Clinical measurement of physical activity appears to be an independent predictor of whether or not patients with chronic obstructive pulmonary disease (COPD) will end up being hospitalized, according to a new study conducted by researchers in Connecticut. The study also corroborates an earlier investigation that linked higher levels of inactivity with an increased incidence of hospitalizations among patients with COPD.
The results of the study were presented at the ATS 2013 International Conference.
"Physical inactivity is common in patients with COPD and appears to predict poor outcome, including more frequent hospitalizations, compared to COPD patients who have higher levels of exercise," said study lead author Sheila Zanoria, MD, resident at the University of Connecticut Health Center in Farmington, Conn. "This remains true even when accounting for other factors that may be present.
"Our study evaluated levels of physical activity and other respiratory measurements, including the six-minute walk distance (6MWD),which measures the distance a patient is able to walk in six minutes," she said. "Then we examined the relationship between those baseline measurements and the subsequent hospitalization rate among the same patients over a four- to five-year follow-up period.
"Ideally, we hoped to identify specific measurements that could be used proactively to help identify which patients are most at risk for hospitalization," Dr. Zanoria added.
The retrospective study looked at baseline data collected from 60 COPD patients in 2008 and compared that data with the number of hospitalizations that occurred during the follow-up period. Initial baseline data were collected from each patient during a period of seven consecutive days. During that time, each patient wore a tri-axial accelerometer, a device worn at the waist and used to measure physical activity in units called vector magnitude units, or VMUs. VMUs are typically measured continually and then summed up every minute to provide usable data.
During the same seven-day period, researchers also evaluated patients' exercise capacity using the 6MWD, supplemental oxygen use and forced expiratory volume in one second measurement, or FEV1, which measures the amount of air a patient is able to exhale in one second.
Next, researchers looked at the baseline data from each patient to determine if any measurements - singly or in combination - were associated with an increase in the number of subsequent hospitalizations during the follow-up period. Using outpatient and hospital databases, the researchers determined that 34 patients were hospitalized from any cause and 21 were hospitalized for respiratory disease-related illness during that period.
In the initial analysis of data from the study, the researchers noted that oxygen use, lower VMU levels and shorter 6MWD values all were associated with greater numbers of overall and respiratory-related hospitalizations after adjusting for disease severity variables. However, in the multivariate testing, only 6MWD and VMU remained as predictive of hospitalizations.
"Specifically, what we found was that patients who were able to walk less than 350 meters during the 6MWD and who had VMU scores of under 150 were significantly more likely to be hospitalized, either for respiratory-related causes or for any cause," Dr. Zanoria said.
"These results underscore the importance of both of these variables in assessing COPD severity," she added. "Knowing this may help clinicians expand their efforts in COPD management towards improving physical activity levels of their patients, thereby hopefully reducing healthcare utilization."
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martin1945
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All I know is that my husband was fantastically improved at the end of his pr course - two years later and the ex revise routine has dwindled he has much less stamina. Excercise is key! TAD x
I am so glad I have my dog. She spurrs me on to get and up walk her. I manage this three times a day . . I am totally done in afterwards and back to my bed. I do manage too prepare a meal once a day, nut choose the easy things like salad etc. I just know if I start to fail on this that I will not only loose muscle, but my quality of life will progressivly get worse.
Keep walking and if you have a four legged companion it is well worth the extra time no matter how slow you walk.
Fresh air and meeting other dog walkers, A BIG yes from me.
Sometimes it is just too easy to give in due to tiredness.
Good luck to all.
Ros.
After all the publications 'medical research' the benefit of regular exercise is emerging as one of the most important issues for 'good' health. As such, i am committed to incorperating some physical activity into my day! It doesn't have to be a five mile run! Simply important to keep moving and preferably do something you enjoy, (otherwise you probably won't do it)
I think gyms and swimming pools should be accessible on prescription. Exercise on the NHS? The closesst i have come is physio and recently cardio rehab...(very similar to pr)
I would recommend you do what you can, when you can with some CAUTION. If you have an exacerbation, or feel exhausted afterwards or suffer with 'over breathlessness' take it easy. Remember you are doing this as a good thing.if it's too cold for you pick your times to go out and play.
Lastly, my cautionary tale, i have had lung problems all my life. I was getting fitter and 'pushing myself' i always thought my lungs were my limiting factor! One session, i was out of breath as usual and i got some chest pain. I thought i had pulled something! This cycle repeated about eight times till i had it investigated. It turned out that as a consequence of my copd the plumbing around my heart needed work. I had a quad bipass in jan 2013 and now am mostly recovered.
