Sarcopenia prevalence and its clinical impact are reportedly variable in chronic obstructive pulmonary disease (COPD) due partly to definition criteria. This review aimed to identify the criteria ...used to diagnose sarcopenia and the prevalence and impact of sarcopenia on health outcomes in people with COPD. This review was registered in PROSPERO (CRD42018092576). Five electronic databases were searched to August 2018 to identify studies related to sarcopenia and COPD. Study quality was assessed using validated instruments matched to study designs. Sarcopenia prevalence was determined using authors' definitions. Comparisons were made between people who did and did not have sarcopenia for pulmonary function, exercise capacity, quality of life, muscle strength, gait speed, physical activity levels, inflammation/oxidative stress, and mortality. Twenty‐three studies (70% cross‐sectional) from Europe (10), Asia (9), and North and South America (4) involving 9637 participants aged ≥40 years were included (69.5% men). Sarcopenia criteria were typically concordant with recommendations of hEuropean and Asian consensus bodies. Overall sarcopenia prevalence varied from 15.5% 95% confidence interval (CI) 11.8–19.1; combined muscle mass, strength, and/or physical performance criteria to 34% (95%CI 20.6–47.3; muscle mass criteria alone) (P = 0.009 between subgroups) and was greater in people with more severe 37.6% (95%CI 24.8–50.4) versus less severe 19.1% (95%CI 10.2–28.0) lung disease (P = 0.020), but similar between men 41.0% (95%CI 26.2–55.9%) and women 31.9% (95%CI 7.0–56.8%) (P = 0.538). People with sarcopenia had lower predicted forced expiratory volume in the first second (mean difference −7.1%; 95%CI −9.0 to −5.1%) and poorer exercise tolerance (standardized mean difference −0.8; 95%CI −1.4 to −0.2) and quality of life (standardized mean difference 0.26; 95%CI 0.2–0.4) compared with those who did not (P < 0.001 for all). No clear relationship was observed between sarcopenia and inflammatory or oxidative stress biomarkers. Incident mortality was unreported in the literature. Sarcopenia is prevalent in a significant proportion of people with COPD and negatively impacts upon important clinical outcomes. Opportunities exist to optimize its early detection and management and to evaluate its impact on mortality in this patient group.
Quantification of physical activities in daily life in patients with chronic obstructive pulmonary disease has increasing clinical interest. However, detailed comparison with healthy subjects is not ...available. Furthermore, it is unknown whether time spent actively during daily life is related to lung function, muscle force, or maximal and functional exercise capacity. We assessed physical activities and movement intensity with the DynaPort activity monitor in 50 patients (age 64 +/- 7 years; FEV1 43 +/- 18% predicted) and 25 healthy elderly individuals (age 66 +/- 5 years). Patients showed lower walking time (44 +/- 26 vs. 81 +/- 26 minutes/day), standing time (191 +/- 99 vs. 295 +/- 109 minutes/day), and movement intensity during walking (1.8 +/- 0.3 vs. 2.4 +/- 0.5 m/second2; p < 0.0001 for all), as well as higher sitting time (374 +/- 139 vs. 306 +/- 108 minutes/day; p = 0.04) and lying time (87 +/- 97 vs. 29 +/- 33 minutes/day; p = 0.004). Walking time was highly correlated with the 6-minute walking test (r = 0.76, p < 0.0001) and more modestly to maximal exercise capacity, lung function, and muscle force (0.28 < r < 0.64, p < 0.05). Patients with chronic obstructive pulmonary disease are markedly inactive in daily life. Functional exercise capacity is the strongest correlate of physical activities in daily life.
Background: Despite a variety of benefits brought by pulmonary rehabilitation to patients with COPD, it is unclear whether these patients
are more active during daily life after the program.
