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Physical Activity vs Psychomotor ActivityPhysical Activity: Prognostication of COPD: Prognostication of COPD FREE TO VIEW

Sundar Gnanavel, MD; Ruby Stella Robert, MBBS
Author and Funding Information

From the Department of Psychiatry (Dr Gnanavel), All India Institute of Medical Sciences, New Delhi; and Physiology and Cardiopulmonary Rehabilitation (Dr Robert), Vallabhbhai Patel Chest Institute.

Correspondence to: Sundar Gnanavel, MD, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, New Delhi 110029, India; e-mail: sundar221103@yahoo.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential 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. See online for more details.


Chest. 2013;144(6):1975. doi:10.1378/chest.13-1732
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To the Editor:

We read with interest the recent article by Nguyen et al1 in CHEST (July 2013), which demonstrated novel findings. However, we would like to draw attention to certain conceptual issues that could effectively question the crux of those findings. As the authors mentioned, objectively measured physical activity is an excellent predictor of prognosis for patients with COPD. However, physical activity is distinct from psychomotor activity. Psychomotor activity is defined as motor/physical activity that is secondary to or dependent on a psychic component and is mostly non-goal-directed.2 For example, manic, psychotic, and anxious patients would demonstrate increased psychomotor activity. This is generally state-dependent, that is, it lasts during the course of psychiatric symptoms and normalizes on effective treatment.

Furthermore, comorbid anxiety symptoms have never been implicated as a good prognostic factor in either COPD or any other chronic illnesses, to our knowledge. If anything, mild anxiety symptoms predict positive outcome negating a sedentary lifestyle; it has to be trait anxiety symptoms that refer to those individuals with anxious predisposition or temperament from adolescence. Considering that the Nguyen et al1 study used a cross-sectional design, state and trait anxiety symptoms could have been discerned using an anxiety inventory like the State-Trait Anxiety Inventory.3

An anxious state resulting in increased step counts per day is expected and logical even in a patient with COPD. This cannot be erroneously interpreted as an increase in physical activity and predictor of good prognosis in patients with COPD. The authors propose no strong hypothesis to explain the better prognosis of mild anxiety symptoms. In fact, we would consider anxiety symptoms as a confounding factor in assessment of physical activity in patients with COPD. A longitudinal study of physical activity in patients with COPD accounting for anxiety or use of an anxiety inventory like the State-Trait Anxiety Inventory (additionally in a cross-sectional study) would better clarify the picture.

References

Nguyen HQ, Fan VS, Herting J, et al. Patients with COPD with higher levels of anxiety are more physically active. Chest. 2013;144(1):145-151. [CrossRef] [PubMed]
 
Sadock BJ, Kaplan HI, Sadock VA. Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. Philadelphia, PA: Wolter Kluwer/Lippincott Williams & Wilkins; 2007.
 
Grös DF, Antony MM, Simms LJ, McCabe RE. Psychometric properties of the State-Trait Inventory for Cognitive And Somatic Anxiety (STICSA): comparison to the State-Trait Anxiety Inventory (STAI). Psychol Assess. 2007;19(4):369-381. [CrossRef] [PubMed]
 

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References

Nguyen HQ, Fan VS, Herting J, et al. Patients with COPD with higher levels of anxiety are more physically active. Chest. 2013;144(1):145-151. [CrossRef] [PubMed]
 
Sadock BJ, Kaplan HI, Sadock VA. Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. Philadelphia, PA: Wolter Kluwer/Lippincott Williams & Wilkins; 2007.
 
Grös DF, Antony MM, Simms LJ, McCabe RE. Psychometric properties of the State-Trait Inventory for Cognitive And Somatic Anxiety (STICSA): comparison to the State-Trait Anxiety Inventory (STAI). Psychol Assess. 2007;19(4):369-381. [CrossRef] [PubMed]
 
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