Physical activity and COPD

Transcription

1 Physical activity and COPD Elena Gimeno- Santos Marc Beaumont ERCA Lyon

2 Physical activity and COPD Generali>es about Physical Ac>vity (PA) Recommenda>ons Physical Ac>vity and COPD Why making an evalua>on How to make an evalua>on, which evalua>on?

3 Generalities Physical Ac>vity = any bodily movement produced by skeletal muscles that requires energy expenditure. Sedentarity = the 4 th risk factor for death in the world (6%) Sedentarity = the main cause of 21 à 25% of breast or colon cancer, 27% diabetes cases Around 30% of Ischemic heart disease. OMS Recommanda2ons mondiales en ma2ère d'ac2vité physique pour la santé

4 Generalities Prac>sing Regular and adequate levels of physical ac>vity : reduce the risk of hypertension, coronary heart disease, stroke, diabetes, breast and colon cancer, depression and the risk of falls improve bone and func>onal health Is a key determinant of energy expenditure, and thus is fundamental to energy balance and weight control. OMS Recommanda2ons mondiales en ma2ère d'ac2vité physique pour la santé

5 What is physical activity? Physical Ac>vity includes: Leisure >me physical ac>vity, Transporta>on (for example walking or cycling), Professionnal ac>vi>es, Household ac>vi>es, Play, games, Sports and planned exercises. OMS Recommanda2ons mondiales en ma2ère d'ac2vité physique pour la santé

6 Recommendations for general population To improve cardiorespiratory and muscular fitness, bone health, reduce the risk of non communicable diseases and depression:, 150 minutes of moderate- intensity aerobic physical ac>vity per week Or 75 of vigorous- intensity aerobic physical ac>vity For addi>onal health benefits increase the moderate- intensity aerobic physical ac>vity to 300 minutes per week, or in 150 minutes of vigorous- intensity OMS Recommanda2ons mondiales en ma2ère d'ac2vité physique pour la santé

7 IPAQ QUESTIONNAIRE

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10 Physical activity and COPD Objec>ve : evaluate the level of physical ac>vity in COPD pa>ents / healthy subjects Endpoints: Ac>vity dura>on intensity Number of movements (steps, upper limbs movements...)

11 Ac>vity in COPD pa>ents is altered in dura>on and number of movements but much less in exercise intensity Low correla>on (or non significant) between physical ac>vity and disesase severity

12 Physical activity and COPD Objec>ve : asses physical ac>vity and intensity movement in COPD pa>ents / healhty 50 COPD pa>ents : age : 64 ± 7 years; FEV1 :43 ± 18% pred 25 healthy subjects: age : 66 ± 5 years; FEV1 : 111 ± 20% pred

13 Percentages of -me spent in each of the ac-vi-es or body posi-ons during the day

14 Correla-on between walking and standing -me versus physiologic variables Walking >me highly correlated to 6MWD Lower correla>on to pulmonary func>on Exercise capacity is stongly correlated to physical ac-vity

15 Physical activity and COPD Objec>ves : Describe the physical ac>vity modali>es, frequency, dura>on and intensity in COPD pa>ents Assess these modali>es according to disease severity Explore adherence of pa>ents to PA recommenda>ons Physical ac>vity is defined for any ac>vity > 10 with an intensity > 1.5 METS

16 Characteris-cs of physical ac-vity Severe and very severe pa>ents make less steps and less PA in dura>on but Exercise intensity is the same whatever the stage Very severe pa>ents do less fragmenta>on of their ac>vity

17 Adherence to physical ac-vity recommenda-ons 25 % of pa>ents follow recommenda>ons (30 per day) propor>on increase to 60% when coun>ng accumulated in bouts

18 In this study, pa>ents tend to over- es>mate the >me spent in physical ac>vity

19 Consequences of inactivity Increase risk of early mortality Increase risk of hospitaliza>on Increase the decline of pulmonary func>on Garcia- Aymerich et al. Thorax 2003; 58: PiLa et al. J Bras Pneumol 2006;32(4): Waschki et al. Chest 2011;140(2): Nyssen et al. J Bras Pneumol 2013;39(6): Garcia- Rio et al. Chest 2012;142: Seidel et al. Int J Tuberc Lung Dis 2012;16: Garcia- Aymerich et al.. Am J Respir Crit Care Med 2007;175:

