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Evaluation of physical activity in patients with COPD.

Evaluation of physical activity in patients with COPD. Hans VAN REMOORTEL Turkish Thoracic Society Congress April 3-7, 2013 Belek - Antalya. Overview. Definition of physical activity Evaluation of physical activity Objective measurements Patient Reported Outcomes

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Evaluation of physical activity in patients with COPD.

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  1. Evaluation of physicalactivity in patientswith COPD. • Hans VAN REMOORTEL • TurkishThoracic Society Congress • April 3-7, 2013 • Belek - Antalya

  2. Overview • Definition of physicalactivity • Evaluation of physicalactivity • Objectivemeasurements • PatientReportedOutcomes • COPD andphysicalactivity • Which patients are at risk forinactivity? • Physicalactivityandrehabilitation • Take home messages

  3. 1. Definition of physicalactivity “Anybodilymovementproducedby the contraction of skeletalmusclethatincreases energy expenditure above a basal level.” 1 MET (restingmetabolism) ~ 3.5 mL*min-1*kg-1 Caspersen et al.; Public Health; 1985

  4. 1. Definition of physicalactivity Environmental influences Healthbeliefs Self-efficacy Lifestyle/habits Physicalactivity Intenseprescribed training Moderate Intense physicalactivity (3-6 METs)    Physicalfitness Health  Modifiedfrom Vanhees et al.; European Journal of Cardiovascular Prevention andRehabilitation; 2005

  5. 1. Definition of physicalactivity

  6. 2. Evaluation of physicalactivitySubjectivemeasurements: Questionnaires StandfordSeven-dayPhysical Activity Recall Questionnaire Garfield et al.; European Respiratory Journal; 2012

  7. 2. Evaluation of physicalactivitySubjectivemeasurements: Questionnaires ICC= 0.40 Garfield et al.; European Respiratory Journal; 2012

  8. Accelerometer Combined 2. Evaluation of physicalactivityObjectivemeasurements: Devices Pedometer Apps smartphone GPS based activity monitor

  9. 2. Evaluation of physicalactivityObjectivemeasurements: Advantages/disadvantages • Advantages No recall-bias No systematicerrors • Disadvantages Price Accuracy/validitydevices Upper-extremityactivities? No information about type of activity Matthews et al.; MedicineandScience in SportsandExercise; 2012 Bossenbroek et al.; Informa Healthcare; 2011

  10. 2. Evaluation of physicalactivitySystematicliteraturereviewonvalidation studies • 1. Few validation studies have been performed in chronicdiseasepopulations. • Chronicdiseases (n=16) • COPD (n=5) • Obesity (n=4) • CHF (n=1) • Chronicorganfailure (n=1) • CLBP (n=1) • Fibromyalgiasyndrome (n=1) • PAD (n=1) • type II diabetes (n=1) • generalchronicdiseasepopulation (n=1) Healthyadults (n=118) Van Remoortel et al.; Int J BehavNutr & Phys Act; 2012

  11. 2. Evaluation of physicalactivitySystematicliteraturereviewonvalidation studies • 2. Activity monitors are less accurate during slow walkingspeeds. 12 studies 69% Slow walk (<3.2 km/hr) Van Remoortel et al.; Int J BehavNutr & Phys Act; 2012

  12. 2. Evaluation of physicalactivityValidation of devices: Lab Study Van Remoortel et al.; Plos One; 2012

  13. 2. Evaluation of physicalactivityValidation of devices: Lab Study TOTAL 59 MINUTES Van Remoortel et al.; Plos One; 2012

  14. 2. Evaluation of physicalactivityValidation of devices: Lab Study Δ Δ Van Remoortel et al.; Plos One; 2012

  15. 2. Evaluation of physicalactivityValidation of devices: Lab Study Relation ΔVO2 with Δmonitor MM 0.94** SW 0.52** AG 0.88** AW 0.59** RT3 0.69** KZ 0.57** Van Remoortel et al.; Plos One; 2012

