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Original Research: COPD |

Physical Activity and Clinical and Functional Status in COPD

Judith Garcia-Aymerich, MD; Ignasi Serra, BStat; Federico P. Gómez, MD; Eva Farrero, MD; Eva Balcells, BMed; Diego A. Rodríguez, BMed; Jordi de Batlle, BMedBiol; Elena Gimeno, PT; David Donaire-Gonzalez, PT; Mauricio Orozco-Levi, MD; Jaume Sauleda, MD; Joaquim Gea, MD; Robert Rodriguez-Roisin, MD, FCCP; Josep Roca, MD; Àlvar G. Agustí, MD; Josep M. Antó, MD; the Phenotype and Course of COPD (PAC-COPD) Study Group
Author and Funding Information

From the Centre for Research in Environmental Epidemiology (Drs. Garcia-Aymerich, Serra, and Antó, and Mr. Donaire- Gonzalez), Barcelona, Spain; the Municipal Institute of Medical Research (Drs. Balcells and Orozco-Levi), Hospital del Mar, Barcelona, Spain; Centro de Investigación Biomédica en Red Epidemiologia y Salud Pública (CIBERESP) [Dr. de Batlle], Barcelona, Spain; Servei de Pneumologia (Drs. Gómez, Rodríguez, and Rodriguez-Roisin, and Ms. Gimeno), Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomedica en Red de Enfermedades Respiratorias (Drs. Gea and Roca), Recinte Hospital Joan March, Bunyola, Spain; Servei de Pneumologia (Dr. Sauleda), Hospital Universitari Son Dureta, Palma de Mallorca, Spain; Servei de Pneumologia (Dr. Farrero), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Llobregat, Spain; and Fundació Caubet-Cimera (Dr. Agustí), Recinte Hospital Joan March, Bunyola, Spain.

Correspondence to: Judith Garcia-Aymerich, MD, Centre for Research in Environmental Epidemiology (CREAL), Doctor Aiguader 88, 08003 Barcelona, Catalonia, Spain; e-mail: jgarcia@creal.cat

*A list of Centers and Members of the PAC-COPD Study Group is located in the Appendix.


All authors have contributed to (1) conception and design of the study; (2) analysis and interpretation of data; (3) writing the article or revising it critically for important intellectual content; and (4) final approval of the version to be published. Drs. Garcia-Aymerich, Serra, and Antó performed the statistical analysis and interpreted the results. Dr. Garcia-Aymerich prepared the first draft of the article. Dr. Garcia-Aymerich had full access to all of the data in the study, and takes responsibility for the integrity of the data and the accuracy of the data analysis.

This research was supported by Fondo de Investigación Sanitaria (FIS PI052292) and Spanish Society of Pneumology and Thoracic Surgery (SEPAR 2004/136). Judith Garcia-Aymerich has a researcher contract from the Instituto de Salud Carlos III (CP05/00118), Ministry of Health, Spain. Jordi de Batlle had a predoctoral fellowship from the Instituto de Salud Carlos III (FI05/01022), Ministry of Health, Spain. Diego A. Rodríguez has a long term research fellowship from the European Respiratory Society (2006/191). The PAC-COPD Study is funded by grants from Fondo de Investigación Sanitaria (FIS PI020541), Ministry of Health, Spain; Agència d'Avaluació de Tecnologia i Recerca Mèdiques (AATRM 035/20/02), Catalonia Government; Spanish Society of Pneumology and Thoracic Surgery (SEPAR 2002/137); Catalan Foundation of Pneumology (FUCAP 2003 Beca Marià Ravà); Red RESPIRA (RTIC C03/11); Red RCESP (RTIC C03/09), Fondo de Investigación Sanitaria (PI052486); Fondo de Investigación Sanitaria (PI052302); Fundació La Marató de TV3 (No. 041110); DURSI (2005SGR00392); and an unrestricted educational grant from Novartis Farmacèutica, Spain. Centro de Investigacíon Biomedica en Red Epidemiologia y Salud Pública (CIBERESP) and CIBERES are funded by the Instituto de Salud Carlos III, Ministry of Health, Spain. No involvement of funding sources in study design; in the collection, analysis, and interpretation of data; in the writing of the report; nor in the decision to submit the article for publication. Researchers are independent from funders.

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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


© 2009 American College of Chest Physicians


Chest. 2009;136(1):62-70. doi:10.1378/chest.08-2532
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Background:  The mechanisms underlying the benefits of regular physical activity in the evolution of COPD have not been established. Our objective was to assess the relationship between regular physical activity and the clinical and functional characteristics of COPD.

Methods:  Three hundred forty-one patients were hospitalized for the first time because of a COPD exacerbation in nine teaching hospitals in Spain. COPD diagnosis was confirmed by spirometry under stable conditions. Physical activity before the first COPD hospitalization was measured using the Yale questionnaire. The following outcome variables were studied under stable conditions: dyspnea, nutritional status, complete lung function tests, respiratory and peripheral muscle strength, bronchial colonization, and systemic inflammation.

Results:  The mean age was 68 years (SD, 9 years), 93% were men, 43% were current smokers, and the mean postbronchodilator FEV1 was 52% predicted (SD, 16% predicted). Multivariate linear regression models were built separately for each outcome variable and adjusted for potential confounders (including remaining outcomes if appropriate). When patients with the lowest quartile of physical activity were compared to patients in the other quartiles, physical activity was associated with significantly higher diffusing capacity of the lung for carbon monoxide (Dlco) [change in the second, third, and fourth quartiles of physical activity, compared with first quartile (+ 6%, + 6%, and + 9% predicted, respectively; p = 0.012 [for trend])], expiratory muscle strength (maximal expiratory pressure [Pemax]) [+ 7%, + 5%, and + 9% predicted, respectively; p = 0.081], 6-min walking distance (6MWD) [+ 40, + 41, and + 45 m, respectively; p = 0.006 (for trend)], and maximal oxygen uptake (V̇o2peak) [+ 55, + 185, and + 81 mL/min, respectively; p = 0.110 (for trend)]. Similarly, physical activity reduced the risk of having high levels of circulating tumor necrosis factor α (odds ratio, 0.78, 0.61, and 0.36, respectively; p = 0.011) and C-reactive protein (0.70, 0.51, and 0.52, respectively; p = 0.036) in multivariate logistic regression.

Conclusions:  More physically active COPD patients show better functional status in terms of Dlco, Pemax, 6MWD, V̇o2peak, and systemic inflammation.

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