Physical activity and COPD

Transcription

1 Physical activity and COPD Fitness experts say your muscles need plnety of rest between workouts! Your last workout was 17 years ago Marc Beaumont & Elena Gimeno- Santos ERCA Lyon

2 Outline Determinants and outcomes of PA in COPD Components of pulmonary rehabilitanon to adress PA in COPD Strategies to improve PA in COPD Summary and take- home message

3 Determinants and outcomes of PA in COPD Some variables may affect physical acnvity in COPD panents. Determinant - dyspnea Regular physical actyivity has many diverse beneficial effects in COPD panents. Outcome - mortality Determinant Dyspnea PHYSICAL ACTIVITY Outcome Mortality

4 Determinants and outcomes of PA in COPD Electronic database search n = MEDLINE n = EMBASE n = PSYCHINFO n = CINAHL n = 476 Gimeno-Santos E et al. Thorax 2014;69:731 After duplicates removed n = 2580 Title and abstract screening Excluded n = 2204 From hand searching n = 18 Included for full text assessment n = 394 Full text assessment Included n = 86 Excluded n = No primary data showed - No physical activity measure provided - No relevant population included - COPD no diagnosed by spirometry - Sample includes <90% COPD - Results not for COPD only - No information on determinants or outcomes - No assumption of directionality - Other reasons n = 51 n = 63 n = 48 n = 3 n = 5 n = 1 n = 23 n = 58 n = 56

5 Determinants and outcomes of PA in COPD Conceptual model for PA in COPD Gimeno-Santos E et al. Thorax 2014;69:731

6

7 Determinants and outcomes of PA in COPD Consistent effects of PA on outcomes such as mortality and COPD exacerbanons. Poor evidence about determinants of PA, including intervennons. Scarce evidence on the NON- physiologic determinants of PA in COPD: Psychological factors MoNvaNon Social issues Garcia-Aymerich J and Pitta F. Clin Chest Med 2014;35:363 Gimeno-Santos E et al. Thorax 2014;69:731

8 Determinants and outcomes of PA in COPD What are the facilitators perceived for COPD panents to be physically acnve? Hartman J et al. J Physioth 2013;59:117

9 Determinants and outcomes of PA in COPD What are the barriers perceived for COPD panents to be physically inacnve? Hartman J et al. J Physioth 2013;59:117

10 If physical acnvity is good, we need to monvate and acnvate our panents But how? Pulmonary rehabilitanon Other non- drugs intervennons Pharmacotherapy

11 If physical acnvity is good, we need to monvate and acnvate our panents But how? Pulmonary rehabilita<on Other non- drugs intervennons Pharmacotherapy

12 Components of pulmonary rehabilitation to adress PA in COPD Exercise training is the cornerstone of PR Physical acnvity is an important outcome of pulmonary rehabilitanon programs Exercise and Physical AcNvity are not idenncal concepts (!!!!) PA is a complex behavior Behavioural intervennons should be included as a part of the pulmonary rehabilitanon programs ATS/ERS Task Force on PulmonaryRehabilitation. Am J Respir Crit Care Med 2013;188:e13 Garcia-Aymerich J and Pitta F. Clin Chest Med 2014;35:363 Caspersen CJ et al. Public Health Rep 1985;100:126-31

13 Components of pulmonary rehabilitation to adress PA in COPD Forest plot for physical acnvity measured in intervennon studies Steele 2003 Pica 2008 Walker 2008 Dallas 2009 Steele 2010 Sewell 2005 ^ Sewell 2005 # De Block De Block 2006* Std Paired Difference and 95% CI a a a p a a a p p RelaNve weight Ng L et al. Chron Respir Dis 2011;9:17 Pre Post

14 Components of pulmonary rehabilitation to adress PA in COPD Drug and non- drug interven<ons Long Term Oxygen Therapy Dietary intervennon Exercise training Physical acnvity advice Long- acnng β2- agonist / Inhaled CorNcosteroids PHYSICAL ACTIVITY Gimeno-Santos E. Thorax 2014;69:731