I know, this was a bit extreme but i felt a bit of irony that i could have killed myself whilst trying to gt fitter.
OK no 5 mile run Kevin, a pile of ironing - that's exercise, kitchen floor needs a good mopping, changing a king size duvet, now that is exercise to the limit, and I will enjoy doing them because it all needs doing and I shall feel better afterwards and I shall enjoy my day.
LOL... that's okay, I'm really well prepared. I take a friend, and I pick my friends carefully - she's slower than me .... Well, I've always believed in having an exit strategy in all circumstances ... Think I've aced this one
Gawd! A bit of chocolate and you are anybody's' lol Love you lots too xxxx
Exercise is vital to health, especially so as we age and especially so with a chronic lung condition. Some just do not want to take it on board even when the evidence is obvious.
For damaged lung folk, anything is better than nothing and build on it, keep it going, increase the repetitions, 1 min walking to 2 min walking to 5 min walking, to 10, to 20 etc.
I hope the research will justify keeping the PR courses going for patients around the world which is something essential to help those newly diagnosed and those who have deconditioned to get back some level of fitness.
I agree with you about exercising being important. But I find that if I exercise with oxygen once Ive finished & sat down I cough so badly that I can barely breathe. I have been on oxygen since Feb'14-1/2 litre for 15 hours a day. Would welcome any advice.
I suppose it could be said that it is a chicken and egg situation . I very much agree that exercise is important and it can make a huge difference to anyone with COPD . What i have found is that being able to exercise is the key , if you are able to exercise then you are fitter and therefore less ill than if you can't exercise . I have been in both camps , a few years ago i did a rehab course and was able to walk a mile or 2 twice a week and go swimming and work in the garden . Now i cannot swim because i am on oxygen when doing anything other than sitting , i can only garden sitting down or laying down and i cannot walk out to the car without getting SOB , I was in hospital with pneumonia in january and have not recovered properly since then , i am even on oxygen at night with the bipap which i have never had before , Apparently my xrays , ct scan , lung functions and blood plus sputum tests are all clear or unchanged . I have been unable to exercise since january due to SOB and feel that sitting too long in the chair has reduced my fitness to a level that has made it very difficult to recover from , though not impossible , i am , as i usually do , forcing myself to walk further and do more each day and not to rely on oxygen as i think you can get used to it .it is not easy and i think having support would help , though i don't have any myself . I would urge all COPD sufferers to put themselves first and try to exercise if you can , even if it means building up slowly but regularly at what may seem like a snails pace ,
Oh yes , and sitting in the chair puts on the wieght too which makes it all harder to recover from . I had lost 7 kilo up to january and now i think i have put most of it back on which is not helping ( steroids and sitting ) .
I totally agree that exercise is the best providing you can do it I had knee replacement last year and the wonderful physios had me working well but afraid this year even though my knee is fine iaam not doing as much exercise as I might though on holiday in wales did a bit of hill walking which was fine have always done exercise in the past and am lucky that have never needed hospilizatoin for COPD had bit of shock this week went to GP for medication review BP check showed borderline hypertension BP alwsys been oy so its back to more exercise and eating less.
I'm not sure about exercise ability - I just puffed and blowed thru 700 metres in 20 mins!!!! not great but it will do for the moment.. Stay well. Martin
I am attending a copd course run by a private company for Kent NHS.
I'm not sure who recommended me for it, my GP or my consultant, but the fact that I'm with 14/15 other sufferers together being told to do simple but effective exercises has got me feeling- ready for sleep at bedtime - more aware of how my body is working - pleasantly stretched and a feeling that as time goes on, I may be able to keep the wost of this crippling disease at bay.
I know some of you guys out there may not even be able to walk across the room, but get a friend or relative to gee you up for a half hour , or so.
You WILL feel better. As I do.
The problems come when the course finishes.
I am starting to search the internet for some CHEAP ways of organizing classes.
Any ideas anyone ??
My work mate who is all but retired at the age of 70 works with me just three days a week, we both have lung problems I have COPD he has asbestos around his lungs, he continues to work because he keeps fit it also makes his lungs work hard, everyday he inspires me as I am only 48.
Am into fourth week of pulmary exercise class and feeling the benefit in breathing and energy. Recommend this if you have recourse to this in your area.
I walk my dog 20mins twice a day. I am forever up and down the stairs due to 'forgetting' what i went up for in the first place plus my toilet is upstairs so that's good exercise isn't it?
I also do all the housework and gardening and am now trying to get into a routine of doing some COPD exercises I saw on Youtube, so hopefully I am doing my bit to help myself.
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