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Assessing Physical Activity and Physical Capacity in Subjects with Chronic Obstructive Pulmonary Disease
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to assess measurement properties of methods suitable for screening or monitoring of physical capacity and physical activity in subjects with chronic obstructive pulmonary disease (COPD), and to explore factors associated with physical activity levels.

Methods: Four observational studies were conducted. Participants in studies I-III (sample sizes) (n=49, n=15, n=73) were recruited from specialist clinics, and in study IV from a population-based cohort (COPD n=470 and Non-COPD n=659). Psychometric properties of methods assessing physical capacity (study I) and physical activity (study II) were investigated in laboratory settings. Daily physical activity and clinical characteristics were assessed with objective methods (study III) and with subjective methods (study IV).

Results: Physical capacity as measured by walking speed during a 30-metre walk test displayed high test-retest correlations (ICC>0.87) and small measurement error. The accuracy for step count and body positions differed between activity monitors and direct observations. In study III 92% of subjects had an activity level below what is recommended in guidelines. Forty five percent of subjects’ activity could be accounted for by clinical characteristics with lung function (22.5%), walking speed (10.1%), quadriceps strength (7.0%) and fat-free mass index (3.0%) being significant predictors. In study IV, low physical activity was significantly more prevalent in COPD subjects from GOLD grade ≥II than among Non-COPD subjects (22.4 vs. 14.6%, p = 0.016). The strongest factors associated with low activity in COPD subjects were a history of heart disease, OR (CI 95%) 2.11 (1.10-4.08) and fatigue, OR 2.33 (1.31-4.13) while obesity was the only significant factor in Non-COPD subjects, OR 2.26 (1.17-4.35).

Conclusion: The 30 meter walk test and activity monitors are useful when assessing physical capacity and physical activity, respectively in patients with COPD. Impaired physical activity in severe COPD is related to low lung function, low walking speed, low muscle strength and altered body composition, whereas comorbidities and fatigue are linked to insufficient physical activity in patients with moderately severe COPD.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. , 64 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 982
Keyword [en]
COPD, chronic obstructive pulmonary disease, physical activity, measurement properties, reliability, accuracy, validity, sedentary behavior, activity monitor, questionnaire, anthropometrics, comorbidity, fatigue
National Category
Physiotherapy
Research subject
Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-220602ISBN: 978-91-554-8905-2 (print)OAI: oai:DiVA.org:uu-220602DiVA: diva2:706671
Public defence
2014-05-09, Gunnesalen, Akademiska sjukhuset, ingång 10, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2014-04-16 Created: 2014-03-17 Last updated: 2014-04-29
List of papers
1. Measuring walking speed in COPD: test-retest reliability of the 30-metre walk test and comparison with the 6-minute walk test
Open this publication in new window or tab >>Measuring walking speed in COPD: test-retest reliability of the 30-metre walk test and comparison with the 6-minute walk test
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2011 (English)In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 20, no 4, 434-440 p.Article in journal (Refereed) Published
Abstract [en]

AIMS:

To examine test-retest reliability of the 30-metre walk test (30mWT) in patients with chronic obstructive pulmonary disease (COPD) and to compare the 30mWT with the 6-minute walk test (6MWT).

METHODS:

Forty-nine subjects with stable COPD were included. The 30mWT consists of walking at different walking intensities over a distance of 30 metres - self-selected speed (ss-30mWT) and maximal speed (ms-30mWT). The test was conducted twice and the time to walk 30 metres was recorded. The 6MWT was performed in duplicate on the same day.

RESULTS:

Test-retest reliability was high: intraclass correlation coefficient (ICC2.1) = 0.93 (95% CI 0.87 to 0.97) for maximal walking speed and 0.87 (95% CI 0.78 to 0.93) for self-selected walking speed. Both maximal and self-selected speed had a standard error of measurement (SEM) of 0.07 m/s and SEM% was 4.4 for maximal speed and 5.9 for self-selected speed. The correlation, criterion validity, between ms-30mWT and the 6MWT was r=0.78 (p<0.001). Heart rate, dyspnoea, exertion and oxygen saturation were more affected after the 6MWT than after the 30mWT (p<0.001).

CONCLUSIONS:

The 30mWT is a reliable submaximal test that is easy to perform and can be used to measure physical function (walking ability) in patients with COPD. It may be well suited for primary care settings.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-162963 (URN)10.4104/pcrj.2011.00082 (DOI)000304279300022 ()21938352 (PubMedID)
Available from: 2011-12-06 Created: 2011-12-06 Last updated: 2017-12-08Bibliographically approved
2. Accuracy of three activity monitors in patients with chronic obstructive pulmonary disease: A comparison with video recordings
Open this publication in new window or tab >>Accuracy of three activity monitors in patients with chronic obstructive pulmonary disease: A comparison with video recordings
2014 (English)In: COPD: Journal of Chronic Obstructive Pulmonary Disease, ISSN 1541-2555, E-ISSN 1541-2563, Vol. 11, no 5, 560-567 p.Article in journal (Refereed) Published
Abstract [en]

Low physical activity and sedentary behaviour characterise the lives of patients with chronic obstructive pulmonary disease (COPD). Using activity monitors, assessment of both aspects are possible, but many outcomes are not well validated. The aim of this study was to assess the accuracy and equivalency of three activity monitors regarding steps, body position and their ability to differentiate between periods of physical activity and inactivity.

Fifteen patients with COPD (8 females; median (interquartile range, IQR) age, 64 (59-69) years; forced expiratory volume in one second, 37 (28-48) % predicted; six-minute walk distance, 444 (410-519) m) were enrolled. The DynaPort ADL-monitor, the DynaPort MiniMod monitor and the SenseWear Armband Pro 3 monitor were assessed. Subjects performed a structured protocol alternating physical activity and inactivity while simultaneously wearing all three monitors and being video recorded.

