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Original Research: COPD |

Percent Emphysema and Daily Motor Activity Levels in the General Population: Multi-Ethnic Study of Atherosclerosis

Christian M. Lo Cascio, MD; Mirja Quante, MD; Eric A. Hoffman, PhD; Alain G. Bertoni, MD, MPH; Carrie P. Aaron, MD; Joseph E. Schwartz, PhD; Mark V. Avdalovic, MD; Vincent S. Fan, MD, MPH; Gina S. Lovasi, PhD, MPH; Steven M. Kawut, MD; John H.M. Austin, MD; Susan Redline, MD, MPH; R. Graham Barr, MD, DrPH
Author and Funding Information

FUNDING/SUPPORT: This study was funded by the National Institutes of Health/National Heart, Lung, and Blood Institute [Grants R01-HL077612, R01-HL093081, R01-HL098433, N01-HC95159-HC95169, UL1-TR000040]; and the Environmental Protection Agency [Grant RD83169701].

aDepartment of Medicine, Columbia University, New York, NY

bDepartment of Radiology, Columbia University, New York, NY

cDepartment of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

dDepartment of Internal Medicine, University of Iowa, Iowa City, IA

eDepartment of Epidemiology and Prevention, Wake Forest University, Winston-Salem, NC

fDepartment of Psychiatry and Behavioral Science, Stony Brook University, Stony Brook, NY

gDepartment of Internal Medicine, UC Davis School of Medicine, Sacramento, CA

hVA Puget Sound Health Care System, Seattle, WA

iDepartment of Medicine, University of Washington, Seattle, WA

jDepartment of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA

CORRESPONDENCE TO: R. Graham Barr, MD, DrPH, Columbia University Medical Center, Presbyterian Hospital 9 E Room 105, 630 W 168th St, New York, NY 10032


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(5):1039-1050. doi:10.1016/j.chest.2016.11.033
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Background  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.

Methods  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 < −950 Hounsfield units on full-lung CT scans. Physical activity was measured by wrist actigraphy over 7 days and a questionnaire. Multivariable linear regression was used to adjust for age, sex, race/ethnicity, height, weight, education, smoking, pack-years, and lung function.

Results  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 = .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 = .004) and among ever (P = .01) and never smokers (P = .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.

Conclusions  Percent emphysema was associated with decreased physical activity in daily life objectively assessed by actigraphy in the general population, among participants without COPD, and nonsmokers.

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