Review of Recent European Respiratory Society Statement Explores Role of Physical Activity in COPD

In a recent article published in the Polish Archives of Internal Medicine, Richard ZuWallack from the Department of Pulmonary and Critical Care, St. Francis Hospital and Medical Center in Hartford, Connecticut conducted a review exploring the concept of physical activity in patients with Chronic Obstructive Pulmonary Disease. The review was a summary of the European Respiratory Society (ERS) statement on physical activity and discussed the concepts of physical activity and exercise which, while interrelated, are not synonymous.

According to the author, physical activity involves bodily movement produced by skeletal muscles that results in energy expenditure. On the other hand, exercise is a subset of physical activity in which generally higher levels of muscular activity are performed for a purpose, such as achieving physical fitness or winning an athletic contest.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality. Global Burden of Disease studies have estimated that COPD is the third leading cause of death worldwide and in the United States. Mortality appears to be decreasing worldwide; despite this, COPD still caused more than 3 million deaths in 2010 alone. It is also the second leading cause of disability adjusted life-years lost; COPD-related mortality more than doubled among women over a 20-year observation period, and exacerbations now account for 50 to 75% of the costs associated with COPD.

Evidence has shown that COPD patients are physically inactive in comparison to healthy age-matched control subjects. Physical inactivity has also been associated with adverse clinical outcomes in COPD, including impaired health status, more rapid disease progression, and increased health care utilization and mortality risk.

The methods to assess physical activity in COPD have mainly included questionnaires and activity monitors (such as simple pedometers and complex accelerometers).

In the review titled “Chronic Obstructive Pulmonary Disease-Evolving Concepts in Treatment: Advances in Pulmonary Rehabilitation,” Richard ZuWallack determined that COPD patients are generally quite inactive and that this physical inactivity is associated with impairment in other areas, including lung function (airways obstruction and dynamic hyperinflation) exercise capacity, and health status, as well as the presence of certain comorbid conditions.

The author further indicates that physical activity is reduced during the COPD exacerbation. Importantly, physical inactivity is associated with adverse outcomes, including increased health care utilization, increased mortality risk and (perhaps) an accelerated decline in cigarette smokers with COPD.

Richard ZuWallack further mentioned that the phenomenon of physical inactivity in COPD is complex, resulting not only from physiologic impairments, but symptomatic, cultural, motivational, and environmental factors.

The review concluded that current efforts to increase physical activity in COPD patients have been challenging, and there appears to be no “quick-fix” to the problem.