title: Physical activity and clinical and functional status in COPD.
abstract: 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.
authors.affiliation: Centre for Research in Environmental Epidemiology, Barcelona, Spain. Electronic address: jgarcia@creal.cat.
authors.forename: Judith
authors.initials: J
authors.lastname: Garcia-Aymerich
authors.affiliation: Centro de Investigación Biomédica en Red Epidemiologia y Salud Pública (CIBERESP) [Dr. de Batlle], Barcelona, Spain.
authors.forename: Ignasi
authors.initials: I
authors.lastname: Serra
authors.affiliation: Servei de Pneumologia, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Federico P
authors.initials: FP
authors.lastname: Gómez
authors.affiliation: Servei de Pneumologia, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Llobregat, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Farrero
authors.affiliation: Municipal Institute of Medical Research, Hospital del Mar, Barcelona, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Balcells
authors.affiliation: Servei de Pneumologia, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Diego A
authors.initials: DA
authors.lastname: Rodríguez
authors.affiliation: Centre for Research in Environmental Epidemiology, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: de Batlle
authors.affiliation: Servei de Pneumologia, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Gimeno
authors.affiliation: Centre for Research in Environmental Epidemiology, Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Donaire-Gonzalez
authors.affiliation: Municipal Institute of Medical Research, Hospital del Mar, Barcelona, Spain.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Orozco-Levi
authors.affiliation: Servei de Pneumologia, Hospital Universitari Son Dureta, Palma de Mallorca, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Sauleda
authors.affiliation: Centro de Investigación Biomedica en Red de Enfermedades Respiratorias, Recinte Hospital Joan March, Bunyola, Spain.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Gea
authors.affiliation: Servei de Pneumologia, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Robert
authors.initials: R
authors.lastname: Rodriguez-Roisin
authors.affiliation: Centro de Investigación Biomedica en Red de Enfermedades Respiratorias, Recinte Hospital Joan March, Bunyola, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Roca
authors.affiliation: Fundació Caubet-Cimera, Recinte Hospital Joan March, Bunyola, Spain.
authors.forename: Àlvar G
authors.initials: ÀG
authors.lastname: Agustí
authors.affiliation: Centre for Research in Environmental Epidemiology, Barcelona, Spain.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Antó
mesh_terms: 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