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Original Research: COPD |

Phenotypic Characteristics Associated With Reduced Short Physical Performance Battery Score in COPDDeterminants of Short Physical Performance Battery

Mehul S. Patel, MBBS; Divya Mohan, MBBS; Yvonne M. Andersson, BSc; Manuel Baz, MD; Samantha S. C. Kon, MBBS; Jane L. Canavan, PhD; Sonya G. Jackson, PhD; Amy L. Clark, BSc; Nicholas S. Hopkinson, PhD; Samantha A. Natanek, PhD; Paul R. Kemp, PhD; Piet L. B. Bruijnzeel, PhD; William D.-C. Man, PhD; Michael I. Polkey, PhD
Author and Funding Information

From the NIHR Respiratory Biomedical Research Unit (Drs Patel, Mohan, Baz, Kon, Canavan, Hopkinson, Natanek, and Man and Prof Polkey), Royal Brompton & Harefield NHS Foundation Trust and Imperial College London, London, England; Respiratory, Inflammation, and Autoimmune Diseases (Ms Andersson and Drs Jackson and Bruijnzeel), AstraZeneca, Mölndal, Sweden; Harefield Pulmonary Rehabilitation Unit (Drs Kon, Canavan, Man, and Ms Clark), London, England; and Department of Molecular Medicine (Dr Kemp), Imperial College London, London, England.

Correspondence to: Michael I. Polkey, PhD, Muscle Laboratory, NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, Fulham Rd, London, SW3 6NP, England; e-mail: m.polkey@rbht.nhs.uk


Funding/Support: This project was supported by an unrestricted grant from AstraZeneca and by the NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton & Harefield NHS Foundation Trust and Imperial College London, who partly fund Prof Polkey’s and completely fund Dr Canavan’s salary. Dr Kon is supported by the Medical Research Council. Dr Man is supported by an NIHR Clinician Scientist Award, Medical Research Council New Investigator Grant, and an NIHR Clinical Trials Fellowship.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(5):1016-1024. doi:10.1378/chest.13-1398
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Background:  The Short Physical Performance Battery (SPPB) is commonly used in gerontology, but its determinants have not been previously evaluated in COPD. In particular, it is unknown whether pulmonary aspects of COPD would limit the value of SPPB as an assessment tool of lower limb function.

Methods:  In 109 patients with COPD, we measured SPPB score, spirometry, 6-min walk distance, quadriceps strength, rectus femoris cross-sectional area, fat-free mass, physical activity, health status, and Medical Research Council dyspnea score. In a subset of 31 patients with COPD, a vastus lateralis biopsy was performed, and the biopsy specimen was examined to evaluate the structural muscle characteristics associated with SPPB score. The phenotypic characteristics of patients stratified according to SPPB were determined.

Results:  Quadriceps strength and 6-min walk distance were the only independent predictors of SPPB score in a multivariate regression model. Furthermore, while age, dyspnea, and health status were also univariate predictors of SPPB score, FEV1 was not. Stratification by reduced SPPB score identified patients with locomotor muscle atrophy and increasing impairment in strength, exercise capacity, and daily physical activity. Patients with mild or major impairment defined as an SPPB score < 10 had a higher proportion of type 2 fibers (71% [14] vs 58% [15], P = .04).

Conclusions:  The SPPB is a valid and simple assessment tool that may detect a phenotype with functional impairment, loss of muscle mass, and structural muscle abnormality in stable patients with COPD.

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