title: Association between morning symptoms and physical activity in COPD: a systematic review.
abstract: Morning symptoms are common in chronic obstructive pulmonary disease (COPD). Many COPD patients consider the morning as the most troublesome part of the day, in which they experience more symptoms and physical activity limitations.To systematically report evidence of the association between morning symptoms and physical activity in COPD patients, a literature search was conducted using relevant MESH terms and text words in PubMed, Embase, Web of Science, COCHRANE, CINAHL and PsycINFO. Quality of the articles was assessed with validated checklists.Eight studies were included. Morning symptoms were present in 39.8-94.4%. In 37.0-90.6% of all COPD patients, there was an association between physical activity and morning symptoms. However, causality could not be proved. Morning symptoms were associated with a sedentary lifestyle (p<0.05). Treatment in line with the guidelines improved the degree of activity limitations due to morning symptoms (p<0.0001).Across all disease stages, COPD patients experience morning symptoms which are negatively associated with physical activity. Physicians should consider morning symptoms as a treatment goal. Pharmacotherapy may improve the degree of activity limitations due to morning symptoms. More objective research should focus on symptoms, activity limitations and physical inactivity of COPD patients, especially in the morning.
authors.affiliation: Dept of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands a.r.van_buul@lumc.nl.
authors.forename: Amanda R
authors.initials: AR
authors.lastname: van Buul
authors.affiliation: Dept of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Marise J
authors.initials: MJ
authors.lastname: Kasteleyn
authors.affiliation: Dept of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Niels H
authors.initials: NH
authors.lastname: Chavannes
authors.affiliation: Dept of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Christian
authors.initials: C
authors.lastname: Taube
mesh_terms: D000328:Adult; D000368:Aged; D002940:Circadian Rhythm / Q000187:drug effects; D018450:Disease Progression; D015444:Exercise; D017079:Exercise Tolerance / Q000187:drug effects; D005260:Female; D006801:Humans; D008168:Lung / Q000187:drug effects / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology*; D012307:Risk Factors; D057185:Sedentary Behavior; D012720:Severity of Illness Index; D013997:Time Factors