  16. 2. Evaluation of physicalactivityValidationof devices: Lab Study/Field Study Rabinovich et al.; European Respiratory Journal; 2013 Van Remoortel et al.; Plos One; 2012

  17. 3. COPD andphysicalactivity COPD Expiratory flow limitation Air trapping Hyperinflation Exacerbations Breathlessness Deconditioning HRQoL Inactivity Muscleweakness ModifiedfromDecramer et al.; International Journal of COPD; 2008

  18. 3. COPD andphysicalactivity 100 80 % Patients 60 40 20 0 GOLD II GOLD III GOLD I GOLD IV GOLD IV GOLD I GOLD II GOLD III Physically Active PredominantlySedentairy VeryInactive AdaptedfromWatz et al.; European Respiratory Journal; 2009

  19. 3. COPD andphysicalactivity Hospitaladmission Garcia-Aymerichet al.; Thorax; 2006

  20. 3. COPD andphysicalactivity All causemortality Garcia-Aymerichet al.; Thorax; 2006

  21. 3. COPD andphysicalactivity PAL> 1.70 1.40<PAL<1.69 PAL< 1.40 PAL= Physical Activity Level= TEE/BMR Waschki et al.; Chest; 2011

  22. 4. Patients at risk forinactivity 1. Pitta et al.; RespiratoryMedicine; 2008 2. Pitta et al.; American Journal of Respiratoryand Critical Care Medicine; 2005

  23. 4. Patients at risk forinactivitySymptomsandinactivity mMRC 0: Onlydyspneaduringheavy exercise mMRC 1: Dyspneawhilehurrying or walkinguphill mMRC 2: Walking slower thenpeers/ dyspneawalking flat at own pace Unpublished data University Hospital Leuven; 2012

  24. 4. Patients at risk forinactivityExacerbationsandinactivity Pitta et al.; Chest; 2006

  25. 5. PhysicalactivityandrehabilitationDefinition pulmonaryrehabilitation (2012) Pulmonary rehabilitation is a comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies, which include, but are not limited to, exercise training, education and behavior change, designed to improve the physical and emotional condition of people with chronic respiratory disease and to promote the long-term adherence of health-enhancing behaviors.

  26. 5. PhysicalactivityandrehabilitationProblem p=0.051 p=0.02 Lowintensity High intensity Lowintensity High intensity Pitta et al.; Respiratory Care; 2011

  27. 5. PhysicalactivityandrehabilitationProblem Statistically significant Not statistically significant Weighted mean +17% Troosters et al.; EurRespirRev; 2010

  28. 5. PhysicalactivityandrehabilitationReason BEHAVIORAL CHANGE

  29. 5. PhysicalactivityandrehabilitationPossiblesolutions • Step counter • De Blok et al.; PatientEducationand counseling; 2009 • Step counter + website • Moy et al.; RespiratoryMedicine; 2010,2012 • Self-management programs • Effing et al.; RespiratoryMedicine; 2011 • NordicWalking • Breyer et al.; Respiratory Research; 2010

  30. 6. Take home messages • Physicalactivity is reduced in patientswith COPD andalready starts in the early stages of the disease. • The most appropriate way tomeasurephysicalactivity is byusingobjectivemeasurementmethods, such as activity monitors. • There are threevalidactivity monitors tobeused in patientswith COPD. • Patientswith frequent exacerbationsandsymptoms are at risk of becomingphysicallyinactive. • Physicalactivity is a behavior, which is difficulttoimprovewithpulmonaryrehabilitation. • Severalmethods are availableto combine withpulmonaryrehabilitation in order toimprovephysicalactivity.

  31. Prof. Dr. M. Decramer Prof. Dr. W. Janssens Prof. Dr. T. Troosters Prof. Dr. R. Gosselink

  32. Thankyouforyourattention! hans.vanremoortel@faber.kuleuven.be

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