20 Benefits of physical activity Decrease anxiety (Coventry et al. PLoS One 2013;8(4):e60532) Decrease dyspnea (Parshall et al. Am J Respir Crit Care Med 2011;185(4): ) Improve quality of life (Mar>n et al. Arch Intern Med Feb 9;169(3):269-78) Decrease number of consulta>ons and hospitaliza>ons (Lacasse et al. Eura Medicophys. 2007;43(4):475-85) Increase life>me without incapaci>es (Garcia- Aymerich et al.thorax ;61(9):772-8) Spruit et al. Am J Respir Crit Care Med Oct 15;188(8):e13-64

21 Physical activity and exercise capacity Physical ac>vity exercise capacity Capacity to prac>ce an ac>vity Is assessed with laboratory test or field tests Physical ac>vity dura>on Intensity Energy expenditure Number of movements Measure of exercise capacity indicates what a person can do while measure of physical ac>vity reflects what this person really do

22 What is evaluating physical activity? Assess exercise capacity Assess quan>ty and quality of ac>vity Source of mo>va>on «Quan>fier l AP consiste à chiffrer, mesurer, déterminer une quan>té d ac>vité physique dont les modalités d interpréta>on dépendent des objec>fs poursuivis» Vuillemin. in la réhabilita2on du malade respiratoire chronique, de Préfaut et Ninot. Masson 2009

23 How evaluate physical activity? Subjec>ve tools Physical ac>vity ques>onnaire Objec>ve tools Ac>meters Pedometers Smartphone applica>ons

24 But the method of valida>on is very debatable (except IPAQ) and not validated in the popula>on of respiratory pa>ents Varray. Rev Mal Respir 2005; 22(5) : Wendel- vos et al. J of Clin Epidem 2003;56: Crinière et al. J Phys Act Health ;8(6): Gimeno- santos et al. Health and quality of life outcomes 2011;9:86 Physical activity questionnaire Many ques>onnaires validated in english : Interna>onal Physical Ac>vity Ques>onnaire IPAQ Physical Ac>vity Scale for the Elderly PASE Modified Baecke ques>onnaire Zutphen Physical Ac>vity Ques>onnaire ZPAQ Stanford Sevenday Physical Ac>vity Recall PAR Yale Physical Ac>vity Survey YPAS Short Ques>onnaire to Assess Health- enhancing physical ac>vity- SQUASH Some ques>onnaires in french: Physical ac>vity ques>onnaire of Saint- E>enne (QAPSE) Score of physical ac>vity of Dijon Baecke ques>onnaire (adapted in french, but strongly modified) Interna>onal Physical Ac>vity Ques>onnaire (IPAQ)

25 Physical activity questionnaires in COPD Ques>onnaires used in COPD : Minnesota Leisure Time Physical Ac>vity (MLTPAQ) (Garcia- Aymerich et al. Med Sci Sports Exerc 2004; 36: ) Zutphen Physical Ac>vity Ques>onnaire (ZPAQ) (Van Gestel et al. PLoS One. 2012;7(11):e48081) Ques>onnaires validated in COPD : Yale Physical Ac>vity Survey (YPAS) (Donaire- Gonzalez et al. Arch Bronconeumol 2011;47(11):552-60) Stanford 7- day Physical Ac>vity Recall (PAR) (Garfield et al. ERJ 2012;40:356-62) Modified Baecke physical ac>vity ques>onnaire (VOORIPS) (Vilaró et al. Med Clin 2007;129(9): Physical Ac>vity Scale in the Elderly (PASE) (de Pew et al. Chronic Respiratory Disease 2013;10(1) 19 27) Ques>onnaires validated in french :..