The mean difference (limits of agreement) in step count from monitors compared to manual step count was -69 (-443 to 305) for the ADL-monitor, -19 (-141 to 103) for the MiniMod and -479 (-855 to -103) for the SenseWear Armband. Compared to the video, the sitting time was 97 (94-100) % when measured by the ADL-monitor and 121 (110-139) % by the MiniMod. Standing time was 114 (107-122) % when measured by the ADL-monitor and 68 (47-106) % by the MiniMod.

Activity monitors are not equivalent in their abilities to detect steps or body positions. The choice of monitor should be based on the particular outcome of interest. 

Keyword
Activity monitor, accuracy, validity, physical activity, sedentary, rehabilitation
National Category
Respiratory Medicine and Allergy
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-220595 (URN)10.3109/15412555.2014.898033 (DOI)000342056200012 ()24734942 (PubMedID)
Available from: 2014-03-17 Created: 2014-03-17 Last updated: 2017-12-05Bibliographically approved
3. Physical activity level and its clinical correlates in chronic obstructive pulmonary disease: a cross-sectional study
Open this publication in new window or tab >>Physical activity level and its clinical correlates in chronic obstructive pulmonary disease: a cross-sectional study
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2013 (English)In: Respiratory research (Online), ISSN 1465-9921, E-ISSN 1465-993X, Vol. 14, 128- p.Article in journal (Refereed) Published
Abstract [en]

Background: Decreased physical activity is associated with higher mortality in subjects with COPD. The aim of this study was to assess clinical characteristics and physical activity levels (PALs) in subjects with COPD. Methods: Seventy-three subjects with COPD (67 +/- 7 yrs, 44 female) with one-second forced expiratory volume percentage (FEV1%) predicted values of 43 +/- 16 were included. The ratio of total energy expenditure (TEE) and resting metabolic rate (RMR) was used to define the physical activity level (PAL) (PAL = TEE/RMR). TEE was assessed with an activity monitor (ActiReg), and RMR was measured by indirect calorimetry. Walking speed (measured over 30-meters), maximal quadriceps muscle strength, fat-free mass and systemic inflammation were measured as clinical characteristics. Hierarchical linear regression was applied to investigate the explanatory values of the clinical correlates to PAL. Results: The mean PAL was 1.47 +/- 0.19, and 92% of subjects were classified as physically very inactive or sedentary. The walking speed was 1.02 +/- 0.23 m/s, the quadriceps strength was 31.3 +/- 11.2 kg, and the fat-free mass index (FFMI) was 15.7 +/- 2.3 kg/m(2), identifying 42% of subjects as slow walkers, 21% as muscle-weak and 49% as FFM-depleted. The regression model explained 45.5% (p < 0.001) of the variance in PAL. The FEV1% predicted explained the largest proportion (22.5%), with further improvements in the model from walking speed (10.1%), muscle strength (7.0%) and FFMI (3.0%). Neither age, gender nor systemic inflammation contributed to the model. Conclusions: Apart from lung function, walking speed and muscle strength are important correlates of physical activity. Further explorations of the longitudinal effects of the factors characterizing the most inactive subjects are warranted.

Keyword
Physical activity, Activity monitor, COPD, Physical function, Body composition
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-213928 (URN)10.1186/1465-9921-14-128 (DOI)000327845500003 ()
Available from: 2014-01-05 Created: 2014-01-05 Last updated: 2017-12-06Bibliographically approved
4. Physical activity and fatigue in chronic obstructive pulmonary disease: A population based study
Open this publication in new window or tab >>Physical activity and fatigue in chronic obstructive pulmonary disease: A population based study
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Introduction

Dyspnea with exertion and fatigue are the cardinal symptoms of chronic obstructive pulmonary disease (COPD); impaired muscle function and reduced exercise capacity are also frequently associated with COPD. We aimed to assess the physical activity levels, in a population based sample study, of subjects with and without COPD. We also aimed to investigate the factors associated with low physical activity in these groups.

Methods

In this study, 470 subjects with COPD (FEV1/FVC< 0.70) and 569 subjects without COPD (Non-COPD) were analyzed. Physical activity was assessed with the International Physical Activity Questionnaire (IPAQ). Fatigue was investigated with the Functional Assessment of Chronic Illness Therapy - Fatigue scale (FACIT-F). An interview questionnaire was used to record the sample characteristics and history of heart disease. Binary logistic regression was used to investigate the factors associated with low physical activity.

Results

Low physical activity was significantly more prevalent in GOLD grade ≥II COPD subjects, and this prevalence was higher than that for Non-COPD subjects (22.4 vs. 14.6%, p = 0.016). The strongest factors associated with low physical activity in COPD subjects were a history of heart disease, OR (CI 95%) 2.11 (1.10 - 4.08), and clinically significant fatigue, OR 2.33 (1.31 - 4.13); obesity was the only significant factor in Non-COPD subjects, OR 2.26 (1.17 – 4.35).

Conclusion

Physical activity levels are reduced for COPD grade II and higher, and the factors associated with lower levels of physical activity are different for the COPD group compared to the Non-COPD group. We propose that measurements of fatigue and a history of heart disease are useful tools to include when screening subjects for pulmonary rehabilitation.

Keyword
COPD, physical activity, fatigue, questionnaire, IPAQ, FACIT-F
National Category
Medical and Health Sciences
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-220600 (URN)
Available from: 2014-03-17 Created: 2014-03-17 Last updated: 2014-04-29

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