The official journal of the American College of Chest Physicians, Chest, just published an abstract of a new study evaluating a range of potential predictors of mortality among COPD patients. Though the contents of the full study are embargoed until the article has gone to press, the abstract provides some interesting insights worth sharing.
First, as regular readers of our blog and e-letters well know, we are strong proponents for daily physical activity among COPD patients and anyone who suffers from chronic shortness of breath. We favor an exercise program based on the principles and practices of the COPD treatment pulmonary rehabilitation but acknowledge that even a simple walking program can confer conditioning benefits for smokers and those with respiratory conditions.
Many previous respiratory health studies have clearly and unambiguously demonstrated that regular physical activity reduces shortness of breath symptoms, increases cardiovascular conditioning, heightens muscle strength, improves self-reported quality of life, reduces hospital admissions and reduces severe shortness of breath attacks known as exacerbations.
When physicians act to address shortness of breath symptoms they typically favor smoking cessation, inhaler-based medications and antibiotics. These are reasonable and prudent treatment options. Smoking cessation confers significant health benefits in both the short and long run but a minority of smokers achieves successful permanent smoking cessation. Inhaler-based bronchodilators, steroids, and antibiotics offer short-term relief of immediate shortness of breath symptoms but their track record in conferring long term health benefits are spotty at best.
Regular physical activity, on the other hand, can deliver both short-term and long-term benefits provided one begins and maintains a regular program of activity. Previous studies have shown that COPD patients who are the most active (whether they exercise the most or simply are up and walking/moving around more frequently) report the highest quality of life, demonstrate the best exercise capacity and record the lowest sensations of breathlessness compared to those who are the least active.
In the new Chest study abstract, the researchers offered one more compelling reason to become more physically active – COPD patients in their study who were the most active reported the best survival rates over the four year follow up period after study enrollment. In fact, of all the diagnostic measures evaluated by the study team, the level of physical activity was considered the strongest predictor of patients likely to survive. [1]
According to the abstract, the Germany based researchers enrolled 170 stable COPD patients in their study. At the outset, they conducted a battery of diagnostic tests on the patients and recorded their respective readings. Tests included evaluations of respiratory function, cardiovascular function, body mass index, nutrition status, blood levels of inflammation markers, exercise capacity and levels of physical activity.
Forty-eight months after enrolling the patients and conducting the diagnostic tests, the researchers followed up with the patients to determine which were still alive and which had passed away (26 of the 170 patients died during the four year follow up period, roughly 15%).
The researchers then compared the mean diagnostic readings for the survivors and non-survivors and determined that among all the diagnostic measures, physical activity level was the measure with the highest inverse correlation between the two groups (meaning the people who did not survive the four year follow up period had recorded the lowest levels of physical activity in the diagnostic tests).
In fact, the study abstract mentioned that each 8-10% increase in physical activity level was associated with approximately 50% lower risk of death! Pretty compelling reason to get up off the couch and get moving, wouldn’t you say?!
Note: Physical activity level (PAL) in the study was measured by attaching a device to patients called a multisensory armband which records energy expenditure from movement over a defined period of time (typically a number of days). The World Health Organization has established that PAL levels between 1.7 and 2.0 are indicative of moderately active adults based on data accumulated over time utilizing this device and associated energy expenditure/metabolism calculations. Those considered sedentary or inactive have PAL levels between 1.4 and 1.7. In the Chest abstract, each .14 increase in PAL yielded 54% lower hazard ratio of death, hence our approximation of 8-10% movement in PAL (.14/1.7 or .14/1.4).
If you are a COPD patient and spend most of the day sitting or lying down, it is strongly worth your while to consider becoming more active (standing, walking, exercising). Not only will doing so improve how you feel and breathe each and every day, it may also help extend your life!
We realize getting started on a physical activity program may feel daunting. For those of you who feel that way, you are likely concerned about your balance, potential shortness of breath episodes, and lack of current energy. All are reasonable concerns but none of these issues will go away by simply sitting or lying down. They will only get worse.
To address these concerns, respiratory care professionals offer a treatment option known as pulmonary rehabilitation which assists COPD patients get started on a regular exercise program by starting slow and gradually increasing the intensity and duration of exercise for each patient based on their respective individual starting conditioning levels. These programs are highly effective and we strongly recommend you ask your pulmonologist for a referral to a program in your area.
One thing to keep in mind, however. Entry into these programs can be challenging. There are not enough pulmonary rehab programs around the country to serve all the COPD patients who could benefit from the treatment. Further, Medicare and insurance reimbursement only applies to Stage II and Stage III COPD patients in most cases (moderate to severe COPD), and the programs only last 8-12 weeks.
If you can’t gain entry into a pulmonary rehab program in your area, we recommend you consider purchasing our Breathe Better for Life guidebook and companion CD-ROM. We have created an at-home (or fitness center) exercise program based on pulmonary rehabilitation guidelines published by the American Thoracic Society and European Respiratory Society. We augmented these guidelines by incorporating exercise recommendations for people with chronic respiratory problems from the American College of Sports Medicine. Whether you follow our program or simply use the guide as a resource to discuss structuring an exercise program with your physician, we believe Breathe Better for Life provides excellent education for COPD patients and smokers on exercise, nutrition, breathing technique and airway clearing techniques to improve how you breathe and live. You can learn more about Breathe Better for Life by visiting www.breathebetterforlife.com.
[1] Waschki B, et al. Physical activity is the strongest predictor of all-cause mortality in patients with chronic obstructive pulmonary disease: a prospective cohort study. Chest. 2011 Jan 27 [Epub ahead of print].
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