Both moderate and severe exacerbations accelerate physical activity decline in COPD patients
Authors: Heleen Demeyer, Marcos Costilla-Frias, Zafeiris Louvaris, Elena Gimeno-Santos, Maggie Tabberer, Roberto A. Rabinovich, Corina de Jong, Michael I. Polkey, Nicholas S. Hopkinson, Niklas Karlsson, Ignasi Serra, Ioannis Vogiatzis, Thierry Troosters, Judith Garcia-Aymerich
Journal: European Respiratory Journal (2018)

Physical activity (PA) is a relevant outcome measure in chronic obstructive pulmonary disease (COPD). Low PA is prevalent and drives prognosis [1]. Unfortunately, the determinants of PA and its change over time are poorly understood [1]. The fact that the PA progressively declines over time along with worsening of lung function and health status [2] suggests that the PA decline could be due to the progression of the disease and specifically to acute exacerbations [3]. An acute reduction in PA at the onset has been reported both in severe exacerbations requiring a hospitalisation [4] and in ambulatory treated exacerbations [5, 6]. A sustained PA reduction has been shown 1 month after hospital discharge [4] whereas PA almost returns to stable levels after community-treated exacerbations [6]. One study found faster PA decline in patients with a history of two or more exacerbations in the 12 months prior to the study [5]. This analysis did not adjust for confounders of the association ( e.g. airflow obstruction, symptom burden) or external variables influencing PA ( e.g. climate). It could also be argued that the greater decline in PA was due to lower health status at baseline. Although PA is an important outcome for COPD patients, little is known about the role of exacerbations in patients' experience of PA. Importantly, both the amount of activity and difficulties experienced during activity are integral to the concept of PA limitation [7]. The aim of the present analysis was to assess the association between the number and severity of exacerbations and changes in PA and PA experience. Exacerbations have a negative impact on long-term daily physical activity of COPD patients <http://ow.ly/olGl30hkdMl> We are grateful for the input from the PROactive project ethics board, advisory board and patient input platform. The PROactive Consortium members are as follows: Nathalie Ivanoff (Almirall, Barcelona, Spain); Niklas Karlsson and Solange Corriol-Rohou (AstraZeneca AB, Gothenburg, Sweden); Ian Jarrod (British Lung Foundation, London, UK); Damijen Erzen (Boehringer Ingelheim, Nieder-Ingelheim, Germany); Mario Scuri and Roberta Montacchini (Chiesi Farmaceutici S.A., Parma, Italy); Paul McBride (Choice Healthcare Solutions, Hitchin, UK); Nadia Kamel (European Respiratory Society, Lausanne, Switzerland); Maggie Tabberer (GlaxoSmithKline, Uxbridge, UK); Thierry Troosters, Wim Janssens, Heleen Demeyer and Fabienne Dobbels (Katholieke Universiteit Leuven, Leuven, Belgium); Judith Garcia-Aymerich (ISGlobal, Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain); Pim de Boer (Netherlands Lung Foundation, Amersfoort, The Netherlands); Karoly Kulich (Novartis, Basel, Switzerland); Michael I. Polkey and Nick S. Hopkinson (Royal Brompton and Harefield NHS Foundation Trust, London, UK); Ioannis Vogiatzis (Thorax Research Foundation, Athens, Greece); Enkeleida Nikai (UCB, Brussels, Belgium); Thys van der Molen and Corina De Jong (University Medical Center, Groningen, The Netherlands); Roberto A. Rabinovich and Bill MacNee (University of Edinburgh, Edinburgh, UK); Milo A. Puhan and Anja Frei (University of Zurich, Zurich, Switzerland).