Methods: ...Physical activities in daily life (activity monitoring), pulmonary function (spirometry), exercise capacity (incremental
cycle-ergometer testing and 6-min walk distance testing), muscle force (quadriceps and handgrip force, and inspiratory and
expiratory maximal pressures), quality of life (chronic respiratory disease questionnaire), and functional status (pulmonary
functional status and dyspnea questionnaire-modified version) were assessed at baseline, after 3 months of a multidisciplinary
rehabilitation program, and at the end of a 6-month multidisciplinary rehabilitation program in 29 patients (mean ± SD age,
67 ± 8 years; FEV 1 , 46 ± 16% predicted).
Results: Exercise capacity, muscle force, quality of life, and functional status improved significantly after 3 months of pulmonary
rehabilitation (all p < 0.05), with further improvements in muscle force, functional status, and quality of life at 6 months.
Movement intensity during walking improved significantly after 3 months (p = 0.046) with further improvements after 6 months
(p = 0.0002). Walking time in daily life did not improve significantly at 3 months (mean improvement, 7 ± 35%; p = 0.21),
but only after 6 months (mean improvement, 20 ± 36%; p = 0.008). No significant changes occurred in other activities or in
the pattern of the time spent walking in daily life. Changes in dyspnea after the program were significantly related to changes
in walking time in daily life ( r = 0.43; p = 0.02).
Conclusion: If one aims at changing physical activity habits in the daily life of COPD patients, the contribution of long-lasting programs
might be important.
COPD
exercise
physical activity
pulmonary rehabilitation
Acute exacerbations (AEs) have a negative impact on various aspects of the progression of COPD, but objective and detailed data on the impact of hospitalizations for an AE on physical activity are ...not available.
We aimed to investigate physical activity using an activity monitor (DynaPort; McRoberts; the Hague, the Netherlands), pulmonary function, muscle force, 6-min walking distance, and arterial blood gas levels in 17 patients (mean age, 69 ± 9 years ± SD; body mass index, 24 ± 5 kg/m2) at the beginning and end of a hospitalization period for an AE and 1 month after discharge.
Time spent on weight-bearing activities (walking and standing) was markedly low both at day 2 and day 7 of hospitalization (median, 7%; interquartile range IQR, 3 to 18% of the time during the day; and median, 9%; IQR, 7 to 21%, respectively) and 1 month after discharge (median, 19% IQR, 10 to 34%; Friedman test, p = 0.13). Time spent on weight-bearing activities was positively correlated to quadriceps force at the end of the hospitalization period (r = 0.47; p = 0.048). Patients with hospitalization for an AE in the previous year had an even lower activity level when compared to those without a recent hospitalization. In addition, patients with a lower activity level at 1 month after discharge were more likely to be readmitted in the following year.
Patients with COPD are markedly inactive during and after hospitalization for an AE. Efforts to enhance physical activity should be among the aims of the disease management during and following the AE periods.
It is important to include large sample sizes and different factors that influence the six-minute walking distance (6MWD) in order to propose reference equations for the six-minute walking test (6 ...MWT).
To evaluate the influence of anthropometric, demographic, and physiologic variables on the 6 MWD of healthy subjects from different regions of Brazil to establish a reference equation for the Brazilian population.
In a multicenter study, 617 healthy subjects performed two 6 MWTs and had their weight, height, and body mass index (BMI) measured, as well as their physiologic responses to the test. Delta heart rate (∆HR), perceived effort, and peripheral oxygen saturation were calculated by the difference between the respective values at the end of the test minus the baseline value.
Walking distance averaged 586 ± 106 m, 54 m greater in male compared to female subjects (p<0.001). No differences were observed among the 6 MWD from different regions. The quadratic regression analysis considering only anthropometric and demographic data explained 46% of the variability in the 6 MWT (p<0.001) and derived the equation: 6 MWD(pred)=890.46-(6.11 × age)+(0.0345 × age(2))+(48.87 × gender)-(4.87 × BMI). A second model of stepwise multiple regression including ∆HR explained 62% of the variability (p<0.0001) and derived the equation: 6 MWD(pred)=356.658-(2.303 × age)+(36.648 × gender)+(1.704 × height)+(1.365×∆HR).
