Published ahead of print on November 29, 2007, doi:10.1164/rccm.200707-1011OC
© 2008 American Thoracic Society doi: 10.1164/rccm.200707-1011OC
Extrapulmonary Effects of Chronic Obstructive Pulmonary Disease on Physical ActivityA Cross-sectional Study1 Pulmonary Research Institute, 2 Center for Pneumology and Thoracic Surgery, Hospital Grosshansdorf, Grosshansdorf, Germany; and 3 Institute of Social Medicine, Medical University Luebeck, Luebeck, Germany Correspondence and requests for reprints should be addressed to Prof. Dr. Helgo Magnussen, M.D., Pulmonary Research Institute at Hospital Grosshansdorf, Center for Pneumology and Thoracic Surgery, Woehrendamm 80, D-22927 Grosshansdorf, Germany. E-mail: magnussen{at}pulmoresearch.de Rationale: Physical activity is reduced in patients with chronic obstructive pulmonary disease (COPD). COPD has a systemic component that includes significant extrapulmonary effects that may contribute to its severity in individual patients. Objectives: To investigate the association of extrapulmonary effects of the disease and its comorbidities with reduced physical activity in patients with COPD. Methods: In a cross-sectional study, 170 outpatients with COPD (GOLD [Global Initiative for Chronic Obstructive Lung Disease] stages I–IV; BODE [body mass index, airway obstruction, dyspnea, and exercise capacity] score 0–10) underwent a series of tests. Physical activity was assessed over 5 to 6 consecutive days by using a multisensor accelerometer armband that records steps per day and the physical activity level (total daily energy expenditure divided by whole-night sleeping energy expenditure). Cardiovascular status was assessed by echocardiography, vascular Doppler sonography, and levels of N-terminal pro–B-type natriuretic peptide. Mental status, metabolic/muscular status, systemic inflammation, and anemia were assessed by Beck Depression Inventory, bioelectrical impedance analysis, handgrip strength, high-sensitivity C-reactive protein/fibrinogen, and hemoglobin, respectively. Measurements and Main Results: In a multivariate linear regression analysis using either steps per day or physical activity level as a dependent variable, the extrapulmonary parameters that were associated with reduced physical activity in patients with COPD independently of GOLD stages or BODE score were N-terminal pro–B-type natriuretic peptide levels, echocardiographically measured left ventricular diastolic function, and systemic inflammation. Conclusions: Higher values of systemic inflammation and left cardiac dysfunction are associated with reduced physical activity in patients with COPD.
Key Words: pulmonary disease, chronic obstructive • ventricular function, left • acute phase reaction • activities of daily living
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