title: Daily activity during stability and exacerbation of chronic obstructive pulmonary disease.
abstract: BACKGROUND
  During most COPD exacerbations, patients continue to live in the community but there is little information on changes in activity during exacerbations due to the difficulties of obtaining recent, prospective baseline data.
  
  
  METHODS
  Patients recorded on daily diary cards any worsening in respiratory symptoms, peak expiratory flow (PEF) and the number of steps taken per day measured with a Yamax Digi-walker pedometer. Exacerbations were defined by increased respiratory symptoms and the number of exacerbations experienced in the 12 months preceding the recording of daily step count used to divide patients into frequent (> = 2/year) or infrequent exacerbators.
  
  
  RESULTS
  The 73 COPD patients (88% male) had a mean (±SD) age 71(±8) years and FEV1 53(±16)% predicted. They recorded pedometer data on a median 198 days (IQR 134-353). At exacerbation onset, symptom count rose by 1.9(±1.3) and PEF fell by 7(±13) l/min. Mean daily step count fell from 4154(±2586) steps/day during a preceding baseline week to 3673(±2258) step/day during the initial 7 days of exacerbation (p = 0.045). Patients with larger falls in activity at exacerbation took longer to recover to stable level (rho = -0.56; p < 0.001). Recovery in daily step count was faster (median 3.5 days) than for exacerbation symptoms (median 11 days; p < 0.001). Recovery in step count was also faster in untreated compared to treated exacerbation (p = 0.030).Daily step count fell faster over time in the 40 frequent exacerbators, by 708 steps/year, compared to 338 steps/year in 33 infrequent exacerbators (p = 0.002).
  
  
  CONCLUSIONS
  COPD exacerbations reduced physical activity and frequent exacerbations accelerate decline in activity over time.
authors.affiliation: Centre for Respiratory Medicine, University College London, Royal Free Campus, London, UK. ayedh.ahmari.10@ucl.ac.uk.
authors.forename: Ayedh D
authors.initials: AD
authors.lastname: Alahmari
authors.forename: Anant R C
authors.initials: AR
authors.lastname: Patel
authors.forename: Beverly S
authors.initials: BS
authors.lastname: Kowlessar
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Mackay
authors.forename: Richa
authors.initials: R
authors.lastname: Singh
authors.forename: Jadwiga A
authors.initials: JA
authors.lastname: Wedzicha
authors.forename: Gavin C
authors.initials: GC
authors.lastname: Donaldson
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D010809:Physical Fitness / Q000502:physiology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology*; D012720:Severity of Illness Index; D013997:Time Factors; D016138:Walking / Q000502:physiology*