The equations proposed in this study, especially the second one, seem adequate to accurately predict the 6 MWD for Brazilians.
Different protocols for the sit-to-stand test (STS) are available for assessing functional capacity in COPD. We sought to correlate each protocol of the STS (ie, the 5-repetition 5-rep STS, the 30-s ...STS, and the 1-min STS) with clinical outcomes in subjects with COPD. We also aimed to compare the 3 protocols of the STS, to verify their association and agreement, and to verify whether the 3 protocols are able to predict functional exercise capacity and physical activity in daily life (PADL).
23 subjects with COPD (11 men; FEV
53 ± 15% predicted) performed 3 protocols of the STS. Subjects also underwent the following assessments: incremental shuttle walking test, 6-min walk test (6MWT), 4-m gait speed test (4MGS), 1-repetition maximum of quadriceps muscle, assessment of PADL, and questionnaires on health-related quality of life and functional status.
The 1-min STS showed significant correlations with the 6MWT (r = 0.40), 4MGS (r = 0.64), and PADL (0.40 ≤ r ≤ 0.52), and the 5-rep STS and 30-s STS were associated with the 4MGS (r = 0.54 and r = 0.52, respectively). The speed differed for each protocol (5-rep STS 0.53 ± 0.16 rep/s, 30-s STS 0.48 ± 0.13 rep/s, 1-min STS 0.45 ± 0.11 rep/s,
= .01). However, they presented good agreement (intraclass correlation coefficient ≥ 0.73 for all) and correlated well with each other (r ≥ 0.68 for all). More marked changes in peripheral oxygen saturation (
= .004), heart rate (
< .001), blood pressure (
< .001), dyspnea (
< .001), and leg fatigue (
< .001) were found after the 1-min STS protocol. Furthermore, the 3 protocols were equally able to identify subjects with low exercise capacity or preserved exercise capacity.
The 1-min STS generated higher hemodynamic demands and correlated better with clinical outcomes in subjects with COPD. Despite the difference in speed performance and physiological demands between the 5-rep STS and 1-min STS, there was a good level of agreement among the 3 protocols. In addition, all 3 tests were able to identify subjects with low exercise capacity or preserved exercise capacity.
The relation between mechanical ventilation (MV) and bronchopulmonary dysplasia (BPD) - a common disease in extremely premature newborn (PTNB) - is well stabilished, but is unknown, however, how much ...time under MV influences the severity of the disease.
To define the duration under MV with greater chance to develop moderate to severe BPD in extremely PTNB and to compare clinical outcomes before and during hospitalization among patients with mild and moderate to severe BPD.
Fifty-three PTNB were separated into mild and moderate to severe BPD groups and their data were analyzed. Time under MV with a greater chance of developing moderate to severe BPD was estimated by the ROC curve. Perinatal and hospitalization outcomes were compared between groups. A logistic regression was performed to verify the influence of variables associated to moderate to severe BPD development, such as pulmonary hypertension (PH), gender, gestational age (GA) and weight at birth, as well the time under MV found with ROC curve. The result of ROC curve was validated using an independent sample (n = 16) by Chi-square test.
Time under MV related to a greater chance of developing moderate to severe BPD was 36 days. Moderate to severe BPD group had more males (14 vs 5, p = 0,047), longer time under MV (43 vs 19 days, p < 0,001), more individuals with PH (12 vs 3, p = 0,016), worse retinopathy of prematurity (grade 3, 2 vs 11, p = 0,003), longer hospital length of stay (109 vs 81,5 days, p < 0,001), greater PMA (41 vs 38 weeks, p < 0,001) and weight (2620 vs 2031 g, p < 0,001) at discharge and the mild BPD group had more CPAP use prior to MV (12 vs 7, p = 0,043). Among all variables included in logistic regression, only PH and MV < 36 days were significant in the model, explaining 72% of variation in moderate to severe BPD development. In the validation sample, prevalence of preterm infants who needed MV for more than 36 days in the moderate to severe BPD group was 100% (n = 6) and 0% in mild BPD group (p = 0,0001).