26 Physical activity questionnaires Allow subjec>ve evalua>on of physical ac>vity Are fast (self- ques>onnaire) Are low cost But the es>ma>on of the pa>ents of the >me spent making ac>vity is rarely correlated to the objec>ve measures (except Stanford 7- day physical Ac>vity Recall) Allow to detect ac>ve or very inac>ve pa>ents PiLa et al. Eur Respir J 2006; 27: Garfield et al. Eur Respir J 2012;40:356-62) Troosters et al. Respiratory Research 2013, 14:115 Donaire- Gonzalez et al. Arch Bronconeumol 2011;47(11): PiLa et al. Arch Phys Med Rehabil Oct;86(10):

27 Tools for objective measure : accelerometers Detect body accelera>ons Allow to assess physical ac>vity under differents aspects : Quan>ty of body movements Intensity of body movements Body posture Ac>vity >me Energy spent Troosters et al. Respiratory Research 2013, 14:115 Watz et al. Eur Respir J. 2014;44(6):

28 Accelerometers Movements detec>on according to One axis 2 axis 3 axis Necessity to validate the tools Watz et al. Eur Respir J. 2014;44(6): Van Remoortel et al. Interna2onal J of Behav Nutri2on and Physical Ac2vity 2012, 9:84

29 les accéléromètres

30 Pa>ents with 6 accelerometers and a portable metabolic system (VO2 mobile) Standardised ac>vi>es during one hour

31 Dynaport minimod Ac>graph GT3X Sensewear Armband = the most validated monitors for the evalua>on of standardized ac>vi>es

32 Same accelerometers than in previous study Evalua>on during 14 days Comparison with the doubly labelled water indirect calorimetry method Criteria of tools valida>on: Significant rela>on with ac>ve energy expenditure (with doubly labelled water method) Capacity to register daily variability of PA Capacity to register the low levels of PA (during the weekends) Pa>ents opinion

33 Results All accelerometers show significant correla>on to Ac>ve energy expenditure All show capacity to register physical ac>vity variability (except RT3 for low levels) All are acceptable pa>ent- reported usability Monitors showing best correla>on are Ac>graph GT3X Dynaport Move Monitor

34 Watz et al. Eur Respir J 2009; 33: Demeyer et al. Chest 2014; 146: Modalities of use Accelerometers must be worn during 5 days for a reliable evalua>on (3 for very severe pa>ents) To evaluate the effect of an interven>on, 4 days seem to be sufficient (without weekend)

35 Accelerometers Allow the objec>ve evalua>on of Physical ac>vity even at low intensity (severe pa>ents) Variability according to models Time of evalua>on quite long Cost??? Constraint for pa>ents??? Watz et al. Eur Respir J 2009; 33:

36 Tools for objective measure : pedometers Could be assimilated to uni- axial ac>meter? Allow to count steps number per day Under es>mate the steps number at low speed Posi>ve rules as source of mo>va>on Watz et al. Eur Respir J 2009; 33: Turner et al. J Cardiopulm Rehabil Prev. 2012;32(5): Moy et al. Respir Med 2012; 106:

37 Pedometers easy Low cost Need to verify efficacity (very severe pa>ents / walking speed) Source of mo>va>on +++ Can be associated to smartphone applica>ons (bouger plus, runsta>c, ac>vites free, coach cardinal )

38 Which tool to choose?

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41 Which tool to choose? Choose according to what we are searching Choose to the targeted popula>on Ask the pa>ents their posi>on Interest of the tool for poten>al behaviour modifica>on Allow the pa>ent to refine their own observa>ons Aguilaniu et Roche. NPJ Prim Care Respir Med ;24:14014

42 Recommendations for COPD

43 Objec>ves : Compare «absolutes» recommenda>ons and «individual» recommenda>ons Assess if differences appear depending of stages of severity

44 Important difference between absolute and individual recommenda>ons according to COPD severity Individual recommenda>ons would be be{er adapted to pa>ents with most severe disease???

45 Synthesis COPD pa>ents o en have an altered physical ac>vity Modali>es of evalua>on should take into account ini>al objec>ve Ques>onaires allow to detect ac>ve and very inac>ve pa>ents Ac>meters allow objec>ve evalua>on but cost is a problem

46 Synthesis Pedometers show a bad detec>on of low speeds but can serve of source of mo>va>on Smartphone applica>on can help as mo>va>on catalyst Choose the best adapted tool for each pa>ent depending on poten>al modifica>ons than can be generated (therapeu>c educa>on)