Chronic obstructive pulmonary disease (COPD) is associated with reduced physical capacity. However, it is unclear whether pulmonary emphysema, which can occur without COPD, is associated with reduced physical activity in daily life, particularly among people without COPD and never smokers. We hypothesized that greater percentage of emphysema-like lung on CT scan is associated with reduced physical activity assessed by actigraphy and self-report.
The Multi-Ethnic Study of Atherosclerosis (MESA) enrolled participants free of clinical cardiovascular disease from the general population. Percent emphysema was defined as percentage of voxels below -950 HU on full-lung CT scans. Physical activity was measured by wrist actigraphy over 7 days and questionnaire. Multivariable linear regression was used to adjust for age, gender, race/ethnicity, height, weight, education, smoking, pack-years, and lung function.
Among 1,435 participants with actigraphy and lung measures, 47% had never smoked and 8% had COPD. Percent emphysema was associated with lower activity levels on actigraphy (p=0.001), corresponding to 1.5 hour less per week of moderately paced walking for the average participant in quintile 2 vs. 4 of percent emphysema. This association was significant among participants without COPD (p=0.004), among ever (p=0.01) and never smokers (p=0.03). It was also independent of coronary artery calcium and left ventricular ejection fraction. There was no evidence that percent emphysema was associated with self-reported activity levels.
Percent emphysema was associated with decreased physical activity in daily life objectively assessed by actigraphy in the general population, among participants without COPD and non-smokers.