Time under MV related to moderate to severe BPD development is 36 days, and worst outcomes are related to disease severity. PH and time under MV for more than 36 days are related to development of moderate to severe BPD.
Summary Background Reference values for the incremental shuttle walking test (ISWT) which are applicable to the whole population need to be solidly established. This study aimed to determine which ...anthropometric and demographic variables influence the walking distance achieved in the ISWT in healthy subjects with a broad age range and to establish a reference equation for predicting ISWT for that population. Methods In a cross-sectional study, 242 healthy subjects (102 male) performed two ISWT and had their weight, height and body mass index (BMI) measured. Results In general, healthy subjects walked 810 IQR 25–75%: 572–1030 m in the ISWT, presenting large variability (range 210–1820 m). The walked distance correlated with age ( r = −0.76), height ( r = 0.49) and BMI ( r = −0.23) ( p < 0.001 for all), but not with weight ( r = 0.06, p = 0.315). A model of stepwise multiple regression showed that gender, age and BMI were independent contributors to the ISWT in healthy subjects, explaining 71% ( p < 0.0001) of the variability. The derived reference equation was: ISWTpred = 1449.701 − (11.735 × age) + (241.897 × gender) − (5.686 × BMI), where male gender = 1 and female gender = 0. Conclusion In conclusion, the variability of the ISWT is explained largely by gender, age and BMI. The reference values for the ISWT can be adequately predicted using the equation proposed in this study.
Despite the high prevalence of sleep disturbances in idiopathic pulmonary fibrosis (IPF), the relationship between physical activity in daily life (PADL) and sleep in this population remains unclear.
...Investigate the impact of sleep on different domains of PADL in IPF and characterize their PADL profile.
Sixty-seven participants (thirty-three with IPF and thirty-four healthy subjects control group) were included. The subjects underwent assessments of pulmonary function, exercise capacity, respiratory and peripheral muscle strength, PADL, sleep, dyspnea, and health-related quality of life. PADL and sleep measures were assessed using an activity monitor (Actigraph®, wGT3x-BT). Associations between sleep and PADL were done using correlation and regression models.
In the IPF, sleep duration at night associated significantly with step counts, sedentary, light, and moderate-to-vigorous physical activity (MVPA) (-0.82 ≤ R ≤ 0.43; p < .05 for all). Lung function and sleep partially explained PADL variables (0.19 ≤ R
≤ 0.65, p < .05 for all). Compared to controls, the IPF subjects presented lower step counts, less time spent in MVPA, standing position, and more time spent in lying position (p < .05, for all).
Sleep duration is associated with PADL in IPF. The PADL profile of patients is worse than in control subjects.
We aimed to investigate the construct validity of the Timed Up & Go (TUG) test in chronic obstructive pulmonary disease (COPD), to identify characteristics related to an abnormal TUG time and to ...examine the responsiveness of the TUG to pulmonary rehabilitation (PR). TUG time was assessed before and after comprehensive PR in 500 COPD patients, and compared cross-sectionally in 100 non-COPD subjects. Physical health outcomes, mental health outcomes, symptom-related outcomes and multidimensional indices were assessed in COPD patients only. Good convergent and discriminant validity was demonstrated by fair-to-moderate correlation with physical health outcomes, symptom-related outcomes and multidimensional indices (rs = 0.18–0.70) and by little correlation with mental health outcomes (rs = 0.21–0.26). COPD patients had a worse TUG time than non-COPD subjects, demonstrating known-groups validity. A TUG time of 11.2 seconds had good sensitivity (0.75) and specificity (0.83) for identifying patients with a baseline 6-minute walk distance <350 m. TUG time improved after PR (p < 0.0001) and a change of 0.9–1.4 seconds was identified as clinically important. The TUG is valid and responsive in COPD. An abnormal result is indicative of poor health outcomes. This simple test provides valuable information and can be adopted in clinical and research settings.
PDF
