Chest
Volume 129, Issue 3, March 2006, Pages 536-544
Journal home page for Chest

Original Research: COPD
Physical Activity and Hospitalization for Exacerbation of COPD

https://doi.org/10.1378/chest.129.3.536Get rights and content

Background:

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.

Objective and measurements:

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.

Results:

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.

Conclusions:

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.

Section snippets

Study Design

Assessment of physical activities was performed on day 2 and day 7 of the hospitalization period and 1 month after discharge from the hospital. Pulmonary function,19 maximal inspiratory pressure (Pimax) and maximal expiratory pressure,20 quadriceps force,7 fat-free mass (by bioimpedance), and arterial blood gas levels were measured on day 3 and day 8 of hospitalization and 1 month after discharge from the hospital (on a different day than the assessment of physical activities). A 6-min walking

Results

Six patients dropped out during the hospitalization period: one patient with a mild exacerbation was discharged on the third day of hospitalization, three patients with very severe exacerbations required intensive care, and two patients refused to continue the tests for personal reasons. As previously mentioned, one patient died of respiratory insufficiency in the fifteenth day of hospitalization. The final analysis was therefore performed with 17 patients (16 men; median age, 69 years;

Discussion

The present study showed that patients with COPD had very low level of physical activity during and after hospitalization for an AE independently of whether the exacerbation was infectious or not. Time spent in weight-bearing activities was low, especially in patients with quadriceps muscle weakness at the end of the hospitalization period. Furthermore, patients with hospitalization for an AE in the previous year had an even lower activity level when compared to patients without a recent AE. In

ACKNOWLEDGMENT:

The authors thank the following professionals for help with the assessments: Iris Coosemans, Veronica Barbier, Alix Debrock, Monique van Vliet, Geert Celis, Ana Balañá, Yannick Taverne, and the Lung Function staff and the nursing staff of the Pneumology Department from UZ Gasthuisberg, Leuven, Belgium.

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    Dr. Pitta is supported by CAPES/Brasil. This study was partially funded by FWO-Vlaanderen grants Levenslijn 7.0007.00, G.0237.01, and foundation Van Goethem-Brichant 2001.

    Dr. Troosters is a postdoctoral fellow of the FWO-Vlaanderen. Dr. Spruit is a postdoctoral fellow at Katholieke Universiteit Leuven (PDM/04/230).

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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