Municipal Institute of Medical Research, Hospital del Mar, Barcelona, Spain.
Rodríguez
Diego A
DA
Servei de Pneumologia, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.
de Batlle
Jordi
J
Centre for Research in Environmental Epidemiology, Barcelona, Spain.
Gimeno
Elena
E
Servei de Pneumologia, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.
Donaire-Gonzalez
David
D
Centre for Research in Environmental Epidemiology, Barcelona, Spain.
Orozco-Levi
Mauricio
M
Municipal Institute of Medical Research, Hospital del Mar, Barcelona, Spain.
Sauleda
Jaume
J
Servei de Pneumologia, Hospital Universitari Son Dureta, Palma de Mallorca, Spain.
Gea
Joaquim
J
Centro de Investigación Biomedica en Red de Enfermedades Respiratorias, Recinte Hospital Joan March, Bunyola, Spain.
Rodriguez-Roisin
Robert
R
Servei de Pneumologia, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.
Roca
Josep
J
Centro de Investigación Biomedica en Red de Enfermedades Respiratorias, Recinte Hospital Joan March, Bunyola, Spain.
Agustí
Àlvar G
ÀG
Fundació Caubet-Cimera, Recinte Hospital Joan March, Bunyola, Spain.
Antó
Josep M
JM
Centre for Research in Environmental Epidemiology, Barcelona, Spain.
D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000209:etiology* / Q000503:physiopathology* / Q000628:therapy; D004734:Energy Metabolism / Q000502:physiology*; D015444:Exercise / Q000502:physiology*; D005260:Female; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000378:metabolism* / Q000503:physiopathology*; D012123:Pulmonary Ventilation / Q000502:physiology; D020127:Recovery of Function; D012189:Retrospective Studies