title: Does Improving Exercise Capacity and Daily Activity Represent the Holistic Perspective of a New COPD Approach?
abstract: In COPD patients a reduced daily activity has been well documented, resulting from both respiratory and non-respiratory manifestations of the disease. An evaluation by multisensory armband has confirmed that daily physical activity is mainly associated with dynamic hyperinflation, regardless of COPD severity. This aspect is crucial, since exercise capacity is closely correlated to life expectancy. Notwithstanding the causal key role of lung impairment in the patient's symptoms, some authors have suggested that other factors, such as systemic inflammation and co-morbidities, have an important role, particularly as mortality risk factors. Many studies suggest the efficacy of bronchodilators and rehabilitation in improving exercise capacity, and, speaking in terms of daily life, in increasing the number of days in which patients are able to perform their usual activities. On this evidence, the first aim in the management of COPD should be to improve exercise capacity and daily activity since these outcomes have direct effects on patients' quality of life, co-morbidities (heart and metabolic diseases), and prognosis. Thus, improving physical activity represents a modern approach aimed at dealing with both pulmonary and systemic manifestations of the disease. It is however worth of notice to remember that in patients affected by COPD the relationship between the improvement of "potential" exercise capacity and daily physical activity has been found to be only moderate to weak. Obtaining a significant behavior modification with regard to daily physical activity, together with the optimization of therapy thus represents currently the true challenge.
authors.affiliation: a Respiratory Unit, Ospedale San Paolo, Dept of Scienze della Salute , Università degli Studi di Milano , Milan , Italy.
authors.forename: Fabiano
authors.initials: F
authors.lastname: Di Marco
authors.affiliation: b Respiratory Unit Fondazione Salvatore Maugeri-Istituto Scientifico di Milano - IRCCS , Università degli Studi di Milano , Milan , Italy.
authors.forename: Pierachille
authors.initials: P
authors.lastname: Santus
authors.affiliation: c Clinical Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences , University of Sassari - Research, Medical Education and Professional Development Unit , AOU Sassari , Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Sotgiu
authors.affiliation: d Respiratory Unit, IRCCS Fondazione Cà Granda Milano, Department of Pathophysiology and Transplantation , University of Milan , Milan , Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Blasi
authors.affiliation: a Respiratory Unit, Ospedale San Paolo, Dept of Scienze della Salute , Università degli Studi di Milano , Milan , Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Centanni
mesh_terms: D000203:Activities of Daily Living; D015897:Comorbidity; D017079:Exercise Tolerance; D006694:Holistic Health; D006801:Humans; D007249:Inflammation / Q000503:physiopathology; D008168:Lung / Q000503:physiopathology; D009043:Motor Activity; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000503:physiopathology / Q000534:rehabilitation*; D011788:Quality of Life
keywords: airflow limitation; bronchodilation; co-morbidities; dyspnea; inflammation; rehabilitation