15 Components of pulmonary rehabilitation to adress PA in COPD Inconsistent results : Increase on PA level stansncally significant aker PR versus not increase on PA levels. Different type of panents, PR programs (content, duranon, frequency...). Different methods to assess PA. Studies without control group or with control group but without random allocanon. Small sample sizes. Gimeno-Santos E. Thorax 2014;69:731 Garcia-Aymerich J and Pitta F. Clin Chest Med 2014;35:363 Troosters T et al. Respir Res 2013;14:115

16 If physical acnvity is good, we need to monvate and acnvate our panents But how? Pulmonary rehabilitanon Other non- drugs intervennons Pharmacotherapy

17 If physical acnvity is good, we need to monvate and acnvate our panents But how? Pulmonary rehabilitanon Other non- drugs interven<ons Pharmacotherapy

18 Strategies to improve PA in COPD

19 Strategies to improve PA in COPD Moy M et al. J Rehab Res Dev 2010;47:485 Moy M et al. Respir Med 2012;106:1342

20 Strategies to improve PA in COPD n=24 COPD subjects 1263 steps/day (43%) Steps/day Baseline p= Post- 3m walking program Moy M et al. Respir Med 2012;106:1342

21 Strategies to improve PA in COPD RCT: PA encouragement vs Pedometer- based program n=97 COPD subjects Mendoza L et al. Eur Respir J 2015;45:347

22 Strategies to improve PA in COPD Nordic walking Barberan-Garcia A et al. Respiration 2015;89:221 Breyer MK et al. Respir Res 2010;11:112

23 Strategies to improve PA in COPD RCT: Nordic walking vs usual care n=60 COPD subjects Breyer MK et al. Respir Res 2010;11:112

24 Strategies to improve PA in COPD Urban walking circuits

25 Strategies to improve PA in COPD RCT: Urban circuits vs usual care aker 3- months PR n=83 COPD subjects Pleguezuelos E et al. Respir Med 2013;107:1948

26 Strategies to improve PA in COPD RCT: Urban circuits vs usual care aker 3- months PR n=83 COPD subjects UCG increased the <me walked 32 min/day Pleguezuelos E et al. Respir Med 2013;107:1948

27 Strategies to improve PA in COPD Effec<veness of an interven<on of urban training in pa<ents with COPD: a randomised controlled trial URBAN TRAINING Primary objec<ve: to assess 12 months effecnveness of the intervennon with respect to (i) physical acnvity level, (ii) hospital admissions due to COPD, (iii) exercise capacity, (iv) body composinon, (v) quality of life, and (vi) mental health. Secondary objec<ves: to idennfy and classify urban walkable trails for the training of COPD panents; to assess cost- effecnveness of the intervennon.

28 Strategies to improve PA in COPD IntervenNon group (n=300) Visit 0 Visit 1 IniNal evaluanon + Accelerometer RandomizaNon + Pick up acceler. Control group (n=300) Visit 2 Visit 3 Final evaluanon + Accelerometer Pick up acceler. 7 days 7 days 12 months Interven<on group Control group Usual care + RecommendaNon of using walkable trails (adapted to panent) + SMS every 2 weeks + Web support Usual care + General recommendanon of physical acnvity

29 Strategies to improve PA in COPD

30 Strategies to improve PA in COPD

31 Strategies to improve PA in COPD

32 Strategies to improve PA in COPD Watz H et al. Eur Respir J 2014;44:1521

33 Take- home message The design of further studies for PA in COPD Number of publica<ons PubMed - PA and COPD Years Large proportion on NON- CONTROLLED or NON- RANDOMIZED clinical trials!!! Cross- sectional designs are useful for hypothesis generating. Potential determinants and/ or outcomes Needed for focusing the research in longitudinal data, and in Randomized Controlled Trials (RCT).

34 Take- home message In other diseases, prescripnon of physical acnvity is comparable with any drug treatment. It is needed to adapt therapeunc strategies: to the panent's abilines, facilitators and barriers to comorbidines to cultural, familiar, geographical environment. PotenNal solunon: promote physical acnvity outside from the tradinonal rehabilitanon setng. Do not avoid technology, it may help. In front of no recommendanons for PA in COPD, use the more logical advise: Be ac<ve in any way!

35 Take- home message